The Clinical Management of Patients with Recurrent Prostate Cancer: Integrative Review

Abstract

SAMPLE ABSTRACT: The 68Ga-PSMA PET/CT precision increase in the Biochemical Recurrence (BR) cell detection brings new challenges in the patients clinical management, specially on RT. Although the RT treatment is a well established practice in 70% of the Prostate Cancer (PCa) patients, 30% to 40% of them show BR after the local Radiotherapy (RT). However, therapeutic innovations, modern imaging techniques and molecular characteristics advances are raising the survival time of recurrent PCa patients. Using target molecules and radiotracers combinations, it was possible to get promising results with radiopharmaceutical therapy directed to PMSA. Aims: This study aims to analyze the new challenges in the clinical management of patients with recurrent PCa through the advent of 68Ga-PSMA PET/CT imaging. Study Design: The bibliographic research of the published articles was realized on the electronic databases: PubMed. The article inclusion criteria, previously defined to the review were: articles in portuguese, spanish or english, between 2016 and 2023, with the abstract and full works online. Articles that were not related were excluded. Place and Duration of Study: between 2016 and 2023. Methodology: The method used was an integrative literature review, through the search for publications in journals indexed in the PubMed databases. 44 articles were identified, from which 30 were removed: 22 being diagnostic studies and 9 being equipment quality control studies. 14 works were selected for the final sample of the study. All of them using 68Ga-PSMA PET/CT in the patient clinical management submitted to RT and 8 identified using other means. Results: According to the European Association of Urology, BCR is the second of ten controversial areas in the management of patients with advanced PCa. Currently, the binding of the Gallium-68 radiotracer to the prostate-specific membrane antigen (PSMA) for Positron Emission Tomography (PET/CT 68Ga-PSMA) imaging in patients may allow for a more rational selection of subsequent ideal therapy, although PSMA is not overexpressed in all PCa cases. The use of 68Ga-PSMA PET/CT and RT has shown promise in several studies for recurrent PCa. It is indeed emerging to increase sensitivity and change the treatment landscape. This is an active area of research that has a significant impact on the clinical management of patients, spanning from conventional techniques to advanced Stereotactic Body Radiotherapy (SBRT). Conclusion: The presented data on this study collaborate with the 68Ga-PSMA PET/CT on the recurrent PCa patients, specially on the selection on to the target molecular therapy. It has become an active investigation, presenting new challenges on the conventional and Hypofractionated (HF) RT on SBRT techniques to the PCa treatment. As research and technology continue to advance, the use of PSMA and other specific markers for diagnosis and treatment is likely to become more refined and widespread. The use of 177Lu-PSMA suggests that molecular targeted therapy is a promising area of development, potentially offering more effective and less invasive treatments for prostate cancer.