Delineating sites of failure following post-prostatectomy radiation treatment using 68 Ga-PSMA-PET

Byrne, Keelan; Eade, Thomas; Kneebone, Andrew; Guo, Linxin; Hsiao, Ed; Schembri, Geoffrey; Kwong, Carolyn; Hunter, J. C.; Emmett, Louise; Hruby, George

doi:10.1016/j.radonc.2017.10.022

Cited by 27 publications

(26 citation statements)

References 20 publications

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“…Using conventional or PET-CT imaging techniques, 244 sites of recurrence were identified in 141 patients. Our data support previous findings: in patients with BF after postoperative RT, metastatic disease is the main failure pattern (18)(19)(20).…”

Section: Discussionsupporting

confidence: 92%

“…To detect recurrence patterns in the setting of first-time PSA failure after postoperative RT, several imaging modalities were available: CT and bone scintigraphy, 18 F-choline PET-CT, or 68 Ga-PSMA-PET-CT. For patients with identified sites of recurrence, number and location of lesions were documented. Failure sites were categorized as local-only (disease within the prostate fossa only), locoregional (nodal disease within the pelvis ± PB) or metastatic failure (at least one lesion outside the pelvis ± locoregional disease).…”

Section: Pattern Of Failure Analysismentioning

confidence: 99%

“…However, it cannot distinguish between local, regional, or systemic recurrence; nevertheless, this information is essential for further management. Positron emission tomography (PET)-CT use, with radioactive tracers including fluorine 18 ( 18 F)-choline, 18 F-fluciclovine, and gallium 68 ( 68 Ga) or 18 F-prostate-specific membrane antigen (PSMA), permits recurrent disease detection, even at low PSA levels. PET-CT can be useful for restaging PC and guiding treatment delivery (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

et al. 2022

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IntroductionAlthough salvage and adjuvant radiotherapy (RT) are effective in prostate cancer (PC) patients, 30%–40% of men will have disease progression. The objective was to describe the pattern of recurrence in PC patients with biochemical failure (BF) following postoperative RT.MethodsWe retrospectively analyzed 935 PC patients treated from 2009 to 2019 with adjuvant or salvage RT at the Institut de Cancérologie de l’Ouest. Of these, 205 (22%) developed BF of whom 166 underwent imaging. Patients with identified radiologic failure prior any specific treatment were included to determine the site of relapse categorized as local (L)-only, locoregional (LR), or metastatic (M) recurrence. Main disease characteristics and RT fields were examined in relation to sites of recurrence.ResultsOne hundred forty-one patients were identified with 244 sites of failure on imaging. Of these, 108 patients had received RT to the PB alone and 33 RT to the PB and pelvic lymph nodes (PB+PLN). Androgen-deprivation therapy was used concomitantly in 50 patients (35%). The median PSA at imaging was 1.6 ng/ml (range, 0–86.7). In all, 74 patients (52%) had M disease (44% in the PB group and 79% in the PB+PLN group), 61 (43%) had LR failure (52% in the PB alone group and 15% in the PB+PLN group), and six (4%) had L-only failure, at a median of 26.7 months (range, 5–110.3) from RT. Metastases were in extra-pelvic LN (37 (15%)), bones (66 (27%)), and visceral organs (eight (3%)). Fifty-three (48%) of the pelvic LN failures in the PB group would have been encompassed by standard PLN RT volume.ConclusionWe found that most patients evaluated for BF after postoperative RT recurred outside the RT field. Isolated pelvic nodal failure was rare in those receiving RT to the PB+PLN but accounted for half of failures in those receiving PB alone RT. Imaging directed salvage treatment could be helpful to personalize radiation therapy plan.

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Section: Discussionsupporting

confidence: 92%

Section: Pattern Of Failure Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

et al. 2022

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“…To reinforce this argument, a PSMA-PET study previously completed at our institution identified sites of failure in men with rising PSA after post-prostatectomy radiotherapy treatment. Only 3 of the 67 men with PSA failure following post-prostatectomy radiotherapy who underwent PSMA scanning demonstrated in-field failure [16]. This study has not evaluated the dosimetric effect that IFD has on surrounding critical structures such as the bladder and rectum and has focused solely on target coverage.…”

Section: Discussionmentioning

confidence: 99%

Intra-fraction displacement of the prostate bed during post-prostatectomy radiotherapy

et al. 2021

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Background To measure intra-fraction displacement (IFD) in post-prostatectomy patients treated with anisotropic margins and daily soft tissue matching. Methods Pre-treatment cone beam computed tomography (CBCT) scans were acquired daily and post-treatment CBCTs for the first week then weekly on 46 patients. The displacement between the scans was calculated retrospectively to measure IFD of the prostate bed (PB). The marginal miss (MM) rate, and the effect of time between imaging was assessed. Results A total of 392 post-treatment CBCT’s were reviewed from 46 patients. The absolute mean (95% CI) IFD was 1.5 mm (1.3–1.7 mm) in the AP direction, 1.0 mm (0.9–1.2 mm) SI, 0.8 mm (0.7–0.9 mm) LR, and 2.4 mm (2.2–2.5 mm) 3D displacement. IFD ≥ ± 3 mm and ≥ ± 5 mm was 24.7% and 5.4% respectively. MM of the PB was detected in 33 of 392 post-treatment CBCT (8.4%) and lymph nodes in 6 of 211 post-treatment CBCT images (2.8%). Causes of MM due to IFD included changes in the bladder (87.9%), rectum (66.7%) and buttock muscles (6%). A time ≥ 9 min between the pre and post-treatment CBCT demonstrated that movement ≥ 3 mm and 5 mm increased from 19.2 to 40.5% and 5 to 8.1% respectively. Conclusions IFD during PB irradiation was typically small, but was a major contributor to an 8.4% MM rate when using daily soft tissue match and tight anisotropic margins.

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“…These data also suggest that patients with a very high PSA level and N0M0 disease by standard imaging modalities (CT and bone scan) may be candidates for pretreatment advanced imaging, such as with PET using tracers (eg, 18 F-sodium fluoride, 18 F-choline, 68 Ga-prostate-specific membrane antigen, and 18 F-fluciclovine). 14 These advanced imaging modalities, which have been well studied in the posttreatment failure setting, 15,16 may more clearly delineate which patients have metastatic versus nonmetastatic disease at diagnosis, allowing physicians to more confidently identify candidates for definitive treatment. PSA level, ng/mL Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns and Outcomes Among Patients With N0M0 Prostate Cancer and a Very High Prostate-Specific Antigen Level

Muralidhar

Nguyen

Mahal

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Management of patients with a very high prostate-specific antigen (PSA) level (≥98.0 ng/mL) but clinically localized (N0M0) prostate cancer is challenging. This study sought to determine practice patterns and outcomes among these patients. Patients and Methods: A total of 748,825 patients with prostate cancer from 2004 through 2012 were identified using the National Cancer Database. These patients were subdivided by PSA level (0–9.9, 10.0–19.9, 20.0–39.9, 40.0–59.9, 60.0–79.9, 80.0–97.9, and ≥98.0 ng/mL), nodal status (N0 vs N1), and distant metastases (M0 vs M1). Rates of locoregional treatment and 5-year overall survival (OS) in each group were determined. Survival was compared using Cox regression after adjusting for multiple patient-specific factors. Results: The rate of locoregional treatment for patients with N0M0 disease and PSA level ≥98.0 ng/mL was significantly lower than for those with N1M0 disease (52.6% vs 60.4%; P<.001) or N0M0 disease and PSA level <98.0 ng/mL (52.6% vs 86.6%; P<.001). The 5-year OS rate was similar for patients with N1M0 disease and those with N0M0 disease and a very high PSA level (63.2% vs 59.1%; adjusted hazard ratio [aHR], 0.91; P=.063). The survival benefit associated with locoregional treatment was higher among those with N0M0 disease and a very high PSA level than among those with N1M0 disease (aHR, 0.28 vs 0.44; P<.001). Conclusions: Patients with clinical N0M0 disease and a very high PSA level (≥98.0 ng/mL) have outcomes similar to those with N1 disease but receive locoregional treatment at a lower rate. Future work is needed to investigate the utility of locoregional treatment in this population.

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Delineating sites of failure following post-prostatectomy radiation treatment using 68 Ga-PSMA-PET

Cited by 27 publications

References 20 publications

Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

Intra-fraction displacement of the prostate bed during post-prostatectomy radiotherapy

Practice Patterns and Outcomes Among Patients With N0M0 Prostate Cancer and a Very High Prostate-Specific Antigen Level

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