Abstract
The study aimed to summarize clinical characteristics associated with Gallium-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA PET/CT) scans as patients were restaged for prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or external beam radiotherapy (EBRT). Our analyses included multiple cox regression analyses. The study evaluated 95 patients with rising values of PSAs after RP and after EBRT. Sixty 63% of patients had a positive 68Ga-PSMA PET/CT scan. Twelve patients (13%) had a positive site in the prostate bed, 29 patients (30%) had a positive site in the regional lymph nodes, and 19 (20%) had positive sites in distant organs. After four years follow-up, 21 patients (22%) died. Using multiple Cox regression analyses, the number of positive sites on the 68Ga-PSMA PET/CT scan significantly predicted overall survival (OS) (p = 0.0001), whereas risk score and regional locations of the positive sites were not significant in the multiple Cox regression analyses. Our study indicates that the specific findings of 68Ga-PSMA PET/CT scans are important because detailed findings of the scans predict the outcome after salvage treatment of patients with PSA relapse examined with 68Ga-PSMA PET/CT scans.
Highlights
A quarter to half of patients with prostate cancer undergoing radical prostatectomy (RP) who had an initial decline of prostate-specific antigen (PSA) to unmeasurable levels later experience a rise of PSA levels [1,2,3]
Many patients treated with external beam radiotherapy (EBRT) who demonstrate a decline of PSA levels to low nadir PSA levels later experience a rise of PSA levels [4]
Patients treated with RP who had ISUP grade 5 cancers especially were often given adjuvant androgen deprivation therapy (ADT) after initial RP (21 of 27 patients with ISUP grade 5 vs. 22 of 68 patients with ISUP grade ≤4, p
Summary
A quarter to half of patients with prostate cancer undergoing radical prostatectomy (RP) who had an initial decline of prostate-specific antigen (PSA) to unmeasurable levels later experience a rise of PSA levels [1,2,3]. With regards to patients with PSA (“biochemical”) relapse and with a long doubling time of the PSA (PSADT) >12 months before they undergo a 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) scan, and with cancers that have a low International Society of Pathology (ISUP) grade 1, few given salvage treatment progress to metastatic disease and cancer-specific death [1,2,5,6,7,8]. Many patients with PSA relapse who have a short PSADT
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