PSMA PET-CT Research Articles

PEACE V \u2013 Salvage Treatment of OligoRecurrent nodal prostate cancer Metastases (STORM): a study protocol for a randomized controlled phase II trial

BackgroundPelvic nodal recurrences are being increasingly diagnosed with the introduction of new molecular imaging techniques, like choline and PSMA PET-CT, in the restaging of recurrent prostate cancer (PCa). At this moment, there are no specific treatment recommendations for patients with limited nodal recurrences and different locoregional treatment approaches are currently being used, mostly by means of metastasis-directed therapies (MDT): salvage lymph node dissection (sLND) or stereotactic body radiotherapy (SBRT). Since the majority of patients treated with MDT relapse within 2 years in adjacent lymph node regions, with an estimated median time to progression of 12–18 months, combining MDT with whole pelvic radiotherapy (WPRT) may improve oncological outcomes in these patients. The aim of this prospective multicentre randomized controlled phase II trial is to assess the impact of the addition of WPRT to MDT and short-term androgen deprivation therapy (ADT) on metastasis-free survival (MFS) in the setting of oligorecurrent pelvic nodal recurrence.Methods & designPatients diagnosed with PET-detected pelvic nodal oligorecurrence (≤5 nodes) following radical local treatment for PCa, will be randomized in a 1:1 ratio between arm A: MDT and 6 months of ADT, or arm B: WPRT added to MDT and 6 months of ADT. Patients will be stratified by type of PET-tracer (choline, FACBC or PSMA) and by type of MDT (sLND or SBRT). The primary endpoint is MFS and the secondary endpoints include clinical and biochemical progression-free survival (PFS), prostate cancer specific survival, quality of life (QoL), toxicity and time to castration-resistant prostate cancer (CRPC) and to palliative ADT. Estimated study completion: December 31, 2023.DiscussionThis is the first prospective multicentre randomized phase II trial assessing the potential of combined WPRT and MDT as compared to MDT alone on MFS for patients with nodal oligorecurrent PCa.Trial registrationClinicalTrials.gov Identifier: NCT03569241, registered June 14, 2018, ;Identifier on Swiss National Clinical Trials Portal (SNCTP): SNCTP000002947, registered June 14, 2018.

PSMA PET-CT outperforms conventional imaging in high-risk prostate cancer.

PSMA PET-CT outperforms conventional imaging in high-risk prostate cancer.

PSMA PET–CT improves staging

PSMA PET–CT improves staging

MP62-18 PRIMARY METASTASIS STAGING USING 18 F-PSMA-1007 PET-CT IN HIGH-RISK PROSTATE CANCER

MP62-18 PRIMARY METASTASIS STAGING USING ¹⁸ F-PSMA-1007 PET-CT IN HIGH-RISK PROSTATE CANCER

The Impact of PSMA PET-CT on Treatment Decisions in Prostate Cancer – Early Experience in a Single Centre

The Impact of PSMA PET-CT on Treatment Decisions in Prostate Cancer – Early Experience in a Single Centre

High negative predictive value of 68Ga PSMA PET-CT for local lymph node metastases in high risk primary prostate cancer with histopathological correlation

BackgroundCurrent guidelines highlight the importance of accurate staging in the management and prognostication of high risk primary prostate cancer. Conventional radiologic imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Despite promising results, there is limited published data on the diagnostic accuracy of PSMA PET-CT to assess local nodal metastases prior to radical prostatectomy.This study aims to assess the diagnostic efficacy of 68Ga PSMA PET-CT in local lymph node staging of high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection.MethodsWe retrospectively analysed consecutive patients with high risk primary prostate cancer referred by urologists for primary staging PSMA PET-CT using a 68Ga-labeled PSMA ligand, Glu-NH-CO-NHLys-(Ahx)-[HBEDD-CC], from October 2015 to October 2017. The scans of patients who underwent radical prostatectomy with pelvic lymph node dissection were interpreted by the consensus reading of two experienced nuclear medicine physicians blinded to clinical and histopathological data. The contemporaneous records of the referring urologists were retrospectively reviewed for noteworthy unexpected PET findings that altered their personal preference for surgical management.ResultsSeventy-one patients were recruited and analysed. PSMA PET-CT showed findings compatible with local disease in 47 patients (66.2%), lymph node metastases in 10 patients (14.1%) and distant metastases in 14 patients (19.7%). Twenty-eight patients (twenty-seven of whom had local disease only) underwent surgery yielding 214 lymph nodes, all of which were negative on histopathological analysis. On a node-based analysis, 213 of 214 lymph nodes were accurately identified as negative for disease with a negative predictive value of 100%. 11 patients had unexpected PET findings contemporaneously documented by urologists to alter their preference for surgical management.ConclusionsPSMA PET-CT appears to have a high negative predictive value for local lymph node metastases in high risk primary prostate cancer when compared to histopathological findings following radical prostatectomy with pelvic lymph node dissection.

203P - Long term outcomes of 2-weekly docetaxel in metastatic high-volume hormone sensitive prostate cancer

Background3-weekly Docetaxel along with androgen deprivation therapy (ADT) improves overall survival in high volume metastatic hormone sensitive prostate cancer (mHSPC). However, this regimen is associated with 30% incidence of grade 3-5 adverse events. 2-weekly Docetaxel is better tolerated than 3-weekly docetaxel in Castration Resistant Prostate Cancer (CRPC). We sought to determine toxicity and efficacy of 2-weekly docetaxel in high volume mHSPC. We also compared these outcomes to those achieved with 3-weekly docetaxel in CHAARTED Trial. Methods29 patients with high volume mHSPC (as per CHAARTED criteria) received ADT + 2-weekly docetaxel between April 2016 & December 2017. Diagnosis was established by TRUS guided prostate biopsy and staging was done by Ga68 PSMA PET CT scan in all patients. Docetaxel was administered at 50 mg/m2 every 2 weekly for total 10 doses. 23 patients received medical ADT and 6 patients underwent surgical castration. Patients were monitored every 2-weekly during treatment & 3-monthly thereafter. Adverse events were recorded as per CTCAE 4.0. Data was analyzed to determine serological complete response rate (sCR - PSA<0.2ng/ml), time to CRPC and overall survival. ResultsMedian age was 64 years & median PSA was 98 ng/ml (range 11 – 4000). Gleason score was <7 in 1 patient, 7 in 7 patients & 8-10 in 21patients, respectively. Bone, lymph node and visceral metastasis were present in 23, 8 & 8 patients, respectively. 27 patients completed the planned chemotherapy and treatment was well tolerated in most patients. 2 patients developed grade 3 paronychia, 1 patient developed pulmonary tuberculosis and 1 patient died of pneumonia. sCR (PSA<0.2ng/ml) was achieved in 12(41.4%) patients, which compares well with 32% reported in CHAARTED trial. After a median follow up of 24 months, 5 patients have died, 1 lost to follow-up while 23 are alive. 14(48.3%) patients have progressed to CRPC. Median time to CRPC was 17 months, which compares well with 20 months reported in CHAARTED trial. ConclusionsWe conclude that 2-weekly docetaxel is better tolerated and results in acceptable long term outcomes compared to 3-weekly docetaxel in mHSPC. This regimen is currently being explored in a large phase 3 randomized trial. Legal entity responsible for the studyMax Healthcare. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Using PSMA PET-CT as a Diagnostic Tool for Detection of Prostatic Cancer at an Early Stage

Using PSMA PET-CT as a Diagnostic Tool for Detection of Prostatic Cancer at an Early Stage

Is it time to fund routine NHS usage of PSMA PET-CT?

Is it time to fund routine NHS usage of PSMA PET-CT?

Role of Local SBRT in Metastatic Carcinoma Prostate Treated with Hormone Therapy

ADT and chemotherapy is the standard of care in metastatic prostate cancer which has shown 5 year survival benefit of 40-60mths. Radiotherapy is usually used for metastatic sites as palliative treatment. Addition of local radiotherapy to prostate has shown improvement in overall survival in low tumor burden. There is limited data for local SBRT to prostate in metastatic prostate cancer on ADT. In this stydy,35 metastatic prostate cancer patients who were treated with local SBRT, on ADT between June 2009 to Dec 2018 were retrospectively analyzed for overall survival.23 out of 35 65.71% patients were oligometastases at presentation. All patients underwent baseline and follow up PSMA PET CT, MRI, and PSA. After completion of 4-6 mths of ADT all patients underwent PSMA PET CT and MRI based SBRT by planning to the prostate to dose of 37.50Gy/5# alternate day,25-30Gy/5# to residual metastatic site in 17 patients. Followed by ADT until progression. In the 35 patients with Metastatic Prostate Cancer treated with robotic radiosurgery on ADT, median age 70 yrs, range 45-75 yrs. All patients tolerated the treatment well with acceptable toxicities. The mean, overall survival was estimated to be 117.53 months with a standard error of 15.834. The 5-year survival rate for this group was 87.5%. In patients with metastatic prostate cancer treated with ADT addition of SBRT is well tolerated and trends towards survival benefit. In our study benefit was more for oligometastases. However this needs further validation with randomized controlled trials.

Addition of docetaxel or abiraterone to androgen deprivation therapy in metastatic castration-naive prostate cancer in South Asian population.

e16514 Background: Clinical trials have shown that addition of Docetaxel or Abiraterone to androgen deprivation therapy (ADT) achieves superior survival outcome in metastatic castration naive prostate cancer (mCNPC) in predominantly western population. We sought to evaluate treatment outcomes of adding Docetaxel or Abiraterone to ADT in South Asian population. Methods: 90 mCNPC patients who received treatment between January 2015 and June 2018 were prospectively followed. Diagnosis was established by TRUS guided prostate biopsy and staging was done by Ga68 PSMA PET CT scan in all patients. Patients who were unfit for combination therapy received ADT alone. Patients diagnosed before June 2017 &amp; fit to receive chemo-hormonal therapy, received ADT+Docetaxel. Patients diagnosed after June 2017 and fit to receive combination were offered ADT+Docetaxel or ADT+Abiraterone and therapy selected based on patient’s choice. Monthly clinical evaluation and PSA measurement was done. Outcome measures analyzed included PSA decline &gt; 90%, serological complete response (PSA &lt; 0.2 ng/ml) and progression to CRPC. 76 patients with atleast 6 months follow-up were included in outcome analysis. Results: Patients received ADT alone (N = 37) or ADT+Docetaxel (N = 31) or ADT+Abiraterone (N = 22). Median age was 72, 64 &amp; 70 years, median PSA was 88, 95 &amp; 38 ng/ml, Gleason score was ≥8 in 57%, 71% &amp; 77% patients in ADT alone, ADT+Docetaxel &amp; ADT+Abiraterone group, respectively. Bone &amp; visceral metastasis were present in 62% &amp; 24%, 74% &amp; 26%, 68% &amp; 23% patients in ADT alone, ADT+Docetaxel &amp; ADT+Abiraterone group, respectively. Outcome analysis in 76 evaluable patients is shown in Table. Conclusions: ADT+Docetaxel &amp; ADT+Abiraterone achieve deeper serological response and reduced progression to CRPC compared to ADT alone in metastatic castration naive prostate cancer patients with South Asian ethnicity. Longer follow up is required to comment on overall survival and also to determine which combination (ADT+Docetaxel or ADT+Abiraterone) is superior to other, if at all.[Table: see text]

Biochemichal recurrence in prostate cancer after salvage surgery in correlation to the site of reccurrent disease.

306 Background: Due to improved diagnostic tools salvage surgery is getting more popular after failure of primary local treatment as radical prostatectomy or radiotherapy. We analyzed PSA progression free survival (PFS) after radical prostatectomy and or radiotherapy in accordance to the location of the recurrence and the performed salvage surgery. Methods: We retrospectively analyzed 274 patients with salvage surgeries. 142, 18, and 114 patients underwent salvage radical prostatectomy (SPRE, Group1), locoregional recurrences mainly in seminal vesical remnants (SVR, Group2) or salvage lymph node dissection (SLND, Group3). All patients were diagnosed either by Choline- or more lately PSMA-PET CT. All surgeries had been done open. In Group1 radical prostatectomy and lymph node dissection, in Group 2 the seminal vesicals and in Group3 an ipsilateral pelvic lymph node dissection had been performed due to imaging results. Results: Median age at time of surgery was 67(62-72)years. Median PSA was 3.1(1.45-5.45)ng/ml. Radiotherapy or hormone therapy before salvage surgery in Group 1,2,3 was done in 100%, 61,1%, 54,39% and 12,6%, 27,8%, 18,42% of the patients. Median progression free survival in Group 1, 2, 3 is 41(11.104), 29 (8-47) and 8 (2-21) months (p &lt; 0.001). PSA PFS in Group1/2 and Group 1/3 differed significantly with an HR of 1.85 (95%CI;1,0-3.44) and HR of 2.72 (95%CI; 1,84-4,04). Only age at time of surgery and interval from primary treatment to salvage procedure in months were significant predictors in an univariate Cox regression analysis. Conclusions: We demonstrate that the best biochemical control in salvage surgeries is achieved in patients with isolated recurrence in the prostate after radiotherapy. The effect of salvage surgery decreases with increasing distance of the site of recurrence to the prostate.

PT140 - Clinical utility of prebiopsy PSMA PET CT in patients suspected of carcinoma prostate

PT140 - Clinical utility of prebiopsy PSMA PET CT in patients suspected of carcinoma prostate

Primary Metastasis Staging Using&nbsp;18F-PSMA-1007 PET-CT in High-Risk Prostate Cancer: A Prospective Comparative Study of Advanced and Traditional Imaging Modalities

Background: Computed tomography (CT) and bone scintigraphy are the imaging modalities currently used for primary metastasis staging of high-risk prostate cancer (PCa). This trial compared these standard staging modalities with potentially more accurate imaging modalities: single photon emission computed tomography-CT (SPECT-CT), magnetic resonance imaging (MRI), prostate specific membrane antigen positron emission tomography (PSMA PET). Methods: This prospective, registered, single-centre, open-label, single-arm trial enrolled patients with primary high-risk PCa. Results of bone scintigraphy and CT were compared with 99mTc-HMDP SPECT-CT, 1.5T whole-body MRI using diffusion-weighted imaging and 18 F-PSMA-1007 PET-CT. Each imaging modality was reviewed by two independent experts blinded for the other modalities. The lesions were classified as benign, equivocal or malignant. Pessimistic and optimistic analyses were performed to resolve equivocal lesion status. Based on clinical data, including follow-up investigations, the best valuable comparator was defined at lesion level in multidisciplinary consensus meetings. Findings: 79 men were included and underwent all imaging modalities, except for one cancelled MRI due to claustrophobia. Mean age was 70 years and median PSA 12 ng/ml (range: 3-2000). Metastatic disease was detected in 27 (34%) patients. In pessimistic and optimistic analysis at patient, region and lesion levels, PSMA PET-CT was superior to all other modalities concerning sensitivity, and the area under curve values (AUC) at the bone region, while maintaining high specificity and demonstrating the highest inter-reader agreement. AUC for detection of bone metastasis for PSMA PET-CT was 0·94 (95%Cl;0·90-0·99) and 0·96 (95%CI;0·92-0·99) (reader 1, and reader 2, respectively) while AUC for all other modalities was in the range of 0·55-0·76. PSMA PET-CT revealed metastatic disease in 18/27 patients where standard imaging was negative. Interpretation: 18F-PSMA-1007 PET-CT outperformed other imaging methods in primary metastasis staging of high-risk PCa. We recommend further evaluation of this method as a new reference standard. Trial Registration number: (ClinicalTrials.gov NCT03537391). Funding Statement: This study was financially supported by grants from Finnish Government Research and Development Funds for Medical Research, Turku University Hospital and TYKS-SAPA Research Fund. Declaration of Interests: Dr. Anttinen reports grants from Profound Medical Inc, Finnish Urological Research Foundation and Finnish Urological Association, outside the submitted work. Dr. Ettala reports non-financial support from Ferring Pharmaceuticals Inc, SwanMedica and Pierre-Fabre Pharma Norden AB, and personal fees from Astellas, outside the submitted work. Dr. Sandell reports personal fees from Roche, outside the submitted work. Dr. Taimen reports personal fees from Roche, AstraZeneca and MSD, and non-financial support from MSD, all outside the submitted work. Dr. Bostrom reports grants from the Cancer Foundation Finland, personal fees from Profound Medical Inc and Janssen-Cilag Company, outside the submitted work. The other authors declare that there is no conflict of interest regarding the publication of this article. Ethical Approval Statement: The trial protocol, included in the Supplemental material, was approved by the ethics committee of the Hospital District of Southwest Finland, and written informed consent was obtained from all participants. The trial was performed in accordance with the principles of the Declaration of Helsinki.

68Ga-PSMA-11 PET-CT study in prostate cancer patients with biochemical recurrence and non-contributive 18F-Choline PET-CT: Impact on therapeutic decision-making and biomarker changes.

In this retrospective study, we investigated the impact of 68 Ga-PSMA-11 PET-CT (PSMA PET-CT) upon the treatment plan and therapeutic response obtained for Prostate Cancer (PCa) patients presenting an occult biochemical recurrence. Forty-two patients with previously negative or doubtful 18F-Choline (FCH) were enrolled. PET images were recorded 1 h after injection of tracer. Only a few months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. PSMA-positive lesions were detected in 34/42 (80.9%) patients. Detection rates were 85.7% and 89.3% for serum PSA levels lower than 2 ng/mL, and >2 ng/mL, respectively. One hundred seventy-three lesions were detected: 132/173 in lymph nodes (76.3%), 22/173 as metastatic sites (bone or lung) (12.7%), and 19/173 in the prostate bed (10.9%). As a result of the PSMA PET-CT, therapeutic management changed in 31/42 patients (73.8%). With a follow-up of 4.9 ± 2.27 months, 32/42 (76.2%) PSA assays after treatment guided by PSMA PET-CT were collected. For 37.5% (12/32) of patients, the serum PSA level was lower than 0.2 ng/mL and a PSA decrease of over 50% in 8 (25.0%) other patients were obtained. Performing a PSMA PET-CT when FCH PET-CT was doubtful or negative allows the recurrence localization in more 80% of patients and this had a major clinical impact, as it resulted in treatment change in more than 70% of patients as well as a significant decrease in PSA levels in more than 60% of them.

Functional, Radiological Imaging and Biochemical (PET PSMA, MRI, ADC, PSA) Response and its Correlation in Low and Intermediate Risk Prostate Cancer Treated with SBRT by Robotic Radiosurgery Alone

Robotic radiosurgery SBRT for Prostate cancer is popularizing due to good local control & low toxicity in low and intermediate risk patients. While PSA & MRI ADC values are established markers for diagnosis and response assessment, PSMA PET CT functional imaging is emerging as a promising diagnostic tool. PSA are susceptible to infections and poses challenges for response assessment and ADC values are usually change slowly and might not detect response in time. This study is an attempt to evaluate the non-inferiority of PSMA PET SUV values as a surrogate marker along with PSA and ADC values for response to robotic radiosurgery SBRT. Thirty-six patients of biopsy-confirmed early prostate cancer were retrospectively analysed. Patients underwent baseline and followup PSMA PET CT scan, MRI, ADC value, PSA. Patients underwent PSMA PET CT, MRI based SBRT by robotic radiosurgery planning to the GTV prostate to dose of 37.50 Gy in 5 fractions alternate day treatment. All 36 patients were analysed for PSA value, PSMA PET CT SUV of tumor, MRI prostate volume, ADC values. Wilcoxon signed rank tests were used. Among 36 patients, mean age was 64.2 years range 51-75 years. Eleven patients were low risk, and 25 were intermediate risk. Mean PSA at baseline, 3 months, 6 months, 12 months, and 24 months was 13.5 ± 7.5 ng/ml, 4.56 ± 5.71 ng/ml, 2.73 ± 1.77 ng/ml, 1.42 ± 1.25 ng/ml, and 0.66±.39 ng/ml, respectively. Mean PSMA PET CT SUV at baseline, 6 months, 12 months, and 24 months were 10.45±12.54, 3.76±1.74, 3.92±0.91, and 2.63±1, respectively. Mean ADC values at baseline, 6 months, 12 months, and 24 months were 0.7913±0.2108, 1.19±0.18, 1.32±0.23, and 4.28±1.06, respectively. Mean MRI volume at baseline, 6 months, 12 months, and 24 months were 4.4±1.2cc, 4.56±0.75cc, 4.42±4.77cc, and 4.28±1cc, respectively. Base line values were compared with their respective post treatment values using the Wilcoxon Signed Rank Test with appropriate Bonferroni corrections. Abstract SU_34_2333; Table 1PSAPSA3MTH- PSApresPSA6mth- PSApresPSA12mth- PSApresPSA24mth- PSApresZ-2.201bBased on positive ranks.-3.724bBased on positive ranks.-3.408bBased on positive ranks.-2.803bBased on positive ranks.Asymp. Sig. (2-tailed).028.000.001.005PSMA PETCT SUVSUV at 6months - SUV at PresentSUV at 12Months - SUV at PresentSUV at 24Months - SUV at Presentz-2.936bBased on positive ranks.-2.310bBased on positive ranks.-1.069bBased on positive ranks.Asymp. Sig. (2-tailed).003.021.285ADC6MMriAdc - DiagMriAdc12MMriAdc - DiagMriAdc12MMriAdc - 6MMriAdcZ-2.670bBased on positive ranks.-1.826bBased on positive ranks.-1.342bBased on positive ranks.Asymp. Sig. (2-tailed).008.068.180MRI6mmmri - Mrisize12mri - Mrisize24mri - Mrisizez-2.532bBased on positive ranks.-2.070bBased on positive ranks.-1.841bBased on positive ranks.Asymp. Sig. (2-tailed).011.038.066aWilcoxon Signed Ranks Test.b Based on positive ranks. Open table in a new tab aWilcoxon Signed Ranks Test. In our study there was a significant reduction in PSA, PSMA PETCT SUV, MRI Tumor Size and ADC values in 6 months of robotic radiosurgery SBRT. Hence, PSMA PET CT SUV values could be used as functional surrogate marker along with PSA biochemical marker earlier than MRI and ADC values. A prospective trial with PSMA done at 3 months is underway and a study with larger numbers may be required to generate stronger towards this conclusion.

Imaging modalities in synchronous oligometastatic prostate cancer

PurposeAlong with a number of other malignancies, the term “oligometastatic” prostate cancer has recently emerged. It represents an attempt to define a subtype of cancer with a limited metastatic load that might perform more favorably than a distinctly disseminated disease, or even one that may be managed in a potentially curative way. Since there is currently a knowledge gap of what imaging modalities should be utilized to classify patients as having this type of tumor, we aimed to shed light on the role of conventional and marker-based imaging in the setting of synchronous oligometastatic prostate cancer as well as summarize the available evidence for its clinical application.MethodsA literature search on December 15th 2017 was conducted using the Pubmed database.ResultsFunctional imaging techniques like 68Ga PSMA. 68Ga PSMA PET-CT has currently been shown the best detection rates for the assessment of nodal, bone and visceral metastases, especially for smaller lesions at low PSA levels.ConclusionsFunctional imaging helps detect low-burden disease metastatic patients. However, these imaging modalities are not available in every center and thus clinicians may be prone to prescribe systemic treatment rather than referring patients for cytoreductive treatments. We hope that the ongoing prospective trials will help guide clinicians in making a more personalized management of synchronous metastatic patients.

EP-1566: Metabolic response assessment using Ga68 PSMA PETCT in HR organ confined Prostate cancer post IGIMRT

EP-1566: Metabolic response assessment using Ga68 PSMA PETCT in HR organ confined Prostate cancer post IGIMRT

EO3 - Ga-68 PSMA PETCT response to androgen deprivation therapy in patients with prostate cancer

EO3 - Ga-68 PSMA PETCT response to androgen deprivation therapy in patients with prostate cancer

The feasibility of prostate-specific membrane antigen positron emission tomography(PSMA PET/CT)-guided radiotherapy in oligometastatic prostate cancer patients.

To investigate the efficacy and toxicity of 68Ga-PSMA-HBED-CC (68Ga-PSMA) PET-CT-guided RT in the treatment of oligometastatic prostate cancer retrospectively. A total of 23 prostate cancer patients with biochemical relapse, of which 13 were castration sensitive (CS) and 10 castration resistant (CR), were treated with intensity-modulated and image-guided RT (IMRT-IGRT) on ≤3 metastases detected by 68Ga PSMA PET-CT. Androgen deprivation therapy was continued in CR patients. A total of 38 metastases were treated. The involved sites were pelvic bone (n=16), pelvic lymph nodes (n=11), paraaortic lymph nodes (n=6), ribs (n=3) and vertebral body (n=2). The median PSA prior to RT was 1.1ng/mL (range 0.1-29.0ng/mL). A median dose of 43.5Gy (range 30-64Gy) was delivered by IMRT-IGRT in 12-27 fractions. At a median follow-up of 7months (range 2-17months), 19 patients (83%) were in remission. Four patients (17%) developed distant recurrences. The actuarial 1-year LC, PFS and OS rates were 100, 51 (95% CI 8-83%) and 100%. Univariate analysis demonstrated a statistically significantly better PFS in CS patients as compared to CR patients (1-year PFS 67 vs. 0%, p<0.01). One patient experienced grade 2 acute gastrointestinal toxicity. Grade 3 or more toxicity events were not observed. By providing optimal LC, low toxicity and a promising PFS in CS patients, the current retrospective study illustrated that 68Ga PSMA PET-CT-guided RT may be an attractive treatment strategy in patients with oligometastatic prostate cancer. Validation by randomized trials is eagerly awaited.