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Abstract Background Radiotherapy (RT) and surgery are potential treatment options in patients with biochemical recurrence (BCR) following primary prostate cancer treatment. This study examines the value of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-informed surgery and RT in patients with BCR treated without systemic therapy. Methods This is a post-hoc subgroup analysis of a prospective clinical trial. Inclusion criteria were: histologically proven prostate cancer at initial curative-intent treatment, BCR after primary treatment with curative intent, having five or fewer lesions identified on [18F]DCFPyL PET/CT, and treatment with either PET/CT-directed RT or surgery without systemic therapy. The biochemical progression-free survival after PSMA ligand PET/CT-directed RT and surgery was determined. Uni- and multivariate Cox regression analyses were performed for the association of patients’ characteristics, tumor-specific variables, and PSMA PET/CT imaging results with biochemical progression at the last follow-up. Results Fifty-eight patients (30 in surgery and 28 in radiotherapy groups) met the inclusion criteria. A total of 87 PSMA-positive lesions were detected: 16 local recurrences (18.4%), 54 regional lymph nodes (62.1%), 6 distant lymph nodes (6,8%), and 11 osseous lesions (12.7%). A total of 85.7% (24 of 28) and 70.0% (21 of 30) of patients showed a ≥ 50% decrease in prostate-specific antigen (PSA) levels after RT and surgery, respectively. At a median follow-up time of 21 months (range, 6–32 months), the median biochemical progression-free survival was 19 months (range, 4 to 23 months) in the radiotherapy group, as compared with 16.5 months (range, 4 to 28 months) in the surgery group. On multivariate Cox regression analysis, the number of PSMA positive lesions (2–5 lesions compared to one lesion), and the anatomic location of the detected lesions (distant metastasis vs. local relapse and pelvic nodal relapse) significantly correlated with biochemical progression at the last follow-up, whereas other clinical, tumor-specific, and imaging parameters did not. Conclusions This study suggests that RT or surgery based on [18F]DCFPyL PET/CT are associated with high PSA response rates. The number and site of lesions detected on the PSMA PET/CT were predictive of biochemical progression on follow-up. Further studies are needed to assess the impact of targeting these sites on patient relevant outcomes. Trial registration Registered September 14, 2016; NCT02899312; https://clinicaltrials.gov/ct2/show/NCT02899312

For residents or fellows outside anesthesiology and critical care training programs, formal training in managing critically sick patients does not exist in India either at the undergraduate level, or at postgraduate level. Acute critical care course (ACCC) is a simulation-based skills development course that has been developed indigenously to address this lacuna in training of interns and residents in surgical specialties and emergency medicine in India. This study is aimed to find out and to assess the effectiveness of this course. This is a prospective interventional study using low-fidelity simulation-based courses. As many as 1036 candidates (interns and residents) were trained in 40 ACCC provider courses, and 165 instructor candidates in 9 instructor courses in 16 teaching hospitals in India in 2014–2021. However, in this report, the authors have analyzed the feedback (verbal and written) from 487 candidates of 19 ACCC provider courses conducted in 14 teaching hospitals in India between 2014 and 2018. Analysis of data was performed by thematic analysis for qualitative data and descriptive analysis for quantitative data. All the 487 candidates in 19 courses over 5 years replied either as very good (above expectations) or as good (as per expectations). In response to the question of the effectiveness of a lecture or skill station, none of them chose the options fair (below expectations) or poor (unacceptable). Fifteen out of 18 interns replied their emails that were sent 3 weeks after ACCC to find out if there was an improvement in their clinical application on a scale of 1–10. The response to the question in regards to improvement in their own ability 'to assess a sick patient', 'in treating a sick patient', 'communication skills with a colleague', and 'confidence in breaking bad news to patient or relatives', respectively, was 7.5, 7.8, 8.3 and 8.3. Mean scores out of 5 in response to content of ACCC course for clarity, utility, adequacy of content, understandable and interaction during course were 4.59, 4.81, 4,78, 4.86 and 4.97 respectively. Qualitative analysis led to 5 themes described in the manuscript. Low fidelity simulation using role-play appeals to the adult learners, breaks the monotony of classroom teaching, encourages interactive learning, and facilitates active participation in skill development necessary for critical care training of residents in surgical specialties and in emergency medicine. Sharing the vision document of ACCC with the deans of medical colleges is the crucial step in implementing applied physiology in step-wise logical approach in managing a sick patient. [ABSTRACT FROM AUTHOR]

Based on in vitro studies, it is known that androgen deprivation therapy (ADT) increases prostate-specific membrane antigen (PSMA) expression on prostate cancer (PCa) cells. However, ADT also has cytoreductive effects which can decrease lesion size. The present evaluation was conducted to further analyze the influence of ongoing ADT on [18F]DCFPyL positron emission tomography/computed tomography (PET/CT) performance in the setting of biochemically recurrent PCa. We retrospectively evaluated two groups of PCa patients, previously treated with radical intent, who had undergone [18F]DCFPyL PET/CT because of biochemical relapse with a minimum PSA level of 0.4 ng/mL. One group consisted of 95 patients under ADT at the time of the PET examination, and the other consisted of 445 patients not receiving ADT at the time of PET/CT. The uptake characteristics of the cardiac blood pool, liver, parotid glands, and five most active lesions were measured and compared between these two groups. The overall detection rate of [18F]DCFPyL PET/CT in patients under ADT at the time of imaging was significantly higher than patients not under ADT (91.6% vs. 80.4%, p-value = 0.007). However, the PSA-stratified differences in detection rates between patients with and without ADT did not reach statistical significance. Except for the maximal standardized uptake values corrected for lean body mass (SULmax) in the PSA range of 1 to <2 ng/mL, the intensity and volume of [18F]DCFPyL accumulation were higher in patients with ADT compared to the patients without. Statistical significance was attained for the SULmax in PSA range of 0.5 to <1 ng/mL (p-value = 0.0004) and metabolic tumor volume (MTV) in all PSA ranges (p-values of 0.0005 to 0.03). No significant difference was observed for radiotracer uptake in normal organs between the two groups with and without ADT. In this study population with biochemical recurrence of PCa and measurable PSA, ongoing ADT at the time of [18F]DCFPyL PET/CT imaging was associated with higher radiotracer uptake and overall lesion detection rate. This could be due in part to the more aggressive disease phenotype in patients with ongoing ADT. [ABSTRACT FROM AUTHOR]