Diagnostic Performance and Safety of Positron Emission Tomography with 18 F-rhPSMA-7.3 in Patients with Newly Diagnosed Unfavourable Intermediate- to Very-high-risk Prostate Cancer: Results from a Phase 3, Prospective, Multicentre Study (LIGHTHOUSE)

Radiohybrid (rh) F-rhPSMA-7.3 is a novel high-affinity prostate-specific membrane antigen (PSMA)-targeting radiopharmaceutical for prostate cancer (PCa) imaging. To evaluate the diagnostic performance and safety of F-rhPSMA-7.3 in newly diagnosed PCa patients planned for prostatectomy. Data on F-rhP...

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Veröffentlicht in:European urology 2023-10, Vol.84 (4), p.361
Hauptverfasser: Surasi, Devaki Shilpa, Eiber, Matthias, Maurer, Tobias, Preston, Mark A, Helfand, Brian T, Josephson, David, Tewari, Ashutosh K, Somford, Diederik M, Rais-Bahrami, Soroush, Koontz, Bridget F, Bostrom, Peter J, Chau, Albert, Davis, Phillip, Schuster, David M, Chapin, Brian F
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container_end_page
container_issue 4
container_start_page 361
container_title European urology
container_volume 84
creator Surasi, Devaki Shilpa
Eiber, Matthias
Maurer, Tobias
Preston, Mark A
Helfand, Brian T
Josephson, David
Tewari, Ashutosh K
Somford, Diederik M
Rais-Bahrami, Soroush
Koontz, Bridget F
Bostrom, Peter J
Chau, Albert
Davis, Phillip
Schuster, David M
Chapin, Brian F
description Radiohybrid (rh) F-rhPSMA-7.3 is a novel high-affinity prostate-specific membrane antigen (PSMA)-targeting radiopharmaceutical for prostate cancer (PCa) imaging. To evaluate the diagnostic performance and safety of F-rhPSMA-7.3 in newly diagnosed PCa patients planned for prostatectomy. Data on F-rhPSMA-7.3 were reported from the phase 3 prospective, multicentre LIGHTHOUSE study (NCT04186819). Patients underwent positron emission tomography/computed tomography (PET/CT) 50-70 min after an injection of 296 MBq F-rhPSMA-7.3. Images were interpreted locally and by three blinded independent readers. The coprimary endpoints were patient-level sensitivity and specificity for the detection of pelvic lymph node (PLN) metastases, validated using histopathology at PLN dissection. Prespecified statistical thresholds (lower bounds of 95% confidence interval [CI]) were set at 22.5% for sensitivity and 82.5% for specificity. Of 372 patients screened, 352 had evaluable F-rhPSMA-7.3-PET/CT and 296 (99 [33%] with unfavourable intermediate-risk [UIR] and 197 [67%] with high-/very-high-risk [VHR] PCa) subsequently underwent surgery. As per the independent reads, 23-37 (7.8-13%) patients had F-rhPSMA-7.3-positive PLN. Seventy (24%) patients had one or more positive PLNs on histopathology. The sensitivity for PLN detection was 30% (95% CI, 19.6-42.1%) for reader 1, 27% (95% CI, 17.2-39.1%) for reader 2, and 23% (95% CI, 13.7-34.4%) for reader 3, not meeting the prespecified threshold. Specificity was 93% (95% CI, 88.8-95.9%), 94% (95% CI, 89.8-96.6%), and 97% (95% CI, 93.7-98.7%), respectively, exceeding the threshold for all readers. Specificity was high (≥92%) across both risk stratifications. Sensitivity was higher among high-risk/VHR (24-33%) than among UIR (16-21%) patients. Extrapelvic (M1) lesions were reported for 56-98/352 (16-28%) patients who underwent F-rhPSMA-7.3-PET/CT irrespective of surgery. Verification of these (predominantly by conventional imaging) gave a verified detection rate of 9.9-14% (positive predictive value, 51-63%). No serious adverse events were observed. Across all risk stratifications, F-rhPSMA-7.3-PET/CT had high specificity, meeting the specificity endpoint. The sensitivity endpoint was not met, although higher sensitivity was noted among high-risk/VHR than among UIR patients. Overall, F-rhPSMA-7.3-PET/CT was well tolerated, and identified N1 and M1 disease prior to surgery in newly diagnosed PCa patients. In order to select the most appropriat
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To evaluate the diagnostic performance and safety of F-rhPSMA-7.3 in newly diagnosed PCa patients planned for prostatectomy. Data on F-rhPSMA-7.3 were reported from the phase 3 prospective, multicentre LIGHTHOUSE study (NCT04186819). Patients underwent positron emission tomography/computed tomography (PET/CT) 50-70 min after an injection of 296 MBq F-rhPSMA-7.3. Images were interpreted locally and by three blinded independent readers. The coprimary endpoints were patient-level sensitivity and specificity for the detection of pelvic lymph node (PLN) metastases, validated using histopathology at PLN dissection. Prespecified statistical thresholds (lower bounds of 95% confidence interval [CI]) were set at 22.5% for sensitivity and 82.5% for specificity. Of 372 patients screened, 352 had evaluable F-rhPSMA-7.3-PET/CT and 296 (99 [33%] with unfavourable intermediate-risk [UIR] and 197 [67%] with high-/very-high-risk [VHR] PCa) subsequently underwent surgery. As per the independent reads, 23-37 (7.8-13%) patients had F-rhPSMA-7.3-positive PLN. Seventy (24%) patients had one or more positive PLNs on histopathology. The sensitivity for PLN detection was 30% (95% CI, 19.6-42.1%) for reader 1, 27% (95% CI, 17.2-39.1%) for reader 2, and 23% (95% CI, 13.7-34.4%) for reader 3, not meeting the prespecified threshold. Specificity was 93% (95% CI, 88.8-95.9%), 94% (95% CI, 89.8-96.6%), and 97% (95% CI, 93.7-98.7%), respectively, exceeding the threshold for all readers. Specificity was high (≥92%) across both risk stratifications. Sensitivity was higher among high-risk/VHR (24-33%) than among UIR (16-21%) patients. Extrapelvic (M1) lesions were reported for 56-98/352 (16-28%) patients who underwent F-rhPSMA-7.3-PET/CT irrespective of surgery. Verification of these (predominantly by conventional imaging) gave a verified detection rate of 9.9-14% (positive predictive value, 51-63%). No serious adverse events were observed. Across all risk stratifications, F-rhPSMA-7.3-PET/CT had high specificity, meeting the specificity endpoint. The sensitivity endpoint was not met, although higher sensitivity was noted among high-risk/VHR than among UIR patients. Overall, F-rhPSMA-7.3-PET/CT was well tolerated, and identified N1 and M1 disease prior to surgery in newly diagnosed PCa patients. In order to select the most appropriate treatment for patients with prostate cancer, it is critical to diagnose the disease burden accurately at initial diagnosis. In this study, we investigated a new diagnostic imaging agent in a large population of men with primary prostate cancer. 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To evaluate the diagnostic performance and safety of F-rhPSMA-7.3 in newly diagnosed PCa patients planned for prostatectomy. Data on F-rhPSMA-7.3 were reported from the phase 3 prospective, multicentre LIGHTHOUSE study (NCT04186819). Patients underwent positron emission tomography/computed tomography (PET/CT) 50-70 min after an injection of 296 MBq F-rhPSMA-7.3. Images were interpreted locally and by three blinded independent readers. The coprimary endpoints were patient-level sensitivity and specificity for the detection of pelvic lymph node (PLN) metastases, validated using histopathology at PLN dissection. Prespecified statistical thresholds (lower bounds of 95% confidence interval [CI]) were set at 22.5% for sensitivity and 82.5% for specificity. Of 372 patients screened, 352 had evaluable F-rhPSMA-7.3-PET/CT and 296 (99 [33%] with unfavourable intermediate-risk [UIR] and 197 [67%] with high-/very-high-risk [VHR] PCa) subsequently underwent surgery. As per the independent reads, 23-37 (7.8-13%) patients had F-rhPSMA-7.3-positive PLN. Seventy (24%) patients had one or more positive PLNs on histopathology. The sensitivity for PLN detection was 30% (95% CI, 19.6-42.1%) for reader 1, 27% (95% CI, 17.2-39.1%) for reader 2, and 23% (95% CI, 13.7-34.4%) for reader 3, not meeting the prespecified threshold. Specificity was 93% (95% CI, 88.8-95.9%), 94% (95% CI, 89.8-96.6%), and 97% (95% CI, 93.7-98.7%), respectively, exceeding the threshold for all readers. Specificity was high (≥92%) across both risk stratifications. Sensitivity was higher among high-risk/VHR (24-33%) than among UIR (16-21%) patients. Extrapelvic (M1) lesions were reported for 56-98/352 (16-28%) patients who underwent F-rhPSMA-7.3-PET/CT irrespective of surgery. Verification of these (predominantly by conventional imaging) gave a verified detection rate of 9.9-14% (positive predictive value, 51-63%). No serious adverse events were observed. Across all risk stratifications, F-rhPSMA-7.3-PET/CT had high specificity, meeting the specificity endpoint. The sensitivity endpoint was not met, although higher sensitivity was noted among high-risk/VHR than among UIR patients. Overall, F-rhPSMA-7.3-PET/CT was well tolerated, and identified N1 and M1 disease prior to surgery in newly diagnosed PCa patients. In order to select the most appropriate treatment for patients with prostate cancer, it is critical to diagnose the disease burden accurately at initial diagnosis. In this study, we investigated a new diagnostic imaging agent in a large population of men with primary prostate cancer. We found it to have an excellent safety profile and to provide clinically useful information regarding the presence of disease beyond the prostate.</description><subject>Gallium Radioisotopes</subject><subject>Humans</subject><subject>Male</subject><subject>Positron Emission Tomography Computed Tomography - methods</subject><subject>Positron-Emission Tomography</subject><subject>Prospective Studies</subject><subject>Prostate - pathology</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - metabolism</subject><subject>Prostatic Neoplasms - surgery</subject><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1PwkAQhjcmRvDjHxgzR01o3bJA0ZtBEBLRxoJXsrRTuth2m9ktpD_dm1Xx7GneZJ7M-2QYu_S463FvcLt1saKKtNvlXeHygcu94RFre0NfOH5_wFvs1Jgt51z078QJawm_5_V83m2zz0clN4U2VkUQICWacllECLKIIZQJ2hp0AoE2ypIuYJwrY1QTFjrXG5JlWsNe2RS8IUwcSoNw_uD4rgBVQCCtwsKaX-AF91kNhzaMYVkkcqcrkusMYVZYpBxjJS06YDW8I9VOqjapQ8p8QECNYbOD0bcc3cMbmiprTiekc5AQpNIgiM4PWGJk1Q47MG8QFTUKhBDaKq7h-nn2NF1MX5fh-OacHScyM3hxmGfsajJejKZOWa0blVVJKpdUr_5-Jf4FvgCXUH67</recordid><startdate>202310</startdate><enddate>202310</enddate><creator>Surasi, Devaki Shilpa</creator><creator>Eiber, Matthias</creator><creator>Maurer, Tobias</creator><creator>Preston, Mark A</creator><creator>Helfand, Brian T</creator><creator>Josephson, David</creator><creator>Tewari, Ashutosh K</creator><creator>Somford, Diederik M</creator><creator>Rais-Bahrami, Soroush</creator><creator>Koontz, Bridget F</creator><creator>Bostrom, Peter J</creator><creator>Chau, Albert</creator><creator>Davis, Phillip</creator><creator>Schuster, David M</creator><creator>Chapin, Brian F</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>202310</creationdate><title>Diagnostic Performance and Safety of Positron Emission Tomography with 18 F-rhPSMA-7.3 in Patients with Newly Diagnosed Unfavourable Intermediate- to Very-high-risk Prostate Cancer: Results from a Phase 3, Prospective, Multicentre Study (LIGHTHOUSE)</title><author>Surasi, Devaki Shilpa ; 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To evaluate the diagnostic performance and safety of F-rhPSMA-7.3 in newly diagnosed PCa patients planned for prostatectomy. Data on F-rhPSMA-7.3 were reported from the phase 3 prospective, multicentre LIGHTHOUSE study (NCT04186819). Patients underwent positron emission tomography/computed tomography (PET/CT) 50-70 min after an injection of 296 MBq F-rhPSMA-7.3. Images were interpreted locally and by three blinded independent readers. The coprimary endpoints were patient-level sensitivity and specificity for the detection of pelvic lymph node (PLN) metastases, validated using histopathology at PLN dissection. Prespecified statistical thresholds (lower bounds of 95% confidence interval [CI]) were set at 22.5% for sensitivity and 82.5% for specificity. Of 372 patients screened, 352 had evaluable F-rhPSMA-7.3-PET/CT and 296 (99 [33%] with unfavourable intermediate-risk [UIR] and 197 [67%] with high-/very-high-risk [VHR] PCa) subsequently underwent surgery. As per the independent reads, 23-37 (7.8-13%) patients had F-rhPSMA-7.3-positive PLN. Seventy (24%) patients had one or more positive PLNs on histopathology. The sensitivity for PLN detection was 30% (95% CI, 19.6-42.1%) for reader 1, 27% (95% CI, 17.2-39.1%) for reader 2, and 23% (95% CI, 13.7-34.4%) for reader 3, not meeting the prespecified threshold. Specificity was 93% (95% CI, 88.8-95.9%), 94% (95% CI, 89.8-96.6%), and 97% (95% CI, 93.7-98.7%), respectively, exceeding the threshold for all readers. Specificity was high (≥92%) across both risk stratifications. Sensitivity was higher among high-risk/VHR (24-33%) than among UIR (16-21%) patients. Extrapelvic (M1) lesions were reported for 56-98/352 (16-28%) patients who underwent F-rhPSMA-7.3-PET/CT irrespective of surgery. Verification of these (predominantly by conventional imaging) gave a verified detection rate of 9.9-14% (positive predictive value, 51-63%). No serious adverse events were observed. Across all risk stratifications, F-rhPSMA-7.3-PET/CT had high specificity, meeting the specificity endpoint. The sensitivity endpoint was not met, although higher sensitivity was noted among high-risk/VHR than among UIR patients. Overall, F-rhPSMA-7.3-PET/CT was well tolerated, and identified N1 and M1 disease prior to surgery in newly diagnosed PCa patients. In order to select the most appropriate treatment for patients with prostate cancer, it is critical to diagnose the disease burden accurately at initial diagnosis. In this study, we investigated a new diagnostic imaging agent in a large population of men with primary prostate cancer. We found it to have an excellent safety profile and to provide clinically useful information regarding the presence of disease beyond the prostate.</abstract><cop>Switzerland</cop><pmid>37414702</pmid><doi>10.1016/j.eururo.2023.06.018</doi></addata></record>
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subjects Gallium Radioisotopes
Humans
Male
Positron Emission Tomography Computed Tomography - methods
Positron-Emission Tomography
Prospective Studies
Prostate - pathology
Prostatic Neoplasms - diagnostic imaging
Prostatic Neoplasms - metabolism
Prostatic Neoplasms - surgery
title Diagnostic Performance and Safety of Positron Emission Tomography with 18 F-rhPSMA-7.3 in Patients with Newly Diagnosed Unfavourable Intermediate- to Very-high-risk Prostate Cancer: Results from a Phase 3, Prospective, Multicentre Study (LIGHTHOUSE)
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