Prognostic risk classification for biochemical relapse-free survival in patients with oligorecurrent prostate cancer after [68Ga]PSMA-PET-guided metastasis-directed therapy

Vogel MME, Kroeze SGC, Henkenberens C, Schmidt-Hegemann NS, Kirste S, Becker J, Burger IA, Derlin T, Bartenstein P, Mix M, La Fougere C, Eiber M, Christiansen H, Belka C, Grosu AL, Mueller AC, Guckenberger M, Combs SE (2020)

Publication Type: Journal article

Publication year: 2020

Journal

European Journal of Nuclear Medicine and Molecular Imaging Springer Verlag (Germany)

Book Volume: 47

Pages Range: 2328-2338

Journal Issue: 10

DOI: 10.1007/s00259-020-04760-8

Abstract

Purpose: Since the success of prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging for patients with oligorecurrent prostate cancer (ORPC), it is increasingly used for radiotherapy as metastasis-directed therapy (MDT). Therefore, we developed a prognostic risk classification for biochemical relapse-free survival (bRFS) for patients after PSMA-PET-guided MDT after radical prostatectomy. Methods: We analyzed 292 patients with local recurrence (LR) and/or pelvic lymph node (LN) lesions and/or up to five distant LN, bone (BM), or visceral metastases (VM) detected with [68Ga]PSMA-PET imaging. Median follow-up was 16 months (range 0–57). The primary endpoint was bRFS after MDT. Cox regression analysis for risk factors was incorporated into a recursive partitioning analysis (RPA) with classification and regression tree method. Results: PSA at recurrence ≥ 0.8 ng/mL, BM, and VM was significantly associated with biochemical relapse. RPA showed five groups with tenfold cross-validation of 0.294 (SE 0.032). After building risk classes I to IV (p < 0.0001), mean bRFS was 36.3 months (95% CI 32.4–40.1) in class I (PSA < 0.8 ng/mL, no BM) and 25.8 months (95% CI 22.5–29.1) in class II (PSA ≥ 0.8 ng/mL, no BM, no VM). LR and/or pelvic LNs caused relapse in classes I and II. Mean bRFS was 16.0 months (95% CI 12.4–19.6) in class III (PSA irrelevant, present BM) and 5.7 months (95% CI 2.7–8.7) in class IV (PSA ≥ 0.8 ng/mL, no BM, present VM). Conclusion: We developed and internally validated a risk classification for bRFS after PSMA-PET-guided MDT. Patients with PSA < 0.8 ng/mL and local relapse only (LR and/or pelvic LNs) had the most promising bRFS. PSA ≥ 0.8 ng/mL and local relapse only (LR and/or pelvic LNs) indicated intermediate risk for failure. Patients with BM were at higher risk regardless of the PSA. However, those patients still show satisfactory bRFS. In patients with VM, bRFS is heavily decreased. MDT in such cases should be discussed individually.

Involved external institutions

Technische Universität München (TUM) DE Germany (DE) University of Zurich / Universität Zürich (UZH) CH Switzerland (CH) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Universitätsklinikum der Ludwig-Maximilians-Universität München DE Germany (DE) Albert-Ludwigs-Universität Freiburg DE Germany (DE) Eberhard Karls Universität Tübingen DE Germany (DE)

How to cite

APA:

Vogel, M.M.E., Kroeze, S.G.C., Henkenberens, C., Schmidt-Hegemann, N.-S., Kirste, S., Becker, J.,... Combs, S.E. (2020). Prognostic risk classification for biochemical relapse-free survival in patients with oligorecurrent prostate cancer after [68Ga]PSMA-PET-guided metastasis-directed therapy. European Journal of Nuclear Medicine and Molecular Imaging, 47(10), 2328-2338. https://doi.org/10.1007/s00259-020-04760-8

MLA:

Vogel, Marco M. E., et al. "Prognostic risk classification for biochemical relapse-free survival in patients with oligorecurrent prostate cancer after [68Ga]PSMA-PET-guided metastasis-directed therapy." European Journal of Nuclear Medicine and Molecular Imaging 47.10 (2020): 2328-2338.

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