A Multi-Institutional Analysis of Prostate Cancer Patients With or Without 68Ga-PSMA PET/CT Prior to Salvage Radiotherapy of the Prostatic Fossa

Frontiers in Oncology

Vikas Prasad¹  Ute Ganswindt²  Claus Belka³  Benjamin Mayer⁴  Constantinos Zamboglou⁵  Peter Bartenstein⁶  Simon Kirste⁷  Simon Spohn⁷  Reinhard Thamm⁸  Thomas Wiegel⁸  Nina-Sophie Schmidt-Hegemann⁹  Chukwuka Eze⁹  Minglun Li⁹  Wolfgang Schultze-Seemann^1,10  Christian Stief^1,11  Christian Bolenz^1,12  Anca-Ligia Grosu^1,13 

[1] 0Department of Nuclear Medicine, University of Ulm, Ulm, Germany;1Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria;2German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany;3Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany;Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany;Department of Radiation Oncology, University Hospital, Ludwig-Maximilians Universität (LMU) Munich, Munich, Germany;Department of Urology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Urology, University Hospital, LMU Munich, Munich, Germany;Department of Urology, University of Ulm, Ulm, Germany;German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany;

关键词: prostate;    cancer;    PSMA PET/CT;    biochemical recurrence;    radiotherapy;   

DOI  :  10.3389/fonc.2021.723536

来源: DOAJ

【 摘 要 】

Introduction68Ga-PSMA PET/CT is associated with unprecedented sensitivity for localization of biochemically recurrent prostate cancer at low PSA levels prior to radiotherapy. Aim of the present analysis is to examine whether patients undergoing postoperative, salvage radiotherapy (sRT) of the prostatic fossa with no known nodal or distant metastases on conventional imaging (CT and/or MRI) and on positron emission tomography/computed tomography (68Ga-PSMA PET/CT) will have an improved biochemical recurrence-free survival (BRFS) compared to patients with no known nodal or distant metastases on conventional imaging only.Material and MethodsThis retrospective analysis is based on 459 patients (95 with and 364 without 68Ga-PSMA PET/CT). BRFS (PSA < post-sRT Nadir + 0.2 ng/ml) was the primary study endpoint. This was first analysed by Kaplan-Meier and uni- and multivariate Cox regression analysis for the entire cohort and then again after matched-pair analysis using tumor stage, Gleason score, PSA at time of sRT and radiation dose as matching parameters.ResultsMedian follow-up was 77.5 months for patients without and 33 months for patients with 68Ga-PSMA PET/CT. For the entire cohort, tumor stage (pT2 vs. pT3-4; p= <0.001), Gleason score (GS ≤ 7 vs. GS8-10; p=0.003), pre-sRT PSA (<0.5 vs. ≥0.5ng/ml; p<0.001) and sRT dose (<70 vs. ≥70Gy; p<0.001) were the only factors significantly associated with improved BRFS. This was not seen for the use of 68Ga-PSMA PET/CT prior to sRT (p=0.789). Matched-pair analysis consisted of 95 pairs of PCa patients with or without PET/CT and no significant difference in BRFS based on the use of PET/CT was evident (p=0.884).ConclusionThis analysis did not show an improvement in BRFS using 68Ga-PSMA PET/CT prior to sRT neither for the entire cohort nor after matched-pair analysis after excluding patients with PET-positive lymph node or distant metastases a priori. As no improved BRFS resulted with implementation of 68Ga-PSMA PET in sRT planning, sRT should not be deferred until the best “diagnostic window” for 68Ga-PSMA PET/CT.

【 授权许可】

Unknown