FREE DAILY AND WEEKLY NEWSLETTERS OFFERED BY CONTENT OF INTEREST
Did you find this article relevant? Subscribe to UroToday-GUOncToday!
The fields of GU Oncology and Urology are advancing rapidly including new treatments, enrolling clinical trials, screening and surveillance recommendations along with updated guidelines. Join us as one of our subscribers who rely on UroToday as their must-read source for the latest news and data on drugs. Sign up today for blogs, video conversations, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.
A second study published in Journal of Urology in 2016 mapped recurrence patterns with [11C] Choline PET and multiparametric MRI for 260 patients treated with radical prostatectomy who had biochemical recurrence. The mean time from biochemical recurrence to identification of disease was only 15 months. Two-thirds of patients had recurrence confined to the pelvis without other sites of distant metastasis.
Finally, 550 patients from 2008-2016 with post radical prostatectomy biochemical recurrence were studied with a 3 tesla mpMRI and [11C] Choline PET. Most metastatic recurrences were detected at a median PSA was 3.3 ng/ml. Patients were treated with ADT (20%), radiation therapy (37%), or radiation + ADT (44%). Of 970 mapped relapse sites, >90% in each cohort were low volume by CHAARTED criteria. Local recurrences were present but lower with postoperative radiation therapy (33% vs 10%). Approximately 50% of recurrences were within the pelvis compared to 66% in the radical prostatectomy only cohort.
The oncologic impact of [11C] Choline PET/CT was then brought into question. A study of 117 patients from 2009-2015 who had biochemical recurrence after radical prostatectomy with node positive disease on evaluation of [11C] Choline PET/CT underwent bilateral salvage pelvic or retroperitoneal lymph node dissections. Around 50% of these patients had normal conventional imaging. Patients had a 31% 5yr biochemical recurrence free survival and 97% 5-year cancer specific morality free survival.
The STOMP trial randomized patients with oligometastatic disease to radiotherapy or surgery. Patients treated with metastasis directed therapy had a 75% PSA decline compared to 35% on surveillance and a statistically significant improvement in biochemical recurrence free survival. The median ADT-free survival was 13 months vs 21 months.
This excellent presentation synthesized existing data on [11C] Choline PET/CT while we await outcomes to fuel unique opportunities in the realm of prostate cancer and biochemical recurrence.
Presented by: R. Jeffrey Karnes, MD, Mayo Clinic
Written by: David B. Cahn, DO, MBS, @dbcahn, Fox Chase Cancer Center, Philadelphia, PA at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC
More Related Content:
Surveillance or metastasis-directed Therapy for OligoMetastatic Prostate cancer recurrence (STOMP): Study protocol for a randomized phase II trial