Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET.
324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (≤3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS).
median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p ≥ 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p ≤ 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p ≤ 0.03).
PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
Cancers. 2022 Dec 30*** epublish ***
Lorenzo Bianchi, Francesco Ceci, Francesco Costa, Eleonora Balestrazzi, Matteo Droghetti, Pietro Piazza, Alessandro Pissavini, Riccardo Mei, Andrea Farolfi, Paolo Castellucci, Stefano Puliatti, Alessandro Larcher, Giorgio Gandaglia, Daniele Robesti, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, Eugenio Brunocilla
Division of Urology, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy., Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy., Nuclear Medicine, IRCCS Azienda Ospedaliero-University of Bologna, 40138 Bologna, Italy., Department of Urology, University of Modena and Reggio Emilia, 41122 Modena, Italy., Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy., Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium., Radiation Oncology, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy.