Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study.
Publisher DOI
PubMed ID
37146766
Abstract
BACKGROUND
/Purpose: 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).
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.
/Purpose: 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).
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.
Date Issued
2023-07
Publication Type
Article
Subject(s)
Subjects
PET negative PSMA PET-CT prostate cancer salvage radiotherapy
Language(s)
en
Author(s)
Scharl, Sophia | |
Zamboglou, Constantinos | |
Strouthos, Iosif | |
Farolfi, Andrea | |
Serani, Francesca | |
Lanzafame, Helena | |
Giuseppe Morganti, Alessio | |
Trapp, Christian | |
Koerber, Stefan A | |
Debus, Jürgen | |
Peeken, Jan C | |
Vogel, Marco M E | |
Vrachimis, Alexis | |
K B Spohn, Simon | |
Ruf, Juri | |
Grosu, Anca-Ligia | |
Ceci, Francesco | |
Fendler, Wolfgang P | |
Bartenstein, Peter | |
Kroeze, Stephanie G C | |
Guckenberger, Matthias | |
Krafcsik, Manuel | |
Klopscheck, Christina | |
Fanti, Stefano | |
Hruby, George | |
Emmett, Louise | |
Belka, Claus | |
Stief, Christian | |
Schmidt-Hegemann, Nina-Sophie | |
Henkenberens, Christoph | |
Mayer, Benjamin | |
Miksch, Jonathan | |
Thamm, Reinhard | |
Wiegel, Thomas |
Additional Credits
Journal
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Publisher
Elsevier Scientific Publ. Ireland
ISSN
1879-0887
Access(Rights)
open.access