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
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.
(2022) European Urology Oncology, volume 5, issue 2, pp. 146 - 152
(Article)
Abstract
BACKGROUND: 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,
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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. OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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. RESULTS AND LIMITATIONS: 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). CONCLUSIONS: PSMA-PET/CT is found to be associated with an improved oncological outcome in patients who undergo SRT for BCR after RARP. PATIENT SUMMARY: 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.
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Keywords: Case-control matching, Oncological outcomes, Prostate cancer, Prostate-specific membrane antigen positron emission tomography imaging, Salvage radiation therapy, Prostate-Specific Antigen, Humans, Male, Prostatic Neoplasms/diagnostic imaging, Prostate/pathology, Gallium Radioisotopes, Antigens, Surface, Positron Emission Tomography Computed Tomography/methods, Glutamate Carboxypeptidase II, Gallium Isotopes, General Medicine, Journal Article
ISSN: 2588-9311
Publisher: Elsevier BV
Note: Publisher Copyright: Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved. Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.
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