Thesis (Ph.D)-Cairo University, 2023.

Bibliography: pages 161-176.

Prostate cancer is the first most common cancer among men. The
evaluation of metastatic prostate cancer under distinct therapies presents several
well-known limitations which may be overcome by PSMA PET/CT.
The aim of this study is to evaluate the role of PSMA ligands PET-CT in the
metastatic prostate cancer after therapy.
Patients and methods:
Our prospective study included total of 53 male patients who were referred to
our center from March 2020 till March 2022 with metastatic prostatic
adenocarcinoma. The study was performed in Nuclear Medicine and Radiation
Oncology department, Kasr El-Ainy hospital, Cairo University after the
approval of the departmental and the university’s ethical review board. The
patients’ data and images were analyzed, PSMA-PET/CT studies were
performed before and after treatment with post-therapy assessment according to
PERCIST and RECIST criteria. Also, correlation between post-therapy serum
PSA level and imaging response is done.
Results: Total 53 patients with metastatic prostate cancer, 33 (62.3%) patients
were with bone metastases, 39 (73.6%) patients were with lymph nodal
metastatic lesions and 5 (9.4%) patient were with visceral deposits. All patients
received interval therapy. Initial and post-therapy assessment was done by
PSMA-PET study using PERCIST criteria (≥ 30% increase of tracer uptake or
new lesions detected were considered as progressive disease, ≥ 30% decrease in
tracer uptake was considered partial response and change in-between partial
response and progressive disease (less than − 30% and less than + 30%) was
considered as stable). Also, assessment of CT changes was done by RECIST
criteria (≥30% decrease in size was considered as partial response, while ≥20%
increase was considered as progressive disease, change in-between less than
−30% and less than+20% was considered as stable disease). Biochemical
response was also assessed as complete response, partial response (if there is ≥
50% decrease in PSA value), progressive disease (if there is ≥ 25% increase in
PSA value) and a change in PSA after therapy between −49% and +24% was
defined as stable disease. Correlation between PET parameters, CT and
biochemical response were done. There is good agreement (kappa value 0.88)
between PERCIST and RECIST criteria. There is moderate agreement (kappa
value 0.57) between PERCIST and post-therapy PSA level response. Also, there
is moderate agreement (kappa value 0.57) between RECIST and post-therapy
PSA level response. There is moderate agreement (kappa value 0.60) between
total lesion PSMA and biochemical response.
Conclusion: PSMA PET/CT has a pivotal role in post-therapy
assessment of patients with metastatic prostate cancer.

تعد أورام البروستاتا الخبيثة أكثر الأورام حدوثاً بين الرجال، و يعد تقييم مرضي سرطان البروستاتا المصاحب بثانويات بعد العلاج من اهم الخطوات المتبعه في علاج المريض.
أجريت دراستنا في الفترة بين مارس 2020 و مارس 2022 حيث تضمنت الرسالة 53 مريضاً بورم سرطاني مع ثانويات منتشره بالجسم تتراوح أعمارهم بين 61-77 عاماً بمتوسط 69 عاماً.
تم عمل فحص الماسح الذري البوزيتروني بالمادة المشار إليها في الرسالة قبل بدء العلاج و بعد الانتهاء منه وايضا تم عمل تحاليل المستضد البروستاتا النوعي قبل و بعد العلاج.
وقد تم إثبات علاقة مباشرة بين إيجابية الفحص وتحليل المستضد البروستاتا النوعي حيث وجد أن نسبة العلاقه بين نتيجه كل منهما بعد العلاج بدرجه متوسطه.
من أهم القيود في هذه الرسالة هو صعوبه الحصول علي عدد اكبر لمرضي سرطان البروستاتا المصاحب بثانويات موافيه لجميع البيانات العلاجيه و تحاليل المستضد البروستاتا النوعي و ايضا صعوبه الحصول علي ابحاث بصدد هذه الدراسه بالرغم من تلك القيود توصلنا إلي أهمية الفحص المذكور في تقييم المرضي بعد العلاج لمعرفه مدي استجابه المريض للعلاج المحدد.

و في النهاية نوصي بمتابعة المرضي من حيث تأثير المسح الذري البوزيتروني على قرار العلاج فيما بعد

Issues also as CD.

Text in English and abstract in Arabic & English.