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Title: 3-year freedom from progression following 68GaPSMA PET CT triaged management in men with biochemical recurrence post radical prostatectomy. Results of a prospective multi-center trial.
Austin Authors: Emmett, Louise;Tang, Reuben;Nandurkar, Rohan H;Hruby, George;Roach, Paul J;Watts, Jo Anne;Cusick, Thomas;Kneebone, Andrew;Ho, Bao;Chan, Lyn;van Leeuwen, Pim;Scheltema, Matthijs;Nguyen, Andrew;Yin, Charlotte;Scott, Andrew M ;Tang, Colin;McCarthy, Michael;Fullard, Karen;Roberts, Matthew;Francis, Roslyn;Stricker, Phillip
Affiliation: Department of Urology, The Netherlands Cancer Institute, Netherlands
Department of Nuclear Medicine/WA PET Services, Sir Charles Gairdner Hospital, Australia
Garvan Institute of Medical Research and & The Kinghorn Cancer Centre
Faculty of Medicine, University of New South Wales, Australia
Faculty of Health and Medical Science, University of Western Australia, Australia
Faculty of Medicine, University of Queensland, Australia
Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Australia
Department of Nuclear Medicine, Fiona Stanley Hospital, Australia
Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
Department of Nuclear Medicine, Royal North Shore Hospital, Australia
Department of Radiation Oncology, Royal North Shore Hospital, Australia
Issue Date: 1-Nov-2019 2019-11-01
Publication information: Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2019; online first: 1 November
Abstract: Background:68Ga PSMA PET CT (PSMA) is increasingly used in men with biochemical recurrence (BCR) post radical prostatectomy (RP), but its longer term prognostic / predictive potential in these men is unknown. The aim of this study was to evaluate the predictive value of PSMA PET for 3 year freedom from progression (FFP) in men with BCR post RP undergoing salvage radiotherapy (sRT). Methods: This prospective multi-center study enrolled 260 men between 2015 and 2017. Eligible patients were referred for PSMA with rising PSA following RP. Management following PSMA was recorded but not mandated. PSMA protocols were standardised across sites and reported prospectively. Clinical, pathological and surgical information, sRT, timing and duration of androgen deprivation (ADT), 3 year PSA results and clinical events were documented. FFP was defined as a PSA rise ≤ 0.2ng/mL above nadir post sRT, with no additional treatment. Results: The median PSA was 0.26ng/mL (IQR 0.15 - 0.59) and follow-up 38 months (IQR 31-43). PSMA was negative in 34.6% (90/260), confined to prostate fossa 21.5% (56/260), pelvic nodes 26.2% (68/260), and distant disease 17.7% (46/260). 71.5% (186/260) received sRT, 38.2% (71/186) to the fossa only, 49.4% (92/186) fossa + pelvic nodes and 12.4% (23/186) nodes alone/SBRT. PSMA was highly predictive of FFP at 3 years following sRT. Overall, FFP was achieved in 64.5% (120/186) of those who received sRT, 81% (81/100) with negative/fossa confined vs. 45% (39/86) for extra fossa disease (p<0.0001). On logistic regression PSMA was more independently predictive of FFP than established clinical predictors, including PSA, T-stage, surgical margin status or Gleason score (P < 0.002). 32% of men with a negative PSMA PET did not receive treatment. Of these, 66% (19/29) progressed, with a mean rise in PSA of 1.59ng/mL over the 3 years. Conclusion: PSMA PET result is highly predictive of FFP at 3 years in men undergoing sRT for BCR following RP. In particular, men with negative PSMA PET or disease identified as still confined to the prostate fossa demonstrate high FFP, despite receiving less extensive radiotherapy and lower rates of additional ADT than those with extra fossa disease.
DOI: 10.2967/jnumed.119.235028
ORCID: Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
PubMed URL: 31676727
Type: Journal Article
Subjects: Oncology: GU
Prostate specific membrane antigen
Radiation Therapy Planning
biochemical failure
post radical prostatectomy
treatment outcome
Appears in Collections:Journal articles

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