Event-free survival after radical prostatectomy according to PSMA PET and EAU Biochemical Recurrence Risk Groups.

To assess the European Association of Urology (EAU) risk groups for biochemically recurrent (BCR) prostate cancer relative to PSMA-PET status and oncological outcomes.

A retrospective analysis of a study that incorporated PSMA PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA PET findings, and deployment of salvage radiation treatment (SRT). The primary oncological outcome was event-free survival (EFS) and analysed relative to clinical and imaging variables. An "event" occurred if PSA rose > 0.2ng/ml above nadir or additional therapies were introduced.

137 patients were included, with most high EAU risk (76%) and/or low PSA (80% <0.5ng/ml) at time of PSMA PET. EAU risk was not associated with PSMA PET regional nodal/distant metastases. Regional nodal/distant metastasis on PSMA PET (compared to negative/local recurrence; HR 2.2; p=0.002) and SRT use (versus no SRT; HR 0.44, p=0.004) were associated with EFS. High EAU risk was not significantly associated with worse EFS (HR 1.7, p=0.12) compared to low EAU risk. Among patients who received SRT, both regional/distant metastasis on PSMA PET (HR 3.1, p<0.001) and high EAU risk (HR 2.9, p=0.04) were independently associated with worse EFS, which was driven by high EAU risk patients with regional/distant metastasis (38%; HR 3.1; p=0.001).

In men with post-RP BCR, PSMA-PET findings and receipt of SRT predicted EFS. In men receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA PET.

BJU international. 2022 Apr 29 [Epub ahead of print]

Matthew J Roberts, Mark D Chatfield, George Hruby, Rohan Nandurkar, Paul Roach, Jo Anne Watts, Thomas Cusick, Andrew Kneebone, Thomas Eade, Bao Ho, Andrew Nguyen, Colin Tang, Michael McCarthy, Roslyn Francis, Phillip Stricker, Louise Emmett

Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia., University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia., Department of Radiation Oncology, Royal North Shore Hospital, Sydney, Australia., Faculty of Medicine, University of New South Wales, Sydney, Australia., Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia., Department of Nuclear Medicine/WA PET Services, Sir Charles Gairdner Hospital, Perth, Australia., Garvan Institute of Medical Research and & The Kinghorn Cancer Centre, Sydney, Australia., Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, Australia., Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia., Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, Australia., Faculty of Health and Medical Science, University of Western Australia, Perth, Australia.

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