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Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer
Koerber, S. A.; Sprute, K.; Kratochwil, C.; Winter, E.; Haefner, M. F.; Katayama, S.; Schlampp, I.; Herfarth, K.; Kopka, K.; Afshar-Oromieh, A.; Zschaebitz, S.; Holland-Letz, T.; Choyke, P. L.; Jaeger, D.; Hohenfellner, M.; Haberkorn, U.; Debus, J.; Giesel, F. L.
First-line treatment of patients with recurrent, metastatic prostate cancer involves hormone therapy with or without additional systemic therapies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) allows the detection of oligometastatic disease that may be amenable to image-guided radiotherapy. The current study classifies the type and localization of metastases and the clinical outcome of PSMA-PET/CT-guided radiotherapy to selected metastases.
Materials and methods.
Between 2011 and 2019, 86 patients with recurrent, oligometastatic prostate carcinoma were identified by PSMA-PET/CT and were treated with image-guided radiotherapy of their metastases. Sites of relapse were characterized, and the primary endpoint overall survival (OS), biochemical progression-free survival (bPFS), and androgen deprivation therapy (ADT)-free survival were tabulated.
In total, 37% of the metastases were bone metastases, 48% were pelvic nodalmetastases, and 15% were nodalmetastases outside of the pelvis. After PSMA-guided radiotherapy, a biochemical response was detected in 83% of the cohort. A statistically significant decrease in the standard uptake value (SUV) was seen in irradiated metastases. After a median follow-up of 26 months, the 3-year OS and bPFS were 84% and 55%, respectively. The median time of ADT-free survival was 13.5 months. A better clinical outcome was observed for patients receiving concomitant ADT or more than 24 fractions of radiation.
PSMA-guided radiotherapy is a promising therapeutic approach with excellent infield control for men with oligorecurrent prostate carcinoma. However, prospective, randomized trials are necessary to determine if this approach confers a survival advantage.
Keywords: Prostate cancer; PSMA; PET; Metastases; SUV; OS
European Journal of Nuclear Medicine and Molecular Imaging (2020)
Online First (2020) DOI: 10.1007/s00259-020-04777-z