Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25321
Title: 3-Year Freedom from Progression After 68Ga-PSMA PET/CT-Triaged Management in Men with Biochemical Recurrence After Radical Prostatectomy: Results of a Prospective Multicenter Trial.
Austin Authors: Emmett, Louise;Tang, Reuben;Nandurkar, Rohan;Hruby, George;Roach, Paul;Watts, Jo Anne;Cusick, Thomas;Kneebone, Andrew;Ho, Bao;Chan, Lyn;van Leeuwen, Pim J;Scheltema, Matthijs J;Nguyen, Andrew;Yin, Charlotte;Scott, Andrew M ;Tang, Colin;McCarthy, Michael;Fullard, Karen;Roberts, Matthew;Francis, Roslyn;Stricker, Phillip
Affiliation: Faculty of Medicine, University of Melbourne, Melbourne, Australia
Faculty of Medicine, University of New South Wales, Sydney, Australia
Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, Australia
Faculty of Medicine, University of Queensland, Brisbane, Australia
Nepean Urology Research Group, Kingswood, New South Wales, Australia
Garvan Institute of Medical Research and Kinghorn Cancer Centre, Sydney, Australia
Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
Faculty of Health and Medical Science, University of Western Australia, Perth, Australia
Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, Australia
Faculty of Medicine, University of New South Wales, Sydney, Australia
Faculty of Medicine, University of Sydney, Sydney, Australia
Department of Urology, St. Vincent's Hospital, Sydney Australia
Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, Australia
Department of Radiation Oncology, Royal North Shore Hospital, Sydney, Australia
Genesis Cancer Care, Sydney, Australia
Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
Department of Nuclear Medicine/Washington PET Services, Sir Charles Gairdner Hospital, Perth, Australia
Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
Molecular Imaging and Therapy
Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, Australia
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Issue Date: Jun-2020
metadata.dc.date: 2019-11-01
Publication information: Journal of Nuclear Medicine 2020; 61(6): 866-872
Abstract: 68Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT is increasingly used in men with biochemical recurrence (BCR) after radical prostatectomy (RP), but its longer-term prognostic or predictive potential in these men is unknown. The aim of this study was to evaluate the predictive value of PSMA PET for a 3-y freedom from progression (FFP) in men with BCR after RP undergoing salvage radiotherapy (sRT). Methods: This prospective multicenter study enrolled 260 men between 2015 and 2017. Eligible patients were referred for PSMA PET with a rising level of prostate-specific antigen (PSA) after RP. Management after PSMA PET was recorded but not mandated. PSMA PET protocols were standardized across sites and reported prospectively. Clinical, pathologic, and surgical information; sRT; timing and duration of androgen deprivation; 3-y PSA results; and clinical events were documented. FFP was defined as a PSA rise of no more than 0.2 ng/mL above nadir after sRT, with no additional treatment. Results: The median PSA was 0.26 ng/mL (interquartile range, 0.15-0.59 ng/mL), and follow-up was 38 mo (interquartile range, 31-43 mo). PSMA PET had negative results in 34.6% (90/260), showed disease confined to the prostatic fossa in 21.5% (56/260), showed disease in the pelvic nodes in 26.2% (68/260), and showed distant disease in 17.7% (46/260). Of the patients, 71.5% (186/260) received sRT: 38.2% (71/186) to the fossa only, 49.4% (92/186) to the fossa plus the pelvic nodes, and 12.4% (23/186) to the nodes alone or stereotactic body radiation therapy. PSMA PET was highly predictive of FFP at 3 y after sRT. Overall, FFP was achieved in 64.5% (120/186) of those who received sRT, 81% (81/100) with negative results or fossa-confined findings versus 45% (39/86) with extrafossa disease (P < 0.0001). On logistic regression, PSMA PET was more independently predictive of FFP than established clinical predictors, including PSA, T stage, surgical margin status, or Gleason score (P < 0.002). Thirty-two percent of men with a negative PSMA PET result did not receive treatment. Of these, 66% (19/29) progressed, with a mean rise in PSA of 1.59 ng/mL over the 3 y. Conclusion: PSMA PET results are highly predictive of FFP at 3 y in men undergoing sRT for BCR after RP. In particular, men with negative PSMA PET results or disease identified as still confined to the prostatic fossa demonstrate high FFP, despite receiving less extensive radiotherapy and lower rates of additional androgen deprivation therapy than those with extrafossa disease.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25321
DOI: 10.2967/jnumed.119.235028
PubMed URL: 31676727
Type: Journal Article
Subjects: PET/CT
PSMA
biochemical failure
prostate-specific membrane antigen
radical prostatectomy
treatment outcome
Appears in Collections:Journal articles

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