Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study.

Male Humans Prostate-Specific Antigen Retrospective Studies Prostatic Neoplasms / diagnostic imaging Lymphatic Metastasis Androgen Antagonists Positron Emission Tomography Computed Tomography / methods Gallium Radioisotopes Neoplasm Recurrence, Local / pathology Positron-Emission Tomography Prostatectomy / methods Salvage Therapy / methods

PET negative PSMA PET-CT Prostate cancer Salvage radiotherapy

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

ISSN: 1879-0887

Titre abrégé: Radiother Oncol

Pays: Ireland

ID NLM: 8407192

Informations de publication

Date de publication:
07 2023

Historique:

received: 21 11 2022

revised: 12 04 2023

accepted: 17 04 2023

medline: 21 6 2023

pubmed: 6 5 2023

entrez: 5 5 2023

Statut: ppublish

Résumé

The present study aimed to assess whether SRT to the prostatic fossa should be initiated in a timely manner after detecting biochemical recurrence (BR) in patients with prostate cancer, when no correlate was identified with prostate-specific membrane antigen positron emission tomography (PSMA-PET). This retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT). This led to a cohort of 341 patients. Biochemical progression-free survival (BPFS) was the primary study endpoint. The median follow-up was 28.0 months. The 3-year BPFS was 71.6% in PET-negative cases and 80.8% in locally PET-positive cases. This difference was significant in univariate (p = 0.019), but not multivariate analyses (p = 0.366, HR: 1.46, 95%CI: 0.64-3.32). The 3-year BPFS in PET-negative cases was significantly influenced by age (p = 0.005), initial pT3/4 (p < 0.001), pathology scores (ISUP) ≥ 3 (p = 0.026), and doses to fossa > 70 Gy (p = 0.027) in univariate analyses. In multivariate analyses, only age (HR: 1.096, 95%CI: 1.023-1.175, p = 0.009) and PSA-doubling time (HR: 0.339, 95%CI: 0.139-0.826, p = 0.017) remained significant. To our best knowledge, this study provided the largest SRT analysis in patients without ADT that were lymph node-negative on PSMA-PET. A multivariate analysis showed no significant difference in BPFS between locally PET-positive and PET-negative cases. These results supported the current EAU recommendation to initiate SRT in a timely manner after detecting BR in PET negative patients.

Sections du résumé

BACKGROUND/PURPOSE

MATERIALS AND METHODS

This retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT). This led to a cohort of 341 patients. Biochemical progression-free survival (BPFS) was the primary study endpoint.

RESULTS

The median follow-up was 28.0 months. The 3-year BPFS was 71.6% in PET-negative cases and 80.8% in locally PET-positive cases. This difference was significant in univariate (p = 0.019), but not multivariate analyses (p = 0.366, HR: 1.46, 95%CI: 0.64-3.32). The 3-year BPFS in PET-negative cases was significantly influenced by age (p = 0.005), initial pT3/4 (p < 0.001), pathology scores (ISUP) ≥ 3 (p = 0.026), and doses to fossa > 70 Gy (p = 0.027) in univariate analyses. In multivariate analyses, only age (HR: 1.096, 95%CI: 1.023-1.175, p = 0.009) and PSA-doubling time (HR: 0.339, 95%CI: 0.139-0.826, p = 0.017) remained significant.

CONCLUSION

To our best knowledge, this study provided the largest SRT analysis in patients without ADT that were lymph node-negative on PSMA-PET. A multivariate analysis showed no significant difference in BPFS between locally PET-positive and PET-negative cases. These results supported the current EAU recommendation to initiate SRT in a timely manner after detecting BR in PET negative patients.

Identifiants

DOI: 10.1016/j.radonc.2023.109678 PMID: 37146766

pubmed: 37146766

pii: S0167-8140(23)00216-5

doi: 10.1016/j.radonc.2023.109678

pii:

doi:

Substances chimiques

Prostate-Specific Antigen EC 3.4.21.77

Androgen Antagonists 0

Gallium Radioisotopes 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

109678

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.