Di Giorgio Andrea, Siepe Giambattista, Serani Francesca, Di Franco Martina, Malizia Claudio, Castellucci Paolo, Fanti Stefano, Farolfi Andrea
Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy.
Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy.
Eur J Nucl Med Mol Imaging. 2025 Apr 5. doi: 10.1007/s00259-025-07255-6.
To evaluate the role of PSMA PET/CT-guided salvage radiotherapy (sRT) in improving long-term biochemical recurrence-free survival (bRFS) in patients with biochemical recurrence (BCR) or PSA persistence (PERS) after radical prostatectomy (RP) for localized prostate cancer.
This single-center retrospective study included 100 patients with BCR or PERS after RP who underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT and sRT according to EAU guidelines. The primary endpoint was bRFS (PSA ≤ 0.2 ng/ml).
Sixty-three patients had BCR and 37 had PERS. Fifteen patients had PSA pre-RT < 0.5 ng/ml, while 75 had PSA pre-RT ≥ 0.5 ng/ml. [⁶⁸Ga]Ga-PSMA-11 PET/CT was positive in 52 patients, with BCR patients more frequently exhibiting local recurrence while PERS patients showed more nodal involvement. Patients with PERS received sRT and androgen deprivation therapy (ADT) in 57% of cases. The hazard ratio (HR) of treatment failure for patients with PSA pre-RT ≥ 0.5 ng/ml vs. < 0.5 ng/ml was 2.2 (p < 0.039). With a median follow-up of 59 months, treatment failure occurred in 36% of patients, with no difference between BCR and PERS groups. Among those with treatment failure, 64% were [⁶⁸Ga]Ga-PSMA-11 PET/CT positive at recurrence, and 39% received a new PSMA PET/CT-based RT. All patients were alive at the last analysis.
[⁶⁸Ga]Ga-PSMA-11 PET/CT-guided sRT demonstrates significant long-term efficacy in patients with BCR or PERS after RP, leading to durable PSA response and guiding further treatment decisions.
244/2016/O/Oss8 November 2016 retrospectively registered.
评估⁶⁸Ga-PSMA-11 PET/CT引导下的挽救性放疗（sRT）在改善局限性前列腺癌根治性前列腺切除术（RP）后出现生化复发（BCR）或前列腺特异性抗原持续存在（PERS）患者的长期无生化复发生存（bRFS）方面的作用。
这项单中心回顾性研究纳入了100例RP后出现BCR或PERS的患者，这些患者根据欧洲泌尿外科学会（EAU）指南接受了⁶⁸Ga-PSMA-11 PET/CT检查和sRT。主要终点是bRFS（前列腺特异性抗原≤0.2 ng/ml）。
63例患者出现BCR，37例出现PERS。15例患者放疗前前列腺特异性抗原<0.5 ng/ml，而75例患者放疗前前列腺特异性抗原≥0.5 ng/ml。⁶⁸Ga-PSMA-11 PET/CT在52例患者中呈阳性，BCR患者更常表现为局部复发，而PERS患者则更多出现淋巴结受累。57%的PERS患者接受了sRT和雄激素剥夺治疗（ADT）。放疗前前列腺特异性抗原≥0.5 ng/ml的患者与<0.5 ng/ml的患者相比，治疗失败的风险比（HR）为2.2（p<0.039）。中位随访59个月时，36%的患者出现治疗失败，BCR组和PERS组之间无差异。在出现治疗失败的患者中，64%在复发时⁶⁸Ga-PSMA-11 PET/CT呈阳性，39%接受了基于PSMA PET/CT的新放疗。在最后一次分析时所有患者均存活。
⁶⁸Ga-PSMA-11 PET/CT引导下的sRT在RP后出现BCR或PERS的患者中显示出显著的长期疗效，可导致持久的前列腺特异性抗原反应并指导进一步的治疗决策。
2016年11月244/2016/O/Oss8回顾性注册。
