Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study.

Scharl, Sophia; Zamboglou, Constantinos; Strouthos, Iosif; Farolfi, Andrea; Serani, Francesca; Lanzafame, Helena; Giuseppe Morganti, Alessio; Trapp, Christian; Koerber, Stefan A; Debus, Jürgen; Peeken, Jan C; Vogel, Marco M E; Vrachimis, Alexis; K B Spohn, Simon; Ruf, Juri; Grosu, Anca-Ligia; Ceci, Francesco; Fendler, Wolfgang P; Bartenstein, Peter; Kroeze, Stephanie G C; ... (2023). Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 184, p. 109678. Elsevier Scientific Publ. Ireland 10.1016/j.radonc.2023.109678

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BACKGROUND

/Purpose: The present study aimed to assess whether SRT to the prostatic fossa should be initiated in a timely manner after detecting biochemical recurrence (BR) in patients with prostate cancer, when no correlate was identified with prostate-specific membrane antigen positron emission tomography (PSMA-PET).

MATERIALS AND METHODS

This retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT). This led to a cohort of 341 patients. Biochemical progression-free survival (BPFS) was the primary study endpoint.

RESULTS

The median follow-up was 28.0 months. The 3-year BPFS was 71.6% in PET-negative cases and 80.8% in locally PET-positive cases. This difference was significant in univariate (p=0.019), but not multivariate analyses (p=0.366, HR: 1.46, 95%CI: 0.64-3.32). The 3-year BPFS in PET-negative cases was significantly influenced by age (p=0.005), initial pT3/4 (p<0.001), pathology scores (ISUP) ≥3 (p=0.026), and doses to fossa >70 Gy (p=0.027) in univariate analyses. In multivariate analyses, only age (HR: 1.096, 95%CI: 1.023-1.175, p=0.009) and PSA-doubling time (HR: 0.339, 95%CI: 0.139-0.826, p=0.017) remained significant.

CONCLUSION

To our best knowledge, this study provided the largest SRT analysis in patients without ADT that were lymph node-negative on PSMA-PET. A multivariate analysis showed no significant difference in BPFS between locally PET-positive and PET-negative cases. These results supported the current EAU recommendation to initiate SRT in a timely manner after detecting BR in PET negative patients.

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