The prognostic significance of a negative PSMA-PET scan prior to salvage radiotherapy following radical prostatectomy.

PET negative PSMA-PET Prostate cancer Salvage radiotherapy

Journal

European journal of nuclear medicine and molecular imaging
ISSN: 1619-7089
Titre abrégé: Eur J Nucl Med Mol Imaging
Pays: Germany
ID NLM: 101140988

Informations de publication

Date de publication:
22 Sep 2023
Historique:
received: 06 08 2023
accepted: 08 09 2023
medline: 22 9 2023
pubmed: 22 9 2023
entrez: 22 9 2023
Statut: aheadofprint

Résumé

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. 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. 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. 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.

Identifiants

DOI: 10.1007/s00259-023-06438-3 PMID: 37736808
pubmed: 37736808
doi: 10.1007/s00259-023-06438-3
pii: 10.1007/s00259-023-06438-3
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Author(s).

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Auteurs

Sonja Adebahr (S)

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany.

Alexander Althaus (A)

Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.

Sophia Scharl (S)

Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.

Iosif Strouthos (I)

Department of Radiation Oncology, German Oncology Center, European University Cyprus, Nicosia, Cyprus.

Andrea Farolfi (A)

Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Francesca Serani (F)

Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Helena Lanzafame (H)

Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Christian Trapp (C)

Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.

Stefan A Koerber (SA)

Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.

Jan C Peeken (JC)

Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.

Marco M E Vogel (MME)

Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum, Munich, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.

Alexis Vrachimis (A)

Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus.
C.A.R.I.C. Cancer Research & Innovation Center, Limassol, Cyprus.

Simon K B Spohn (SKB)

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Anca-Ligia Grosu (AL)

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.

Stephanie G C Kroeze (SGC)

Radiation Oncology Center KSA-KSB, Canton Hospital of Aarau, Aarau, Switzerland.
Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.

Matthias Guckenberger (M)

Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.

Stefano Fanti (S)

Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

George Hruby (G)

Department of Radiation Oncology, Royal North Shore Hospital - University of Sydney, Sydney, Australia.

Louise Emmett (L)

Department of Theranostics and Nuclear medicine, St Vincent's Hospital Sydney, Sydney, Australia.
St Vincent's Clinical School, University of New South Wales, Sydney, Australia.

Claus Belka (C)

Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
Bavarian Cancer Research Center (BZKF), Munich, Germany.

Nina-Sophie Schmidt-Hegemann (NS)

Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
Bavarian Cancer Research Center (BZKF), Munich, Germany.

Christoph Henkenberens (C)

Department of Radiotherapy and Special Oncology, Medical School Hannover, Hanover, Germany.

Daniel M Aebersold (DM)

Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.

Thomas Wiegel (T)

Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.

Ali Afshar-Oromieh (A)

Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Constantinos Zamboglou (C)

Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany.
Department of Radiation Oncology, German Oncology Center, European University Cyprus, Nicosia, Cyprus.
Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Mohamed Shelan (M)

Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. mohamed.shelan@insel.ch.
ORCID: 0000-0002-6477-6655

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