TY - JOUR
T1 - Delphi consensus project on prostate-specific membrane antigen (PSMA)–targeted surgery—outcomes from an international multidisciplinary panel
AU - Berrens, Anne-Claire
AU - Scheltema, Matthijs
AU - Maurer, Tobias
AU - Hermann, Ken
AU - Hamdy, Freddie C.
AU - Knipper, Sophie
AU - Dell’Oglio, Paolo
AU - Mazzone, Elio
AU - de Barros, Hilda A.
AU - Sorger, Jonathan M.
AU - van Oosterom, Matthias N.
AU - Stricker, Philip D.
AU - van Leeuwen, Pim J.
AU - Rietbergen, Daphne D. D.
AU - Valdes Olmos, Renato A.
AU - Vidal-Sicart, Sergi
AU - Carroll, Peter R.
AU - Buckle, Tessa
AU - van der Poel, Henk G.
AU - van Leeuwen, Fijs W. B.
PY - 2023
Y1 - 2023
N2 - Purpose: Prostate-specific membrane antigen (PSMA) is increasingly considered as a molecular target to achieve precision surgery for prostate cancer. A Delphi consensus was conducted to explore expert views in this emerging field and to identify knowledge and evidence gaps as well as unmet research needs that may help change practice and improve oncological outcomes for patients. Methods: One hundred and five statements (scored by a 9-point Likert scale) were distributed through SurveyMonkey®. Following evaluation, a consecutive second round was performed to evaluate consensus (16 statements; 89% response rate). Consensus was defined using the disagreement index, assessed by the research and development project/University of California, Los Angeles appropriateness method. Results: Eighty-six panel participants (72.1% clinician, 8.1% industry, 15.1% scientists, and 4.7% other) participated, most with a urological background (57.0%), followed by nuclear medicine (22.1%). Consensus was obtained on the following: (1) The diagnostic PSMA-ligand PET/CT should ideally be taken < 1 month before surgery, 1–3 months is acceptable; (2) a 16–20-h interval between injection of the tracer and surgery seems to be preferred; (3) PSMA targeting is most valuable for identification of nodal metastases; (4) gamma, fluorescence, and hybrid imaging are the preferred guidance technologies; and (5) randomized controlled clinical trials are required to define oncological value. Regarding surgical margin assessment, the view on the value of PSMA-targeted surgery was neutral or inconclusive. A high rate of “cannot answer” responses indicates further study is necessary to address knowledge gaps (e.g., Cerenkov or beta-emissions). Conclusions: This Delphi consensus provides guidance for clinicians and researchers that implement or develop PSMA-targeted surgery technologies. Ultimately, however, the consensus should be backed by randomized clinical trial data before it may be implemented within the guidelines.
AB - Purpose: Prostate-specific membrane antigen (PSMA) is increasingly considered as a molecular target to achieve precision surgery for prostate cancer. A Delphi consensus was conducted to explore expert views in this emerging field and to identify knowledge and evidence gaps as well as unmet research needs that may help change practice and improve oncological outcomes for patients. Methods: One hundred and five statements (scored by a 9-point Likert scale) were distributed through SurveyMonkey®. Following evaluation, a consecutive second round was performed to evaluate consensus (16 statements; 89% response rate). Consensus was defined using the disagreement index, assessed by the research and development project/University of California, Los Angeles appropriateness method. Results: Eighty-six panel participants (72.1% clinician, 8.1% industry, 15.1% scientists, and 4.7% other) participated, most with a urological background (57.0%), followed by nuclear medicine (22.1%). Consensus was obtained on the following: (1) The diagnostic PSMA-ligand PET/CT should ideally be taken < 1 month before surgery, 1–3 months is acceptable; (2) a 16–20-h interval between injection of the tracer and surgery seems to be preferred; (3) PSMA targeting is most valuable for identification of nodal metastases; (4) gamma, fluorescence, and hybrid imaging are the preferred guidance technologies; and (5) randomized controlled clinical trials are required to define oncological value. Regarding surgical margin assessment, the view on the value of PSMA-targeted surgery was neutral or inconclusive. A high rate of “cannot answer” responses indicates further study is necessary to address knowledge gaps (e.g., Cerenkov or beta-emissions). Conclusions: This Delphi consensus provides guidance for clinicians and researchers that implement or develop PSMA-targeted surgery technologies. Ultimately, however, the consensus should be backed by randomized clinical trial data before it may be implemented within the guidelines.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85178125172&origin=inward
U2 - 10.1007/s00259-023-06524-6
DO - 10.1007/s00259-023-06524-6
M3 - Article
C2 - 38012448
SN - 1619-7070
JO - European journal of nuclear medicine and molecular imaging
JF - European journal of nuclear medicine and molecular imaging
ER -