The optimal management for early recurrent prostate cancer following radical prostatectomy (RP) in patients with negative prostate-specific membrane antigen positron-emission tomography (PSMA-PET) scan is an ongoing subject of debate. The aim of this study was to evaluate the outcome of salvage radiotherapy (SRT) in patients with biochemical recurrence with negative PSMA PET finding.
This retrospective, multicenter (11 centers, 5 countries) analysis included patients who underwent SRT following biochemical recurrence (BR) of PC after RP without evidence of disease on PSMA-PET staging. Biochemical recurrence-free survival (bRFS), metastatic-free survival (MFS) and overall survival (OS) were assessed using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predefined predictors of survival outcomes.
Three hundred patients were included, 253 (84.3%) received SRT to the prostate bed only, 46 (15.3%) additional elective pelvic nodal irradiation, respectively. Only 41 patients (13.7%) received concomitant androgen deprivation therapy (ADT). Median follow-up after SRT was 33 months (IQR: 20-46 months). Three-year bRFS, MFS, and OS following SRT were 73.9%, 87.8%, and 99.1%, respectively. Three-year bRFS was 77.5% and 48.3% for patients with PSA levels before PSMA-PET ≤ 0.5 ng/ml and > 0.5 ng/ml, respectively. Using univariate analysis, the International Society of Urological Pathology (ISUP) grade > 2 (p = 0.006), metastatic pelvic lymph nodes at surgery (p = 0.032), seminal vesicle involvement (p < 0.001), pre-SRT PSA level of > 0.5 ng/ml (p = 0.004), and lack of concomitant ADT (p = 0.023) were significantly associated with worse bRFS. On multivariate Cox proportional hazards, seminal vesicle infiltration (p = 0.007), ISUP score >2 (p = 0.048), and pre SRT PSA level > 0.5 ng/ml (p = 0.013) remained significantly associated with worse bRFS.
Favorable bRFS after SRT in patients with BR and negative PSMA-PET following RP was achieved. These data support the usage of early SRT for patients with negative PSMA-PET findings.
European journal of nuclear medicine and molecular imaging. 2023 Sep 22 [Epub ahead of print]
Sonja Adebahr, Alexander Althaus, Sophia Scharl, Iosif Strouthos, Andrea Farolfi, Francesca Serani, Helena Lanzafame, Christian Trapp, Stefan A Koerber, Jan C Peeken, Marco M E Vogel, Alexis Vrachimis, Simon K B Spohn, Anca-Ligia Grosu, Stephanie G C Kroeze, Matthias Guckenberger, Stefano Fanti, George Hruby, Louise Emmett, Claus Belka, Nina-Sophie Schmidt-Hegemann, Christoph Henkenberens, Daniel M Aebersold, Thomas Wiegel, Ali Afshar-Oromieh, Constantinos Zamboglou, Mohamed Shelan
Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany., Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Radiation Oncology, German Oncology Center, European University Cyprus, Nicosia, Cyprus., Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany., Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany., Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus., Radiation Oncology Center KSA-KSB, Canton Hospital of Aarau, Aarau, Switzerland., Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland., Department of Radiation Oncology, Royal North Shore Hospital - University of Sydney, Sydney, Australia., Department of Theranostics and Nuclear medicine, St Vincent's Hospital Sydney, Sydney, Australia., Department of Radiotherapy and Special Oncology, Medical School Hannover, Hanover, Germany., Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. .