recurrence risk

PSMA PET/MRI Accurately Predicts Prostate Cancer Recurrence Risk

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Prostate specific membrane antigen (PSMA) PET/MRI can successfully determine whether cancer is likely to return within two years of a prostatectomy in men recently diagnosed with intermediate or high-grade prostate cancer. The research, published in the The Journal of Nuclear Medicine, will help physicians identify patients who could benefit from additional treatment and/or frequent surveillance.

Prostate cancer is known to have very variable behavior and outcomes. While many cases of localized prostate cancer can be treated successfully, some patients experience a rapid progression even after prostatectomy or radiation therapy. Therefore, initial risk stratification is important to determine treatment decisions and subsequent management of prostate cancer patients.

“Clinicians currently use biopsy findings and clinical information, such as prostate-specific antigen (PSA) levels, to predict if prostate cancer is slow- growing or if it will spread quickly and require aggressive treatments,” said Andrei Iagaru, MD, professor of Radiology–Nuclear Medicine and chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University Medical Center in Stanford, California. “However, functional imaging, such as PET/MRI, is increasingly being considered as a way to identify patients at risk for persistent or recurrent disease.”

In the study, researchers examined the value of 68Ga-PSMA-11 PET/MRI for risk stratification of newly diagnosed prostate patients prior to initial therapy. Seventy-three patients with a new diagnosis of intermediate- or high-grade prostate cancer were imaged with 68Ga-PSMA-11 PET/MR between April 2016 and December 2020. PET findings were divided into groups based on low versus high uptake in the primary lesion and the presence or absence of metastatic disease. These findings were compared to biopsy results and clinical information. The relationship between the PET/MRI findings and patient outcomes were also examined.

High uptake in the primary lesion and the presence of PSMA metastasis were associated with biochemical failure or rapid recurrence within two years of prostatectomy. In contrast, patients with low uptake in the primary lesion who did not have evidence of metastatic disease on PET/MRI had a low likelihood of experiencing recurrence during the follow-up period.

“PSMA PET/MRI adds value to the pre-therapy evaluation of patients with newly diagnosed prostate cancer, and the information from PET seems to be as reliable, if not more reliable, than biopsy findings and clinical information in predicting which patients will have suboptimal outcome,” stated Farshad Moradi, MD, PhD, clinical associate professor of Radiology–Nuclear Medicine at Stanford University Medical Center in Stanford, California. “This study provides support for including PSMA PET to aid in clinical decision making about prostate cancer therapy options. PSMA pre-surgery may contribute to establishing one of the ‘killer applications’ for PET/MRI.”

Clip Ligation Shows Long-term Durability for Aneurysms

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Microsurgical clip ligation in the treatment of intracranial aneurysm shows long-term durability, with a small risk for recurrence when residual aneurysms are present after treatment, according to a new study.

“This is the largest study to date with the longest follow-up data that confirms the long-term efficacy of aneurysm clip ligation,” said first author Mason Brown, a medical student with the Indiana University School of Medicine, Indianapolis, in presenting the findings at the American Association of Neurological Surgeons (AANS) 83rd Annual Meeting.

Previous studies have estimated the recurrence risk with aneurysm clip ligation to be approximately 0.26% to 0.053% annually, and the risk for de novo aneurysm at 0.84% to 1.8% per year; however there is currently no standard protocol for the timing or length of follow-up after surgery, Brown said.

For the study, the researchers retrospectively reviewed records on 616 patients (mean age, 48 years) who underwent microsurgical clip ligation and follow-up imaging for more than 1 year following discharge from the university’s medical center.

Among the patients, 919 aneurysms were treated, including 753 that underwent surgical clip ligation for ruptured and unruptured aneurysms.

With angiographic imaging available on the aneurysms at a mean of 7.2 years after discharge, the authors found only one recurrent aneurysm (0.14%) of the 699 (92.2%) clipped aneurysms that showed no residua following the initial operation.

The recurrence rate was higher among the 59 (7.8%) known residual aneurysms following clip ligation, with 8 (13.6%) of the aneurysms regrowing and 4 requiring treatment.

Of 111 patients presenting with multiple aneurysms on admission, 8 (7.2%) had a de novo aneurysm formation on follow-up. Meanwhile, there were no de novo aneurysms among patients presenting with a single aneurysm on admission.

“Our results demonstrate a low recurrence of 0.14% to 13.6% after clip ligation, while recurrence rates after coil embolization can be as high as 30% to 40%,” Brown said.

Nevertheless, he underscored that the findings indicate that anything less that completely clipped aneurysms should have careful follow-up.

“There is a significant growth risk for residual aneurysms after incomplete clip ligation, and the findings necessitate continued follow-up, late angiographic imaging and further intervention.”

Adam S. Arthur, MD, MPH, from the Semmes-Murphey Clinic in Memphis, Tennessee, who co-moderated the session, agreed that the findings provide important insights on potential areas of risk after clip ligation.

“These findings document the low risk of aneurysm recurrence after clip ligation,” he told Medscape Medical News.

“Importantly, however, this recurrence risk is not zero. As we have developed new ways to treat aneurysms we have struggled to evaluate the long-term durability of these treatments.”

“It has become clear that we should also research the durability of the gold standard historical treatment for aneurysms, surgical clipping.”