There are few randomized trials to evaluate the use of PSMA-PET in the planning of post-prostatectomy radiotherapy. There are two unresolved questions 1) should we increase the dose to lesions visible on PSMA-PET 2) can we reduce dose in the case of a negative PSMA-PET. In this review, we summarize and discuss the available evidence in the literature. We found that in general, there seems to be an advantage for dose-increase, but ta large recent study from the pre-PSMA era didn't show an advantage for dose escalation. Retrospective studies have shown that conventional doses to PSMA-PET-positive lesions seem sufficient. On the other hand, in the case of a negative PSMA-PET, there is no evidence that dose-reduction is possible. In the future, the combination of PSMA-PET with genomic classifiers could help in better identify patients who might benefit from either dose- de-or -increase. We further need to identify intraindividual references to help identify lesions with higher aggressiveness.
Frontiers in oncology. 2023 Sep 20*** epublish ***
Ambroise Champion, Daniel Rudolf Zwhalen, Christoph Oehler, Daniel Taussky, Stephanie G C Kroeze, Irene A Burger, David Benzaquen
Radiation Oncology, Hôpital de La Tour, Meyrin, Switzerland., Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland., Department of Radiation Oncology Kantonsspital Aarau and Baden, Kantonsspital Aarau, Aarau, Switzerland., Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.