Evaluation of the interest of PET-PSMA imaging potentiated by androgen blockade in patients with biological relapse or persistent biological disease of a localized prostatic adenocarcinoma after initial treatment
The identification of lesions responsible for biological recurrence or persistent biological disease in patients with prostatic adenocarcinoma (PA) remains an outstanding problem due to the lack of sensitivity of standard imaging techniques. The efficacy of empirical radiation therapy of the prostate + pelvis zone in only half of patients with increased PSA suggests an underestimation of lesions. PET-68Ga-PSMA or PET-PSMA technique showed a clear gain in sensitivity for the detection of lesions in this context compared to PET-Choline which was already more sensitive than standard imaging. It is about 50% for a PSA \<0.5 ng / ml vs 20% for a PSA \<1 ng / ml for TEP-Choline technique. However, the indication of empirical radiotherapy is raised when the PSA exceeds 0.2 ng / ml. It is therefore still necessary to increase the sensitivity of PET-PSMA. A flare-up-related effect was observed in a small animal experiment and in a patient after androgen blocking treatment, inducing a sharp increase in the intensity of previously visualized lesions and the appearance of 13 new lesions. It would therefore be possible to increase the expression of PSMA by the lesions at the origin of the biological recurrence of AP and thus to improve their detection by PET-PSMA after potentiation by short-term androgen blocking by an antagonist of LH-RH.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
57
120 mg subcutaneous Injection of Firmagon after a TEP-PSMA
Chu Gabriel Montpied
Clermont-Ferrand, France
Centre Jean Perrin
Clermont-Ferrand, France
Centre Hospitalier de Grenoble Hôpital Nord Michallon
La Tronche, France
Centre Léon Bérard
Lyon, France
Comparison of the proportion of patients presenting a positive PET during the initial PSMA-PET (prior to androgenic blockade) and the PSMA-H-PET (PSMA PET after androgenic blockade), patient being his own witness
PSMA-PET
Time frame: Day 14 after the androgenic blockade
Evaluation of the reproductibility of the PSMA-PET and PSMA-H-PET interpretation
PSMA-PET and PSMA-H-PET
Time frame: Day 14 after the androgenic blockade
Evaluation of the impact of androgenic blockade on lesions revealed by PSMA-H PET in comparison with the initial PSMA-PET
Number of lesions (PSMA-ET and PSMA-H PET)
Time frame: Day 14 after the androgenic blockade
Evaluation of the impact of androgenic blockade on lesions revealed by PSMA-H PET in comparison with the initial PSMA-PET
Fixation intensity (PSMA-ET and PSMA-H PET)
Time frame: Day 14 after the androgenic blockade
Evaluation of the PSMA-PET and PSMA-H PET impact in the therapeutic management modifications
Comparison between treatments planned after PSMA-PET and treatments planned after PSMA-H-PET
Time frame: Day 14 after the androgenic blockade
Evaluation of the interest of late pelvic acquisition 3 hours after the PSMA-68Ga injection
PSMA-PET and PSMA-H-PET efficience
Time frame: Day 14 after the androgenic blockade
Evaluation of the results correlation of each PSMA-PET with clinical data, histologic primary tumor and biologic data of the recurrence (PSA kinetic and velocity assessed at screening)
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APHM - Hôpital Nord
Marseille, France
Centre Hospitalier Lyon Sud
Pierre-Bénite, France
PSMA-PET efficience
Time frame: Day 14 after the androgenic blockade
Evaluation of the results correlation of each PSMA-PET with clinical data, histologic primary tumor and biologic data of the recurrence (PSA kinetic and velocity assessed at screening)
PSA rate
Time frame: Day 14 after the androgenic blockade
Evaluation of the correlation between the PSA and testosterone rates variations between D0 and D14 and the PSMA-PET results
PSA and testosterone rates and PSMA-PET results
Time frame: Day 14 after the androgenic blockade
Tolerance profile
Incidence of PSMA-H-PET Adverse Events assessed by the Common Terminology Criteria for Adverse Events (CTCAE version 5.0)
Time frame: Up to Day 15-30 visit