A substantial number of patients will develop further biochemical progression after radical prostatectomy (RP) and salvage radiotherapy (sRT). Recently published data using prostate-specific membrane antigen ligand positron emission tomography (PSMA - PET) for re-staging suggest that those recurrences are often located outside the prostate fossa and most of the patients have a limited number of metastases, making them amenable to metastasis-directed treatment (MDT).
We analyzed 78 patients with biochemical progression after RP and sRT from a retrospective European multicenter database and assessed the biochemical recurrence-free survival (bRFS; PSA < nadir + 0.2 ng/ml or no PSA decline) as well as the androgen deprivation therapy- free survival (ADT-FS) using Kaplan-Meier curves. Log-rank test and multivariate analysis was performed to determine influencing factors.
A total of 185 PSMA - PET positive metastases were detected and all lesions were treated with radiotherapy (RT). Concurrent ADT was prescribed in 16.7% (13/78) of patients. The median PSA level before RT was 1.90 ng/mL (range, 0.1-22.1) and decreased statistically significantly to a median PSA nadir level of 0.26 ng/mL (range, 0.0-12.25; p < 0.001). The median PSA level of 0.88 ng/mL (range, 0.0-25.8) at the last follow-up was also statistically significantly lower (p = 0.008) than the median PSA level of 1.9 ng/mL (range, 0.1-22.1) before RT. The median bRFS was 17.0 months (95% CI, 14.2-19.8). After 12 months, 55.3% of patients were free of biochemical progression. Multivariate analyses showed that concurrent ADT was the most important independent factor for bRFS (p = 0.01). The median ADT-FS was not reached and exploratory statistical analyses estimated a median ADT-FS of 34.0 months (95% CI, 16.3-51.7). Multivariate analyses revealed no significant parameters for ADT-FS.
RT as MDT based on PSMA - PET of all metastases of recurrent prostate cancer after RP and sRT represents a viable treatment option for well-informed and well-selected patients.
BMC cancer. 2020 Apr 29*** epublish ***
Ann-Kathrin Oehus, Stephanie G C Kroeze, Nina-Sophie Schmidt-Hegemann, Marco M E Vogel, Simon Kirste, Jessica Becker, Irene A Burger, Thorsten Derlin, Peter Bartenstein, Matthias Eiber, Michael Mix, Christian la Fougère, Claus Belka, Stephanie E Combs, Anca-Ligia Grosu, Arndt-Christian Müller, Matthias Guckenberger, Hans Christiansen, Christoph Henkenberens
Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30629, Hannover, Germany., Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland., Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany., Department of Radiation Oncology, Technical University Munich, Munich, Germany., Department of Radiation Oncology, University of Freiburg, Freiburg, Germany., Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany., Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland., Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany., Department of Nuclear Medicine, University Hospital LMU Munich, München, Germany., Department of Nuclear Medicine, Technical University Munich, München, Germany., Department of Nuclear Medicine, University of Freiburg, Freiburg, Germany., Department of Nuclear Medicine, University Hospital Tübingen, Tübingen, Germany., Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30629, Hannover, Germany. .