Abstract
Simple SummaryThe early treatment of oligometastatic disease (OMD) is a promising therapeutic option for prostate cancer as it has the potential of delaying androgen-deprivation therapy (ADT) and disease progression. Next-generation imaging targeting the prostate-specific membrane antigen (PSMA-PET/CT) is considered the most accurate technique for recurrent prostate cancer. Finding clinico-pathological factors predicting positivity with OMD detection on PSMA-PET/CT, as well as assessing its impact on treatment management, were the main objectives of our study. We selected a homogenous population of ADT-free prostate cancer patients with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). OMD was detected in 44% of patients for a total positivity rate of 60%. PSA at the moment of PET, PSAdt, and the absence of previous salvage treatment were factors predicting PSMA-PET/CT positivity with OMD. A change in clinical management occurred in more than half of the patients, mostly to perform metastasis-directed therapy after OMD detection.Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95% CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT.
Highlights
Prostate cancer (PCa) is the most common cancer in men in Europe and the second worldwide with 1.4 million new cases in 2020 [1]
Recurrent disease after radical prostatectomy (RP) can benefit from salvage radiotherapy, recommended at prostate-specific antigen (PSA) levels < 0.5 ng/mL, where it has been demonstrated as an outcome benefit [5]
From the analysis of clinico-pathological predictive factors, our study found that PSA at the moment of PET and previous salvage treatment were inversely associated with the presence of oligometastatic disease (OMD) on a positive scan
Summary
Prostate cancer (PCa) is the most common cancer in men in Europe and the second worldwide with 1.4 million new cases in 2020 [1]. After initial treatment for localized disease with radical prostatectomy (RP), between 27% and 53% of patients will develop a biochemical recurrence (BCR) defined by an increase in prostate-specific antigen (PSA) level > 0.2 ng/mL [2]. CITs are not recommended at PSA levels < 20 ng/mL [3], as they present limited accuracy, with a sensitivity of only 11% [4], resulting in an enormous number of negative or inconclusive investigations. It is, crucial to distinguish between localized vs extended metastatic disease as prognosis differs completely, as well as consequent therapeutic strategies. Multimetastatic disease will require systemic therapies based on androgen deprivation therapy (ADT) with or without novel antiandrogen drugs or docetaxel chemotherapy [7,8]
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