capromab-pendetide and Neoplasm-Metastasis

The role of imaging in the diagnosis and management of prostate is reviewed. Transrectal ultrasonography, which can be used to guide biopsy, is most frequently used imaging technique in cancer detection. For determining the extent of disease, CT and MR imaging are the most commonly used modalities; bone scintigraphy and positron emission tomography have roles only in advanced disease. Currently, the role of imaging in prostate cancer is evolving to improve disease detection and staging, to determine the aggressiveness of disease, and to predict outcomes in different patient populations

Topics: Age Factors; Aged; Antibodies, Monoclonal; Biopsy, Needle; Bone Neoplasms; Follow-Up Studies; Humans; Indicators and Reagents; Lymphatic Metastasis; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Physical Examination; Positron-Emission Tomography; Prognosis; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiotherapy, Adjuvant; Risk Factors; ROC Curve; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Capromab pendetide (ProstaScint) is an indium In 111 ((111)In)-labeled monoclonal antibody to prostate-specific membrane antigen (PSMA) used to image prostate cancer. The appropriate techniques for obtaining images with this modality and the appropriate clinical indications for this study are in the process of being optimized.. From 1994 to 2000, 631 monoclonal antibody imaging studies with (111)In capromab pendetide were performed. The accuracy and utility of this modality in the primary staging of patients with disease at high risk of metastasis and patients with recurrent or residual disease after primary therapy were evaluated.. In high-risk patients evaluated for risk of lymph node metastases prior to pelvic lymph node dissection, capromab pendetide imaging was found to have a positive predictive value (PPV) of 62%, negative predictive value (NPV) of 72%, sensitivity of 62%, and specificity of 72%. In patients evaluated with capromab pendetide imaging for prostatic fossa recurrence using prostatic fossa needle biopsy as the gold standard, capromab pendetide imaging was found to have a PPV of 50%, NPV of 70%, sensitivity of 49%, and specificity of 71%.. The sensitivity and NPV of (111)In capromab pendetide imaging are better than those of computed tomography and magnetic resonance imaging for detection of soft-tissue and nodal metastases from prostate cancer. The utility of this modality has been demonstrated in the primary staging of patients with disease at high risk of metastasis. Patients with recurrent or residual disease after primary therapy also may benefit from capromab pendetide imaging prior to selection of salvage therapy. Innovative methods for the use of capromab pendetide imaging in radiation therapy treatment planning are under development.

Topics: Antibodies, Monoclonal; Humans; Indium Radioisotopes; Lymphatic Metastasis; Male; Neoplasm Metastasis; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging

Capromab Pendetide imaging illustrates the successful translation of monoclonal antibody technology from the laboratory to the clinic. It provides a means of identifying otherwise occult soft tissue metastases in patients with adenocarcinoma of the prostate. When utilized with other clinical, pathological and laboratory findings, Capromab Pendetide imaging enables more accurate disease staging and monitoring than is afforded by other imaging modalities such as CT and MRI. In the primary disease setting Capromab Pendetide imaging should be reserved for use in patients with negative bone scans who are at high risk for metastatic disease based on such factors as advanced clinical stage, high Gleason score and significantly elevated serum PSA or alkaline phosphatase. Due to low sensitivity for small-volume disease, a negative Mab scan may not eliminate the need for a staging lymph node dissection but should encourage further consideration of local treatment options. Capromab Pendetide should be used with caution in patients at low risk for metastatic disease. Positive scan findings in low risk patients should be confirmed before altering the treatment plan since some false positive scans should be anticipated in a population with low disease prevalence. Capromab Pendetide imaging has not been shown to be reliable in determining the local extent of the primary tumor but new techniques involving co-registration of SPECT and CT images show promise in this regard. In the patient with recurrent disease following primary therapy, the predictive value of Capromab Pendetide imaging of the prostate or prostate fossa is limited, particularly following RT. Its more important role in this setting is to identify lymph node metastases in the high risk patient with a negative bone scan who might otherwise be a candidate for local salvage therapy. A large prospective study is needed for confirmation, but preliminary data suggest that Capromab Pendetide imaging is helpful in identifying those patients with PSA elevation after radical prostatectomy who are most likely to benefit from salvage RT. As with any imaging technique, Capromab Pendetide has strengths and weaknesses that must be understood to maximize patient benefit by utilizing the scan in clinical settings where it is most likely to be useful and least likely to be misleading. Capromab Pendetide is a technically demanding procedure best performed and interpreted at sites with experience and expertise.

Topics: Adenocarcinoma; Alkaline Phosphatase; Antibodies, Monoclonal; Biomarkers, Tumor; Bone Neoplasms; Combined Modality Therapy; Evaluation Studies as Topic; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Metastasis; Neoplasm Proteins; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasm, Residual; Preoperative Care; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radioimmunodetection; Radioisotope Teletherapy; Salvage Therapy; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

To determine the diagnostic performance of In-111 capromab pendetide single photon emission computed tomography/computed tomography (SPECT/CT), in the prostate gland, seminal vesicles, and lymph nodes via correlation to a gold standard of histopathology.. In this study, we retrospectively reviewed all In-111 capromab pendetide SPECT/CT acquired at our institution for dedicated histopathology within a 4-month period. Statistical measures of performance were calculated in terms of glandular, seminal vesicle, and lymph node activity. The accuracies of glandular and seminal vesicle activity were then correlated to the indices of risk, including the stage, Gleason score, and prostate-specific antigen level, as well as the treatment history.. Of the 200 scans meeting the criteria of our study, 197 had prostate gland histopathology, 94 had bilateral seminal vesicle histopathology, and 5 had a total of 43 resected lymph nodes for comparison. The overall accuracies of the scan results were determined to be 77.7% (area under the receiver operating characteristic curve [AUC] = 0.539) for the gland, 67.0% (AUC = 0.510) for the seminal vesicles, and 93.0% (AUC = 0.787) for lymph nodes. For glandular activity alone, scan accuracy was found to significantly improve with increasing Gleason score (P < 0.0001), and in a setting prior to treatment (P = 0.0005). No statistically significant differences were found between different scan groups with regards to seminal vesicle activity.. The results of this study provide substantiating evidence In-111 capromab pendetide can be used to accurately diagnose lymph node metastases from primary cancers of the prostate; however, they also suggest the test may have limited utility in diagnosing tumors within the prostate gland and seminal vesicles.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Humans; Indium Radioisotopes; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Seminal Vesicles; Tomography, X-Ray Computed

To report the results of a retrospective study of 2290 ProstaScint scans of 2154 patients with prostate carcinoma done at 15 institutions.. The results were analyzed by logistic regression after stratification of the patients into four groups: group 1, newly diagnosed; group 2, after radical prostatectomy with a rising prostate-specific antigen (PSA) level; group 3, after radiation therapy with a rising PSA level; and group 4, after hormonal therapy.. The PSA level and ProstaScint scans positive in the prostate bed (P <0.001) and for pelvic metastases (P <0.001), but not for extrapelvic metastases, correlated significantly in group 1 patients. In group 2, the association for detecting fossa recurrence was weaker (P = 0.033) and was insignificant for pelvic and extrapelvic metastases. Patients in group 3 also exhibited a weak PSA-ProstaScint association for detecting fossa recurrence (P = 0.038), and was insignificant for pelvic and extrapelvic metastases. No significant PSA-ProstaScint correlation was found in patients in group 4 for fossa recurrence, pelvic or extrapelvic metastases. The distribution of positive ProstaScint results among the prostate/prostate bed, pelvic nodes, and extrapelvic nodes was nearly equal for all groups, except that a significantly greater percentage of extrapelvic metastases was found in the hormonal group (group 4). The ProstaScint results were independent of the Gleason score for 260 patients before and 285 patients after therapy.. The results of this study underscore the complementary diagnostic value of ProstaScint to PSA level and Gleason score as an independent indicator of prostate cancer recurrence and metastases and in identifying extrapelvic metastases in both newly diagnosed and recurrent prostate cancer.

Topics: Antibodies, Monoclonal; Humans; Indium Radioisotopes; Logistic Models; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Metastasis; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

To evaluate whether In-111 capromab pendetide (an antibody conjugate directed to a glycoprotein found primarily on the cell membrane of prostate tissue) radioimmunoscintigraphy can localize residual or metastatic prostatic carcinoma in 15 patients after prostatectomy and lymphadenectomy for prostatic carcinoma with rising serum prostate-specific antigen. One patient with 0.6 ng/ml serum prostate-specific antigen had normal imaging results and 14 patients had scintigraphic evidence of residual prostatic bed or metastatic prostatic carcinoma. Two patients with borderline abnormal bone scans had abnormal activity in the same regions on In-111 capromab pendetide images. All patients had negative radiographic abdominal and pelvic cross-sectional prestudy images, and there were no adverse effects related to In-111 capromab pendetide infusion and little human antimouse antibody response.

Topics: Antibodies, Monoclonal; Female; Humans; Indium Radioisotopes; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Tomography, X-Ray Computed