68 Ga-PSMA PET/CT Mapping of Early Biochemical Recurrence (PSA &lt;1 ng/mL) After Primary Surgery in 270 Patients: Impact on Salvage Radiation Therapy Planning

Calais, Jérémie; Czernin, J.; Cao, Min; Fendler, WP; Herrmann, Karin; Rauscher, Isabel; Schmidt-Hegemann, Nina-Sophie; Poeppel, Thorsten D.; King, Christopher R.; Kishan, Amar U.; Hegde, John V.; Shaverdian, Narek; Sandler, Kiri A.; Steinberg, Michael L.; Reiter, Robert E.; Rettig, M.; Eiber, Matthias; Nickols, Nicholas G.

doi:10.1016/j.ijrobp.2017.09.016

Cited by 1 publication

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“…On the other hand, approximately half of the patients will develop oligoprogressive disease after MDT [10], making these patients amenable to repeated MDT [27]. Furthermore, the presented cohort had PSMA ligand imaging for staging purposes, and fewer metastases should be missed compared to conventional imaging and choline PET [4,5,22], indicating well-selected patients. Moreover, no data about the biological evolution of prostate cancer are available in the context of prior local therapies such as RP and sRT.…”

Section: Discussionmentioning

confidence: 91%

“…The implementation of PSMA ligand imaging has substantially improved the diagnostic accuracy for the detection of (oligo) metastatic PCa at low PSA levels [5,22], leading to the recent guidelines by the European Organization for Research and Treatment of Cancer (EORTC) demanding modern imaging methods for trials investigating MDT in oligometastatic PCa [23]. Although large randomized prospective studies are lacking, approximately two-thirds of the experts at the 2017 Advanced Prostate Cancer Consensus Conference considered MDT ADT androgen deprivation therapy, CF-RT conventionally fractionated radiotherapy type, Gy Gray, LNs lymph node metastases, PCa prostate cancer, PSMA-PET prostate-specific membrane antigen positron emission tomography, PSA prostate-specific antigen, RP radical prostatectomy, sRT salvage radiotherapy, SBRT stereotactic body radiation therapy, SIB simultaneous integrated boost as a treatment option for patients with oligorecurrent PCa [13].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, a substantial number of patients will not benefit permanently from sRT and will develop biochemical progression [2,3]. Recently published data suggest that early recurrences are often located outside the prostate fossa [4][5][6], and a large proportion of these patients (40-70%) have a limited number of metastases, making them amenable to metastasis-directed treatment (MDT) [7]. These cases are usually considered oligorecurrent disease.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of PSMA ligand PET-based radiotherapy for recurrent prostate cancer after radical prostatectomy and salvage radiotherapy

Oehus¹,

Kroeze²,

Schmidt-Hegemann³

et al. 2020

BMC Cancer

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Background: A substantial number of patients will develop further biochemical progression after radical prostatectomy (RP) and salvage radiotherapy (sRT). Recently published data using prostate-specific membrane antigen ligand positron emission tomography (PSMA-PET) for re-staging suggest that those recurrences are often located outside the prostate fossa and most of the patients have a limited number of metastases, making them amenable to metastasis-directed treatment (MDT). Methods: We analyzed 78 patients with biochemical progression after RP and sRT from a retrospective European multicenter database and assessed the biochemical recurrence-free survival (bRFS; PSA < nadir + 0.2 ng/ml or no PSA decline) as well as the androgen deprivation therapy-free survival (ADT-FS) using Kaplan-Meier curves. Logrank test and multivariate analysis was performed to determine influencing factors. Results: A total of 185 PSMA-PET positive metastases were detected and all lesions were treated with radiotherapy (RT). Concurrent ADT was prescribed in 16.7% (13/78) of patients. The median PSA level before RT was 1.90 ng/mL (range, 0.1-22.1) and decreased statistically significantly to a median PSA nadir level of 0.26 ng/mL (range, 0.0-12.25; p < 0.001). The median PSA level of 0.88 ng/mL (range, 0.0-25.8) at the last follow-up was also statistically significantly lower (p = 0.008) than the median PSA level of 1.9 ng/mL (range, 0.1-22.1) before RT. The median bRFS was 17.0 months (95% CI, 14.2-19.8). After 12 months, 55.3% of patients were free of biochemical progression. Multivariate analyses showed that concurrent ADT was the most important independent factor for bRFS (p = 0.01). The median ADT-FS was not reached and exploratory statistical analyses estimated a median ADT-FS of 34.0 months (95% CI, 16.3-51.7). Multivariate analyses revealed no significant parameters for ADT-FS. Conclusions: RT as MDT based on PSMA-PET of all metastases of recurrent prostate cancer after RP and sRT represents a viable treatment option for well-informed and well-selected patients.

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