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 Jul 30:11:715020.
doi: 10.3389/fonc.2021.715020. eCollection 2021.

Feasibility and Outcome of PSMA-PET-Based Dose-Escalated Salvage Radiotherapy Versus Conventional Salvage Radiotherapy for Patients With Recurrent Prostate Cancer

Marco M E Vogel  1   2 , Sabrina Dewes  1 , Eva K Sage  1 , Michal Devecka  1 , Kerstin A Eitz  1   2   3 , Jürgen E Gschwend  4 , Matthias Eiber  5 , Stephanie E Combs  1   2   3 , Kilian Schiller  1
Affiliations

Feasibility and Outcome of PSMA-PET-Based Dose-Escalated Salvage Radiotherapy Versus Conventional Salvage Radiotherapy for Patients With Recurrent Prostate Cancer

Marco M E Vogel et al. Front Oncol. .

Abstract

Introduction: Prostate-specific membrane antigen-positron emission tomography-(PSMA-PET) imaging facilitates dose-escalated salvage radiotherapy (DE-SRT) with simultaneous-integrated boost (SIB) for PET-positive lesions in patients with prostate cancer (PC). Therefore, we aimed to compare toxicity rates of DE-SRT with SIB to conventional SRT (C-SRT) without SIB and to report outcome.

Materials and methods: We evaluated 199 patients who were treated with SRT between June 2014 and June 2020. 101 patients received DE-SRT with SIB for PET-positive local recurrence and/or PET-positive lymph nodes. 98 patients were treated with C-SRT to the prostate bed +/- elective pelvic lymphatic pathways without SIB. All patients received PSMA-PET imaging prior to DE-SRT ([68Ga]PSMA-11: 45.5%; [18F]-labeled PSMA: 54.5%). Toxicity rates for early (<6 months) and late (>6 months) gastrointestinal (GI) toxicities rectal bleeding, proctitis, stool incontinence, and genitourinary (GU) toxicities hematuria, cystitis, urine incontinence, urinary obstruction, and erectile dysfunction were assessed. Further, we analyzed the outcome with disease-free survival (DFS) and prostate-specific antigen (PSA) response.

Results: The overall toxicity rates for early GI (C-SRT: 2.1%, DE-SRT: 1.0%) and late GI (C-SRT: 1.4%, DE-SRT: 5.3%) toxicities ≥ grade 2 were similar. Early GU (C-SRT: 2.1%, DE-SRT: 3.0%) and late GU (C-SRT: 11.0%, DE-SRT: 14.7%) toxicities ≥ grade 2 were comparable, as well. Early and late toxicity rates did not differ significantly between DE-SRT versus C-SRT in all subcategories (p>0.05). PSA response (PSA ≤0.2 ng/ml) in the overall group of patients with DE-SRT was 75.0% and 86.4% at first and last follow-up, respectively.

Conclusion: DE-SRT showed no significantly increased toxicity rates compared with C-SRT and thus is feasible. The outcome of DE-SRT showed good results. Therefore, DE-SRT with a PSMA-PET-based SIB can be considered for the personalized treatment in patients with recurrent PC.

Keywords: disease-free survival; positron emission tomography; prostate-specific membrane antigen; relapse; side effects; simultaneous-integrated boost.

PubMed Disclaimer

Conflict of interest statement

ME reports an advisory role for Blue Earth Diagnostics, Point Biopharma, Telix and Janssen and patent application for rhPSMA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cox regression (adjusted for the use of additive androgen deprivation therapy) of disease-free survival (DFS) for dose-escalated salvage radiotherapy (DE-SRT) versus conventional salvage radiotherapy (C-SRT) in the overall group (A) and subgroup of patients with DE-SRT for the prostate bed (PB) and local recurrence versus C-SRT for the PB only (B) (HR, hazard ratio; 95%-CI, 95%-confidence interval).
Figure 2
Figure 2
Cox regression of disease-free survival (DFS) for dose-escalated salvage radiotherapy (DE-SRT) in the subgroups of patients with/without additive androgen deprivation therapy (ADT) (A) and Cox regression (adjusted for use of additive androgen deprivation therapy) with respect to the PET results (B) (LR, local recurrence; LN, pelvic lymph node(s); HR, hazard ratio; 95%-CI, 95%-confidence interval).
See this image and copyright information in PMC

References

    1. Fichtner J. The Management of Prostate Cancer in Patients With a Rising Prostate-Specific Antigen Level. BJU Int (2000) 86(2):181–90. 10.1046/j.1464-410x.2000.00701.x - DOI - PubMed
    1. Kneebone A, Fraser-Browne C, Duchesne GM, Fisher R, Frydenberg M, Herschtal A, et al. . Adjuvant Radiotherapy Versus Early Salvage Radiotherapy Following Radical Prostatectomy (TROG 08.03/ANZUP RAVES): A Randomised, Controlled, Phase 3, Non-Inferiority Trial. Lancet Oncol (2020) 21(10):1331–40. 10.1016/s1470-2045(20)30456-3 - DOI - PubMed
    1. Parker CC, Clarke NW, Cook AD, Kynaston HG, Petersen PM, Catton C, et al. . Timing of Radiotherapy After Radical Prostatectomy (RADICALS-RT): A Randomised, Controlled Phase 3 Trial. Lancet (London England) (2020) 396(10260):1413–21. 10.1016/s0140-6736(20)31553-1 - DOI - PMC - PubMed
    1. Sargos P, Chabaud S, Latorzeff I, Magné N, Benyoucef A, Supiot S, et al. . Adjuvant Radiotherapy Versus Early Salvage Radiotherapy Plus Short-Term Androgen Deprivation Therapy in Men With Localised Prostate Cancer After Radical Prostatectomy (GETUG-AFU 17): A Randomised, Phase 3 Trial. Lancet Oncol (2020) 21(10):1341–52. 10.1016/s1470-2045(20)30454-x - DOI - PubMed
    1. Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. . Sensitivity, Specificity, and Predictors of Positive (68)Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-Analysis. Eur Urol (2016) 70(6):926–37. 10.1016/j.eururo.2016.06.021 - DOI - PubMed