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. 2021 Jan;48(1):143-151.
doi: 10.1007/s00259-020-04777-z. Epub 2020 May 13.

Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer

Stefan A Koerber  1   2   3 , Katharina Sprute  4 , Clemens Kratochwil  4   5 , Erik Winter  4 , Matthias F Haefner  6   7   8 , Sonja Katayama  6   7   8 , Ingmar Schlampp  6   7   8 , Klaus Herfarth  6   7   8   9 , Klaus Kopka  10   11   12 , Ali Afshar-Oromieh  13 , Stefanie Zschaebitz  14 , Tim Holland-Letz  15 , Peter L Choyke  16 , Dirk Jaeger  14 , Markus Hohenfellner  17 , Uwe Haberkorn  4   5 , Juergen Debus  6   7   8   9   12   18 , Frederik L Giesel  4   5   12
Affiliations

Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer

Stefan A Koerber et al. Eur J Nucl Med Mol Imaging. 2021 Jan.

Abstract

Purpose: First-line treatment of patients with recurrent, metastatic prostate cancer involves hormone therapy with or without additional systemic therapies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) allows the detection of oligometastatic disease that may be amenable to image-guided radiotherapy. The current study classifies the type and localization of metastases and the clinical outcome of PSMA-PET/CT-guided radiotherapy to selected metastases.

Materials and methods: Between 2011 and 2019, 86 patients with recurrent, oligometastatic prostate carcinoma were identified by PSMA-PET/CT and were treated with image-guided radiotherapy of their metastases. Sites of relapse were characterized, and the primary endpoint overall survival (OS), biochemical progression-free survival (bPFS), and androgen deprivation therapy (ADT)-free survival were tabulated.

Results: In total, 37% of the metastases were bone metastases, 48% were pelvic nodal metastases, and 15% were nodal metastases outside of the pelvis. After PSMA-guided radiotherapy, a biochemical response was detected in 83% of the cohort. A statistically significant decrease in the standard uptake value (SUV) was seen in irradiated metastases. After a median follow-up of 26 months, the 3-year OS and bPFS were 84% and 55%, respectively. The median time of ADT-free survival was 13.5 months. A better clinical outcome was observed for patients receiving concomitant ADT or more than 24 fractions of radiation.

Conclusion: PSMA-guided radiotherapy is a promising therapeutic approach with excellent infield control for men with oligorecurrent prostate carcinoma. However, prospective, randomized trials are necessary to determine if this approach confers a survival advantage.

Keywords: Metastases; OS; PET; PSMA; Prostate cancer; SUV.

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Conflict of interest statement

KS reports personal fees from ABX Pharmaceuticals, outside the submitted work. UH has a patent PSMA1007 issued. FLG is a member of the ABX Pharmaceutical advisory board.

All other authors declare no potential conflict of interests.

Figures

Fig. 1
Fig. 1
PSA profile before and after radiotherapy. Boxplot of PSA-values
Fig. 2
Fig. 2
Kaplan-Meier estimates of overall survival (left) and biochemical progression-free survival (right)
Fig. 3
Fig. 3
64-year old prostate cancer patient with a bone metastasis in T2, before PSMA-guided radiotherapy (a–c; SUVmax 13.3) and after irradiation (d–f; SUVmax 0)
Fig. 4
Fig. 4
Corresponding PSA-values after local irradiation with PSA response followed by biochemical progression in 12/201. ADT, androgen deprivation therapy
See this image and copyright information in PMC

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