Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Rec

Prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET) allows detection of metastatic prostate cancer (PC) lesions at low prostate-specific antigen (PSA) values. To facilitate their intraoperative detection during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (RGS).

To describe the outcome of a large cohort of patients treated with PSMA-targeted RGS and to establish prognostic factors.

A total of 121 consecutive patients with recurrent PC as defined by PSMA-ligand PET (median PSA: 1.13ng/ml) underwent PSMA-targeted RGS.

The frequency of a complete biochemical response (cBR; PSA <0.2ng/ml) without additional treatment and the duration of biochemical recurrence-free survival (bRFS, time from PSMA-targeted RGS with PSA <0.2ng/ml without further treatment) were evaluated and correlated with preoperatively available clinical variables.

In almost all patients (120/121, 99%) metastatic tissue could be removed. A cBR was achieved in 77 patients (66%). The chance of cBR was highest in patients with both low preoperative PSA and a single lesion (38/45: 84%). Median bRFS was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR. Significantly longer median bRFS was observed in patients with a low preoperative PSA value (p=0.004, hazard ratio 1.48, 95% confidence interval 1.13-1.93) and with a single lesion in preoperative PSMA-ligand PET (14.0 vs 2.5mo, p=0.002).

PSMA-targeted RGS leads to a remarkable interval of bRFS in a subset of patients. The frequency of cBR and the duration of bRFS were highest in patients with a low preoperative PSA value and a single lesion on PSMA-ligand PET.

Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome.

European urology. 2019 Apr 12 [Epub ahead of print]

Thomas Horn, Markus Krönke, Isabel Rauscher, Bernhard Haller, Stephanie Robu, Hans-Jürgen Wester, Margret Schottelius, Fijs W B van Leeuwen, Henk G van der Poel, Matthias Heck, Jürgen E Gschwend, Wolfgang Weber, Matthias Eiber, Tobias Maurer

Department of Urology, Technical University of Munich, Munich, Germany., Department of Nuclear Medicine, Technical University of Munich, Munich, Germany., Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany., Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Munich, Germany., Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands., Department of Urology, Antoni van Leeuwenhoek Hospital-The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Technical University of Munich, Munich, Germany; Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: .