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The prognostic significance of a negative PSMA-PET scan prior to salvage radiotherapy following radical prostatectomy.
Eur. J. Nucl. Med. Mol. Imaging 51, 558-567 (2024)
Aim: The optimal management for early recurrent prostate cancer following radical prostatectomy (RP) in patients with negative prostate-specific membrane antigen positron-emission tomography (PSMA-PET) scan is an ongoing subject of debate. The aim of this study was to evaluate the outcome of salvage radiotherapy (SRT) in patients with biochemical recurrence with negative PSMA PET finding. Methods: This retrospective, multicenter (11 centers, 5 countries) analysis included patients who underwent SRT following biochemical recurrence (BR) of PC after RP without evidence of disease on PSMA-PET staging. Biochemical recurrence-free survival (bRFS), metastatic-free survival (MFS) and overall survival (OS) were assessed using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predefined predictors of survival outcomes. Results: Three hundred patients were included, 253 (84.3%) received SRT to the prostate bed only, 46 (15.3%) additional elective pelvic nodal irradiation, respectively. Only 41 patients (13.7%) received concomitant androgen deprivation therapy (ADT). Median follow-up after SRT was 33 months (IQR: 20–46 months). Three-year bRFS, MFS, and OS following SRT were 73.9%, 87.8%, and 99.1%, respectively. Three-year bRFS was 77.5% and 48.3% for patients with PSA levels before PSMA-PET ≤ 0.5 ng/ml and > 0.5 ng/ml, respectively. Using univariate analysis, the International Society of Urological Pathology (ISUP) grade > 2 (p = 0.006), metastatic pelvic lymph nodes at surgery (p = 0.032), seminal vesicle involvement (p < 0.001), pre-SRT PSA level of > 0.5 ng/ml (p = 0.004), and lack of concomitant ADT (p = 0.023) were significantly associated with worse bRFS. On multivariate Cox proportional hazards, seminal vesicle infiltration (p = 0.007), ISUP score >2 (p = 0.048), and pre SRT PSA level > 0.5 ng/ml (p = 0.013) remained significantly associated with worse bRFS. Conclusion: Favorable bRFS after SRT in patients with BR and negative PSMA-PET following RP was achieved. These data support the usage of early SRT for patients with negative PSMA-PET findings.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Pet Negative ; Prostate Cancer ; Psma-pet ; Salvage Radiotherapy; Adjuvant Radiotherapy; Radiation; Therapy; Men; Phase-3; Antigen; Cancer
Language
english
Publication Year
2024
Prepublished in Year
2023
HGF-reported in Year
2023
ISSN (print) / ISBN
1619-7070
e-ISSN
1432-105X
Quellenangaben
Volume: 51,
Issue: 2,
Pages: 558-567
Publisher
Springer
Publishing Place
One New York Plaza, Suite 4600, New York, Ny, United States
Reviewing status
Peer reviewed
Institute(s)
Institute of Radiation Medicine (IRM)
POF-Topic(s)
30203 - Molecular Targets and Therapies
Research field(s)
Radiation Sciences
PSP Element(s)
G-501300-001
Grants
University of Bern
WOS ID
001071705500001
Scopus ID
85171733085
PubMed ID
37736808
Erfassungsdatum
2023-10-18