Zachariah Taylor, DO: No financial relationships to disclose
Introduction/Purpose: 18F-Flotufolastat (18F-rhPSMA-7.3) is a promising PSMA ligand for detecting oligometastatic prostate cancer (PCa), with recent studies demonstrating high sensitivity and sensitivity in identifying metastatic disease. This study evaluates its sensitivity and specificity in high-risk PCa patients with negative conventional imaging and the associated change in medical management.
Methods or Case Description: Prospective Phase 3b trial assessing rhPSMA-7.3 PET/CT in high-risk PCa patients. Inclusion criteria: male, >18 years, histologically confirmed high-risk adenocarcinoma. Primary objective: comparing rhPSMA-7.3 PET/CT with conventional imaging for detecting metastatic disease. Primary endpoint: percentage of men upstaged following 18F-Flotufolastat imaging and the percentage of men who had an alteration in management recommendations.
Outcomes: 43 patients enrolled, 40 underwent 18F-Flotufolastat imaging. Mean age: 68.2 years, mean PSA: 17.9. Pre-PSMA staging: 22 stage IIIA, 5 stage IIIB, 13 stage IIIC. Imaging revealed positive pelvic nodes in 27.5%, bone lesions in 20.0%, and extrapelvic nodes in 7.5%. 45.0% of patients upstaged, 32.5% to metastatic disease. Changes in management occurred in all but one patient diagnosed with metastases, commonly involving extended radiation fields in addition to androgen deprivation therapy and/or chemotherapy.
Conclusion: Early findings suggest 18F-Flotufolastat PET/CT more accurately stages high-risk PCa when compared to conventional imaging, leading to significant changes in clinical management.
Learning Objectives:
Upon completion, participant will be able to better understand the limitations of conventional imaging for prostate cancer
Upon completion, participant will be able to better understand the likelihood of upstaging on PSMA imaging
Upon completion, participant will be able to better understand impact in clinical management of PSMA imaging
