Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 29:30:1-6.
doi: 10.1016/j.ctro.2021.06.004. eCollection 2021 Sep.

PSMA-11-PET/CT versus choline-PET/CT to guide stereotactic ablative radiotherapy for androgen deprivation therapy deferral in patients with oligometastatic prostate cancer

Charlotte L Deijen  1 , Gerbert L Vrijenhoek  1 , Eva E Schaake  1 , Wouter V Vogel  1   2 , Luc M F Moonen  1 , Floris J Pos  1 , Henk G van der Poel  3 , Gerben R Borst  1
Affiliations

PSMA-11-PET/CT versus choline-PET/CT to guide stereotactic ablative radiotherapy for androgen deprivation therapy deferral in patients with oligometastatic prostate cancer

Charlotte L Deijen et al. Clin Transl Radiat Oncol. .

Abstract

Background: In patients with oligometastatic recurrent prostate cancer, standard treatment is androgen deprivation therapy (ADT). However, ADT has many potential side effects that may result in impaired quality of life. Early identification to select patients suitable for stereotactic ablative radiotherapy (SABR) is of utmost importance to prevent or delay start of ADT and its side effects. Because Prostate-Specific Membrane Antigen-11-Positron Emission Tomography (PSMA-11-PET) has a higher sensitivity than choline-PET, we hypothesise that PSMA-11-PET based SABR results in longer response duration and subsequent longer delay in starting ADT than choline-PET.

Methods: Patients with oligometastatic (≤4 metastases) recurrent prostate cancer (with no local recurrence) based on PSMA-11-PET or choline-PET treated with SABR from January 2012 until December 2017 were included. Primary endpoint was ADT-free survival. Secondary endpoints were Prostate Specific Antigen (PSA) response after SABR and time to PSA rise after SABR.

Results: Fifty patients (n = 40 PSMA-11-PET and n = 10 choline-PET) with in total 72 lesions were included. Median follow-up was 24.3 months. PSMA-11-PET enabled eligibility of patients with lower PSA levels than choline-PET (median 1.8 versus 4.2 ng/mL, p = 0.03). The PSMA-11-PET group had a significant longer PSA response duration (median 34.0 months (95% confidence interval (CI), 16.0-52.0) versus 14.7 months (95% CI 4.7-24.7), p = 0.004) with a subsequent longer ADT-free survival (median 32.7 months (95% CI, 20.8-44.5) versus 14.9 months (95% CI, 5.7-24.1), p = 0.01).

Conclusions: With PSMA-11-PET we are able to select patients with oligometastatic recurrent prostate cancer suitable for SABR in an earlier disease stage at lower PSA levels. PSMA-11-PET guided SABR resulted in a significant longer response duration and ADT-free survival compared with choline-PET and can therefore prevent or delay ADT related side effects.

Keywords: Androgen deprivation therapy; Oligometastases; PSMA-11-PET; Prostate cancer; SABR.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Duration PSA response (responders).
Fig. 2
Fig. 2
Flowchart of treatment.
Fig. 3
Fig. 3
ADT-free survival responders versus non-responders.
Fig. 4
Fig. 4
ADT-free survival PSMA-11-PET versus choline-PET.
See this image and copyright information in PMC

References

    1. Heidenreich A., Bastian P.J., Bellmunt J., Bolla M., Joniau S., van der Kwast T. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing and castration resistant prostate cancer. Eur Urol. 2014;65(2):467–479. - PubMed
    1. Cornford P., van den Bergh R.C.N., Briers E., Van den Broeck T., Cumberbatch M.G., De Santis M. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II-2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol. 2021;79(2):263–282. - PubMed
    1. Nishiyama T., Kanazawa S., Watanabe R., Terunuma M., Takahashi K. Influence of hot flashes on quality of life in patients with prostate cancer treated with androgen deprivation therapy. Int J Urol. 2004;11(9):735–741. - PubMed
    1. Bouman-Wammes E.W., van Dodewaard-De Jong J.M., Dahele M., Cysouw M.C.F., Hoekstra O.S., van Moorselaar R.J.A. Benefits of using stereotactic body radiotherapy in patients with metachronous oligometastases of hormone-sensitive prostate cancer detected by (18F)fluoromethylcholine PET/CT. Clin Genitourin Cancer. 2017;15(5):e773–e782. - PubMed
    1. Ingrosso G., Trippa F., Maranzano E., Carosi A., Ponti E., Arcidiacono F. Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience. World J Urol. 2017;35(1):45–49. - PubMed