Zamboglou Constantinos, Staus Paulina, Wolkewitz Martin, Peeken Jan C, Ferentinos Konstantinos, Strouthos Iosif, Farolfi Andrea, Koerber Stefan A, Vrachimis Alexis, Spohn Simon K B, Aebersold Daniel M, Grosu Anca-Ligia, Kroeze Stephanie G C, Fanti Stefano, Hruby George, Wiegel Thomas, Emmett Louise, Hayoz Stefanie, Ceci Francesco, Guckenberger Matthias, Belka Claus, Schmidt-Hegemann Nina-Sophie, Ghadjar Pirus, Shelan Mohamed
Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany; German Cancer Consortium, Freiburg Partner Site, Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiation Oncology, German Oncology Center, European University Cyprus, Limassol, Cyprus.
Institute of Medical Biometry and Statistics, Methods in Clinical Epidemiology Division, University of Freiburg Medical Center, Freiburg, Germany.
Eur Urol Focus. 2024 Nov 27. doi: 10.1016/j.euf.2024.11.006.
Up to 50% of patients with prostate cancer experience prostate-specific antigen (PSA) relapse following primary radical prostatectomy (RP). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is increasingly being used for staging after RP owing to its high detection rate. Our aim was to compare outcomes for patients who received salvage radiotherapy (sRT) with versus without PSMA PET guidance.
In this observational case-control study, the control group consisted of 344 patients from the SAKK09/10 trial (sRT without PSMA PET guidance from 2011 to 2014). The treatment group consisted of 1548 patients from a retrospective multicenter cohort (PSMA PET-guided sRT from July 2013 to 2020). Data were collected up to November 2023. Patients with pN1 status at RP, initial cM1 status, cM1 status on PET, or PSA >0.5 ng/ml were excluded. Patients with detectable PSA after RP who were treated with sRT were eligible. We assessed 3-yr biochemical recurrence-free survival (BRFS) and metastasis-free survival (MFS).
The study population of 717 patients comprised a control group (n = 255) with median follow-up of 75 mo and a PSMA PET group (n = 462) with median follow-up of 31 mo. In the PSMA PET cohort, 103 patients (22.3%) had PSMA-positive pelvic lymph nodes (PLNs), 85 (18.4%) received androgen deprivation therapy (ADT), and 104 (22.5%) underwent PLN irradiation. The BRFS rate at 3 yr was 71% (95% confidence interval [CI] 64-78%) for the control group and 77% (95% CI 72-82%) for the PSMA PET group. The PSMA PET group had favorable BRFS at 18-24 mo after sRT (hazard ratio 0.32, 95% CI 0.0.14-0.75; p = 0.01) and a lower rate of lymph node relapse after sRT (standardized mean difference 0.603). The MFS rate at 3 yr was 89.2% (95% CI 84.6-94.1%) for the control group and 91.2% (95% CI 88.1-94.4%) for the PSMA PET group.
Our results suggest a moderate improvement in short-term BRFS if PSMA PET is used to guide sRT. One possible reason is individualized PLN coverage facilitated by PET. MFS was not improved by PSMA PET guidance for sRT.
PATIENTS' SUMMARY: For patients who experience recurrence of prostate cancer after surgical removal of their prostate, salvage radiotherapy (sRT) is a further treatment option. We found that a type of scan called PSMA PET (prostate-specific membrane antigen positron emission tomography) to identify recurrence and guide sRT can improve recurrence-free survival because of better targeting of pelvic lymph nodes that may contain cancer cells.
高达50%的前列腺癌患者在初次根治性前列腺切除术（RP）后会出现前列腺特异性抗原（PSA）复发。前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）因其高检测率越来越多地用于RP后的分期。我们的目的是比较接受与未接受PSMA PET引导的挽救性放疗（sRT）的患者的结局。
在这项观察性病例对照研究中，对照组由来自SAKK09/10试验的344例患者组成（2011年至2014年未接受PSMA PET引导的sRT）。治疗组由来自一项回顾性多中心队列的1548例患者组成（2013年7月至2020年接受PSMA PET引导的sRT）。数据收集至2023年11月。排除RP时pN1状态、初始cM1状态、PET上的cM1状态或PSA>0.5 ng/ml的患者。RP后PSA可检测且接受sRT治疗的患者符合条件。我们评估了3年无生化复发生存率（BRFS）和无转移生存率（MFS）。
717例患者的研究人群包括对照组（n = 255），中位随访75个月，以及PSMA PET组（n = 462），中位随访31个月。在PSMA PET队列中，103例患者（22.3%）有PSMA阳性盆腔淋巴结（PLN），85例（18.4%）接受雄激素剥夺治疗（ADT），104例（22.5%）接受PLN照射。对照组3年BRFS率为71%（95%置信区间[CI]64 - 78%），PSMA PET组为77%（95%CI 72 - 82%）。PSMA PET组在sRT后18 - 24个月有良好的BRFS（风险比0.32，95%CI 0.14 - 0.75；p = 0.01），且sRT后淋巴结复发率较低（标准化平均差0.603）。对照组3年MFS率为89.2%（95%CI 84.6 - 94.1%），PSMA PET组为91.2%（95%CI 88.1 - 94.4%）。
我们的结果表明，如果使用PSMA PET来引导sRT，短期BRFS会有适度改善。一个可能的原因是PET有助于实现个性化的PLN覆盖。PSMA PET引导sRT并未改善MFS。
对于前列腺手术切除后出现前列腺癌复发的患者，挽救性放疗（sRT）是一种进一步的治疗选择。我们发现一种名为PSMA PET（前列腺特异性膜抗原正电子发射断层扫描）的扫描方式，用于识别复发并引导sRT，由于能更好地靶向可能含有癌细胞的盆腔淋巴结，可提高无复发生存率。
