European association of urology risk stratification predicts outcome in patients receiving PSMA-PET-planned salvage radiotherapy for biochemical recurrence following radical prostatectomy.

The European Association of Urology (EAU) proposed a risk stratification (high vs. low risk) for patients with biochemical recurrence (BR) following radical prostatectomy (RP). Here we investigated whether this stratification accurately predicts outcome, particularly in patients staged with PSMA-PET.

For this study, we used a retrospective database including 1222 PSMA-PET-staged prostate cancer patients who were treated with salvage radiotherapy (SRT) for BR, at 11 centers in 5 countries. Patients with lymph node metastases (pN1 or cN1) or unclear EAU risk group were excluded. The remaining cohort comprised 526 patients, including 132 low-risk and 394 high-risk patients.

The median follow-up time after SRT was 31.0 months. The 3-year biochemical progression-free survival (BPFS) was 85.7 % in EAU low-risk versus 69.4 % in high-risk patients (p = 0.002). The 3-year metastasis-free survival (MFS) was 94.4 % in low-risk versus 87.6 % in high-risk patients (p = 0.005). The 3-year overall survival (OS) was 99.0 % in low-risk versus 99.6 % in high-risk patients (p = 0.925). In multivariate analysis, EAU risk group remained a statistically significant predictor of BPFS (p = 0.003, HR 2.022, 95 % CI 1.262-3.239) and MFS (p = 0.013, HR 2.986, 95 % CI 1.262-7.058).

Our data support the EAU risk group definition. EAU risk grouping for BCR reliably predicted outcome in patients staged lymph node-negative after RP and with PSMA-PET before SRT. To our knowledge, this is the first study validating the EAU risk grouping in patients treated with PSMA-PET-planned SRT.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2024 Mar 07 [Epub]

Sophia Scharl, Constantinos Zamboglou, Iosif Strouthos, Andrea Farolfi, Francesca Serani, Stefan A Koerber, Jürgen Debus, Jan C Peeken, Marco M E Vogel, Stephanie G C Kroeze, Matthias Guckenberger, Manuel Krafcsik, George Hruby, Louise Emmett, Nina-Sophie Schmidt-Hegemann, Christian Trapp, Simon K B Spohn, Christoph Henkenberens, Benjamin Mayer, Mohamed Shelan, Daniel M Aebersold, Reinhard Thamm, Thomas Wiegel

Department of Radiation Oncology, University Hospital Ulm, Germany. Electronic address: ., Department of Radiation Oncology, Medical Center -Faculty of Medicine, University of Freiburg, Germany., Department of Radiation Oncology, German Oncology Center, University Hospital of the European University, Limassol, Cyprus., Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Department of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany., Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany., Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Germany., Radiation Oncology Center KSA-KSB, Canton Hospital of Aarau, Aarau, Switzerland., Department of Radiation Oncology, University Hospital Zürich, Switzerland., Department of Radiation Oncology, University Hospital Ulm, Germany., Department of Radiation Oncology, Royal North Shore Hospital - University of Sydney, Australia., St Vincent's Clinical School, University of New South Wales, Sydney, Australia., Department of Department of Radiotherapy and Oncology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, 81377 Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany., Department of Department of Radiotherapy and Oncology, University Hospital, LMU Munich, Germany., Department of Radiotherapy and Special Oncology, Medical School Hannover, Hannover, Germany., Institute for Epidemiology and Medical Biometry, University Ulm, Ulm, Germany., Department of Radiation Oncology, Inselspital Bern, Bern University Hospital, University of Bern, Switzerland.