Comparison of Hormone-Sensitive Oligorecurrent Prostate Cancer Patients Based on Routine Use of Choline and/or PSMA PET/CT to Guide Metastasis-Directed Therapy

• Published in: Cancers Vol. 15; no. 6; p. 1898
• Main Authors: Metz, Raphaël, Rauscher, Aurore, Vaugier, Loïg, Supiot, Stéphane, Drouet, Franck, Campion, Loic, Rousseau, Caroline
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 22-03-2023; MDPI
• Subjects: Antigens; Care and treatment; Choline; Comparative analysis; Computed tomography; CT imaging; Health aspects; Localization; Metastases; Metastasis; Methods; Multivariate analysis; Nuclear medicine; Patients; PET imaging; Prostate cancer; Prostate-specific antigen; Prostatectomy; Radiation therapy; Surveillance; Survival; Tomography; Urology; Values; France; [68Ga]Ga-PSMA; prostate cancer; external radiotherapy; PET/CT; [18F]F-choline; oligorecurrent
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15061898

In hormone-sensitive oligorecurrent prostate cancer (PC), the literature showed [68Ga]Ga-PSMA (PSMA) and [18F]F-choline (FCH) PET/CT can successfully guide metastasis-directed therapies (MDT). This observational retrospective study aimed to explore, in routine use, the impact of FCH or PSMA PET/CT in guiding MDT for hormone-sensitive oligometastatic PC at different recurrences.
In 2017-2020, patients initially treated with radical prostatectomy but, in biochemical recurrence (with PSA ≤ 2 ng/mL), diagnosed as oligometastatic based on FCH or PSMA PET/CT, were identified. MDT was stereotactic body radiotherapy (SBRT), elective nodal or prostate bed radiotherapy ± boost and ± androgen deprivation therapy (ADT). The primary endpoint was biochemical relapse-free survival (BR-FS), defined as a PSA increase ≥ 0.2 ng/mL above the nadir and increasing over two successive samples and the secondaries were ADT-free survival (ADT-FS).
123 patients (70 PSMA and 53 FCH) were included. The median follow-up was 42.2 months. The median BR-FS was 24.7 months in the PSMA group versus 13.0 months in the FCH group (
= 0.008). Similarly, ADT-FS (
= 0.001) was longer in patients in the PSMA group. In multivariate analysis, a short PSA doubling time before imaging (
= 0.005) and MDT with SBRT (
= 0.001) were poor prognostic factors for BR-FS.
Routine use of FCH or PSMA PET/CT in hormone-sensitive PC showed an advantage for using PSMA PET/CT to guide MDT in terms of BR-FS and ADT-FS in patients with low PSA value. Prospective studies are needed to confirm these hypotheses.