Delphi consensus project on prostate-specific membrane antigen (PSMA)-targeted surgery-outcomes from an international multidisciplinary panel
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Anne-Claire Berrens1,2, Matthijs Scheltema3,4, Tobias Maurer5,6
1Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. a.berrens@nki.nl.
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.
Insights
Expert consensus on prostate-specific membrane antigen (PSMA)-targeted surgery suggests optimal timing and imaging techniques for prostate cancer. Further randomized trials are needed to confirm oncological value and guide clinical implementation.
Area of Science:
- Oncology
- Surgical Innovation
- Molecular Imaging
Background:
- Prostate-specific membrane antigen (PSMA) is emerging as a key target for precision surgery in prostate cancer.
- Expert consensus is needed to guide the implementation of PSMA-targeted surgical approaches.
Purpose of the Study:
- To establish a consensus among experts on the use of PSMA-targeted surgery for prostate cancer.
- To identify knowledge gaps and research needs in this developing field.
Main Methods:
- A Delphi consensus process involving 86 experts from urology, nuclear medicine, and industry.
- 105 statements were evaluated, followed by a second round focusing on 16 statements with an 89% response rate.
Main Results:
- Consensus reached on optimal timing (ideally <1 month pre-surgery) and tracer injection-to-surgery intervals (16-20h) for PSMA-ligand PET/CT.
- PSMA targeting is most valuable for identifying nodal metastases; gamma, fluorescence, and hybrid imaging are preferred guidance technologies.
- Randomized controlled trials are essential to define oncological value; consensus on PSMA-targeted surgery for margin assessment was inconclusive.
Conclusions:
- The Delphi consensus provides initial guidance for PSMA-targeted surgery in prostate cancer.
- Further randomized clinical trial data is required to support guideline implementation and confirm oncological benefits.
