Metastasis-Free Survival and Patterns of Distant Metastatic Disease After Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET)-Guided Salvage Radiation Therapy in Recurrent or Persistent Prostate Cancer After Prostatectomy

Zamboglou C, Strouthos I, Sahlmann J, Farolfi A, Serani F, Medici F, Cavallini L, Morganti AG, Trapp C, Koerber SA, Peeken JC, Vogel MME, Schiller K, Combs SE, Eiber M, Vrachimis A, Ferentinos K, Spohn SKB, Kirste S, Gratzke C, Ruf J, Grosu AL, Ceci F, Fendler WP, Miksch J, Kroeze S, Guckenberger M, Lanzafame H, Fanti S, Hruby G, Wiegel T, Emmett L, Schmidt-Hegemann NS, Henkenberens C (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 113

Pages Range: 1015-1024

Journal Issue: 5

DOI: 10.1016/j.ijrobp.2022.04.048

Abstract

Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is increasingly used to guide salvage radiation therapy (sRT) in patients with prostate cancer and biochemical recurrence/persistence after prostatectomy. This work examined (1) metastasis-free survival (MFS) after PSMA-PET guided sRT and (2) the metastatic patterns on PSMA-PET images after sRT. Methods and Materials: This retrospective, multicenter (9 centers, 5 countries) study included patients referred for PSMA-PET due to recurrent/persistent disease after prostatectomy. Patients with distant metastases (DM) on PSMA-PET before sRT were excluded. Cox regression was performed to assess the effect of clinical parameters on MFS. The distribution of PSMA-PET detected DM after sRT and their respective risk factors were analyzed. Results: All (n = 815) patients received intensity modulated RT to the prostatic fossa. In the case of PET-positive pelvic lymph nodes (PLN-PET) (n = 275, 34%), pelvic lymphatics had been irradiated. Androgen deprivation therapy had been given in 251 (31%) patients. The median follow-up after sRT was 36 months. The 2-/4-year MFS after sRT were 93%/81%. In multivariate analysis, the presence of PLN-PET was a strong predictor for MFS (hazard ratio, 2.39; P <.001). After sRT, DM were detected by PSMA-PET in 128/198 (65%) patients, and 2 metastatic patterns were observed: 43% had DM in sub-diaphragmatic para-aortic LNs (abdominal-lymphatic), 45% in bones, 9% in supra-diaphragmatic LNs, and 6% in visceral organs (distant). Two distinct signatures with risk factors for each pattern were identified. Conclusions: MFS in our study is lower compared with previous studies, obviously due to the higher detection rate of DM in PSMA-PET after sRT. Thus, it remains unclear whether MFS is a surrogate endpoint for overall survival in PSMA PET-staged patients in the post-sRT setting. PLN-PET may be proposed as a new surrogate parameter predictive of MFS. Analysis of recurrence patterns in PET after sRT revealed risk factor signatures for 2 metastatic patterns (abdominal-lymphatic and distant), which may allow individualized sRT concepts in the future.

Involved external institutions

Albert-Ludwigs-Universität Freiburg Germany (DE) German Oncology Center (GOC) Cyprus (CY) Ospedaliero Universitaria di Bologna Policlinico S.Orsola-Malpighi Italy (IT) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Technische Universität München (TUM) Germany (DE) European University Cyprus (EUC) / Ευρωπαϊκό Πανεπιστήμιο Κύπρου Cyprus (CY) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) Italy (IT) Universität Duisburg-Essen (UDE) Germany (DE) University of Sydney (USYD) Australia (AU) Universitätsklinikum Ulm Germany (DE) University of Zurich / Universität Zürich (UZH) Switzerland (CH) St Vincent's Hospital Australia (AU) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE)

How to cite

APA:

Zamboglou, C., Strouthos, I., Sahlmann, J., Farolfi, A., Serani, F., Medici, F.,... Henkenberens, C. (2022). Metastasis-Free Survival and Patterns of Distant Metastatic Disease After Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET)-Guided Salvage Radiation Therapy in Recurrent or Persistent Prostate Cancer After Prostatectomy. International Journal of Radiation Oncology Biology Physics, 113(5), 1015-1024. https://dx.doi.org/10.1016/j.ijrobp.2022.04.048

MLA:

Zamboglou, Constantinos, et al. "Metastasis-Free Survival and Patterns of Distant Metastatic Disease After Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET)-Guided Salvage Radiation Therapy in Recurrent or Persistent Prostate Cancer After Prostatectomy." International Journal of Radiation Oncology Biology Physics 113.5 (2022): 1015-1024.

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