MP15-19 68Ga-PSMA PET/CT For RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY: WHAT IS NEXT?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-19 68Ga-PSMA PET/CT For RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY: WHAT IS NEXT? Giorgio Gandaglia, Daniele Robesti, Nicola Fossati, Armando Stabile, Enrico Camisassa, Vito Cucchiara, Marco Moschini, Andrea Necchi, Giuseppe Rosiello, Riccardo Leni, Renzo Colombo, Pierre I. Karakiewicz, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Armando StabileArmando Stabile More articles by this author , Enrico CamisassaEnrico Camisassa More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of 68Ga-PSMA PET/CT is recommended for prostate cancer (PCa) re-staging in patients with either PSA persistence or biochemical recurrence (BCR) after radical prostatectomy (RP). Although PSMA PET/CT is characterized by a high sensitivity even at low PSA values, its prognostic implications as well as the patterns of subsequent progression has been poorly addressed METHODS: We retrospectively identified 182 patients who were evaluated with 68Ga-PSMA PET/CT for BCR after RP between 2016 and 2020. Patients were stratified according to PSMA PET/CT into two groups: positive (n=116) vs. negative (n=66) scan. Pathological features and salvage treatments were compared. Kaplan-Meier analyses assessed the time the first PSMA PET/CT to disease progression. Cox regression analyses assessed the impact of a positive PSMA PET/CT on progression after adjusting for confounders. Per-lesion analysis using Pearson Chi-square assessed the impact of a positive PSMA PET/CT on the location of clinical recurrence after PSMA PET/CT RESULTS: Median PSA at PSMA PET/CT scan and time from surgery to BCR were 0.7 ng/ml and 49 months. At a median follow-up of 16 months after the first PSMA PET/CT, 46 patients experienced progression. Overall, 13 vs. 33 patients experienced progression in negative vs. positive groups. No differences were observed for pathologic stage, ISUP group grade, pN status and the rate of salvage RT and HT (all p≥0.07). The 3-year progression-free survival rates were 75 vs. 40% for negative vs. positive PSMA PET/CT scan at the time of BCR. At MVA, a positive PSMA PET/CT scan was associated with a 2-fold higher risk of progression compared to a negative PSMA PET/CT (p=0.01). Median time to secondary progression in PSMA negative and positive PET was 44 and 25 months (p=0.006). In men with negative PSMA (n=66) patterns of recurrence was not influenced by receipt of salvage RT (no SRT: 37% pelvic, 62% lung vs. SRT 30% pelvic, 70% lung). In men with positive PSMA PET/CT no differences in terms of site of recurrences were seen between those receiving metastasis directed therapy (MDT) vs androgen deprivation therapy (ADT: pelvic 28%, bone 35% visceral 35% vs MDT pelvic 50% bone 10% visceral 40%). CONCLUSIONS: A negative PSMA PET/CT scan is a protective factor for metastases during follow-up. Patents with negative PSMA did not show any bony progression during follow-up. The pattern of recurrence was not influenced by the use of any salvage treatment both in negative and positive PSMA PET patients. Salvage therapies might impact on disease progression but do not alter patterns of PCa dissemination Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e271-e271 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia More articles by this author Daniele Robesti More articles by this author Nicola Fossati More articles by this author Armando Stabile More articles by this author Enrico Camisassa More articles by this author Vito Cucchiara More articles by this author Marco Moschini More articles by this author Andrea Necchi More articles by this author Giuseppe Rosiello More articles by this author Riccardo Leni More articles by this author Renzo Colombo More articles by this author Pierre I. Karakiewicz More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...