Outcome After 68Ga-PSMA-11 versus Choline PET-Based Salvage Radiotherapy in Patients with Biochemical Recurrence of Prostate Cancer: A Matched-Pair Analysis.

Nina-Sophie Hegemann ,Christian Schäfer,Peter Bartenstein,Ute Ganswindt,Paul Rogowski,Christian Gratzke,Sebastian Lang,Chukwuka Eze,Simon Kirste,Minglun Li,Harun Ilhan,Wolfgang Schultze-Seemann,Constantinos Zamboglou,Claus Belka,Rieke Steffens,Alexander Büchner ,Christian G Stief ,Anca‐Ligia Grosu ,Philipp T Meyer ,Wolfgang P Fendler ,Simon Spohn

doi:10.3390/cancers12113395

Abstract

The purpose of this analysis was primarily to analyze biochemical-recurrence free survival (BRFS) after positron emission tomography (PET)-guided salvage radiotherapy (sRT) in a large cohort, and to further compare BRFS after PSMA vs. choline PET/ computer tomography (CT)-based sRT. This retrospective analysis is based on 421 patients referred for PSMA or choline PET/CT after radical prostatectomy due to biochemically recurrent or persistent disease. BRFS (PSA: 0.2 ng/mL) was defined as the study endpoint. Cox regression analyses were performed to assess the impact of different clinical parameters on BRFS. Additionally, propensity score matching was performed to adjust patient cohorts (PSMA vs. choline PET/CT-based sRT). The median follow-up time was 30 months. BRFS at three years after sRT was 58%. In the multivariate analysis, only PSA before PET imaging and PSA before sRT were significantly associated with BRFS (p < 0.05). After propensity score matching, 272 patients were further analyzed; there was no significant difference in three-year BRFS between patients with PSMA PET-based vs. choline PET-based sRT (55% vs. 63%, p = 0.197). The present analysis confirmed the overall high BRFS rates after PET-based sRT and the strong prognostic effect of PSA level prior to sRT. PSMA PET-based sRT did not have superior BRFS rates when compared with choline PET-based sRT.

Highlights

Within the first five years after radical prostatectomy (RPE), almost one-third of prostate cancer (PCa) patients have a biochemical relapse (BR) [1]
Pathologic lymph nodes were evident in 23.5% of all patients at the time of radical prostatectomy and 40.6% of patients had persistent persistent disease. BRFS (PSA) after surgery
It was corroborated that positron emission tomography (PET) results are highly predictive of biochemical-recurrence free survival (BRFS) in men undergoing salvage radiotherapy (sRT) for biochemical persistence or recurrence after radical prostatectomy, with overall lower BRFS in patients with PET-positive disease not confined to the prostatic fossa

Summary

Introduction

Within the first five years after radical prostatectomy (RPE), almost one-third of prostate cancer (PCa) patients have a biochemical relapse (BR) [1]. In this oncologic setting, current guidelines recommend early salvage radiation therapy (sRT) of the former prostate bed with or without androgen deprivation therapy (ADT) [2]. Choline PET/CT imaging demonstrated the highest accuracy for staging and sRT guidance in patients with biochemical relapse after RPE. In the last few years, prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) has rapidly evolved to be the new gold standard in staging patients with

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