Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Is Associated with Improved Oncological Outcome in Men Treated with Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer

Patients who underwent restaging prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) for biochemically recurrent disease after radical prostatectomy had better short-term oncological outcomes after salvage radiation therapy (SRT) than those who underwent...

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Published in:	European urology oncology Vol. 5; no. 2; pp. 146 - 152
Main Authors:	Meijer, Dennie, Eppinga, Wietse S.C., Mohede, Roos M., Vanneste, Ben G.L., Meijnen, Philip, Meijer, Otto W.M., Daniels, Laurien A., van den Bergh, Roderick C.N., Lont, Anne P., Ettema, Rosemarijn H., Oudshoorn, Frederik H.K., van Leeuwen, Pim J., van der Poel, Henk G., Donswijk, Maarten L., Oprea-Lager, Daniela E., Schaake, Eva E., Vis, André N.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-04-2022
Subjects:	Antigens, Surface Case-control matching Gallium Isotopes Gallium Radioisotopes Glutamate Carboxypeptidase II Humans Male Oncological outcomes Positron Emission Tomography Computed Tomography - methods Prostate - pathology Prostate cancer Prostate-Specific Antigen Prostate-specific membrane antigen positron emission tomography imaging Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - pathology Prostatic Neoplasms - radiotherapy Salvage radiation therapy Case-control matching Oncological outcomes Salvage radiation therapy Prostate-specific membrane antigen positron emission tomography imaging Prostate cancer
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Summary:	Patients who underwent restaging prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) for biochemically recurrent disease after radical prostatectomy had better short-term oncological outcomes after salvage radiation therapy (SRT) than those who underwent “blind” SRT. Thus, PSMA-PET/CT is associated with an improved oncological outcome in a selected series of patients. Radiolabeled prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has shown superior diagnostic accuracy to conventional imaging for the detection of prostate cancer deposits . Consequently, clinical management changes have been reported in patients with biochemical recurrence (BCR) of disease after robot-assisted radical prostatectomy (RARP). We hypothesized that, due to the exclusion of patients with metastatic disease on PSMA-PET/CT, those who underwent local salvage radiation therapy (SRT) after restaging PSMA-PET/CT for BCR may have better oncological outcomes than patients who underwent “blind” SRT. To compare the oncological outcome of a patient cohort that underwent PSMA-PET imaging prior to SRT with that of a patient cohort that did not have PSMA-PET imaging before SRT. We included 610 patients who underwent SRT, of whom 298 underwent PSMA-PET/CT prior to SRT and 312 did not. No additional hormonal therapy was prescribed. To compare both cohorts, case-control matching was performed, using the prostate-specific antigen (PSA) value at the initiation of SRT, pathological grade group, pathological T stage, surgical margin status, and biochemical persistence after RARP as matching variables. The outcome variable was biochemical progression at 1 yr after SRT, defined as either a rise of PSA ≥0.2 ng/ml above the nadir after SRT or the start of additional treatment. After case-control matching, 216 patients were matched in both cohorts (108 patients per cohort). In the patient cohort without PSMA-PET/CT prior to SRT, of 108 patients, 23 (21%) had biochemical progression of disease at 1 yr after SRT, compared with nine (8%) who underwent restaging PSMA-PET/CT prior to SRT (p = 0.007). PSMA-PET/CT is found to be associated with an improved oncological outcome in patients who undergo SRT for BCR after RARP. Performing prostate-specific membrane antigen positron emission tomography/computed tomography imaging in patients with biochemical recurrence of disease after robot-assisted radical prostatectomy, before initiating salvage radiation therapy, resulted in improved short-term oncological outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2588-9311 2588-9311
DOI:	10.1016/j.euo.2022.01.001