. 2023 Mar 29;15(7):2027.

doi: 10.3390/cancers15072027.

PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment

Lorenzo Bianchi^{1

2}, Francesco Ceci^{3

4}, Eleonora Balestrazzi¹, Francesco Costa¹, Matteo Droghetti¹, Pietro Piazza¹, Alessandro Pissavini¹, Massimiliano Presutti¹, Andrea Farolfi⁵, Riccardo Mei⁵, Paolo Castellucci⁵, Giorgio Gandaglia⁶, Alessandro Larcher⁶, Daniele Robesti⁶, Alexandre Mottrie^{7

8}, Alberto Briganti⁶, Alessio Giuseppe Morganti⁹, Stefano Fanti^{2

3}, Francesco Montorsi⁶, Riccardo Schiavina^{1

2}, Eugenio Brunocilla^{1

2}

Affiliations

¹ Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
² Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy.
³ Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
⁴ Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
⁵ Nuclear Medicine Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
⁶ Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
⁷ Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium.
⁸ ORSI Academy, 9090 Melle, Belgium.
⁹ Radiation Oncology Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.

PMID: 37046687
PMCID: PMC10093227
DOI: 10.3390/cancers15072027

PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment

Lorenzo Bianchi et al. Cancers (Basel). 2023.

. 2023 Mar 29;15(7):2027.

doi: 10.3390/cancers15072027.

Authors

Affiliations

¹ Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
² Department of Medical and Surgical Sciences, University of Bologna, 40127 Bologna, Italy.
³ Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
⁴ Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
⁵ Nuclear Medicine Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.
⁶ Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy.
⁷ Department of Urology, Onze-Lieve-Vrouwziekenhuis, 9300 Aalst, Belgium.
⁸ ORSI Academy, 9090 Melle, Belgium.
⁹ Radiation Oncology Division, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy.

PMID: 37046687
PMCID: PMC10093227
DOI: 10.3390/cancers15072027

Abstract

Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is used to select recurrent prostate cancer (PCa) patients for metastases-directed therapy (MDT). We aimed to evaluate the oncologic outcomes of second-line PSMA-guided MDT in oligo-recurrent PCa patients.

Methods: we performed a retrospective analysis of 113 recurrent PCa after previous radical prostatectomy and salvage therapies with oligorecurrent disease at PSMA-PET (≤3 lesions in N1/M1a-b) in three high-volume European centres. Patients underwent second-line salvage treatments: MDT targeted to PSMA (including surgery and/or radiotherapy), and the conventional approach (observation or Androgen Deprivation Therapy [ADT]). Patients were stratified according to treatments (MDT vs. conventional approach). Patients who underwent MDT were stratified according to stage in PSMA-PET (N1 vs. M1a-b). The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were Metastases-free survival (MFS) and Castration Resistant PCa free survival (CRPC-FS). Kaplan-Meier analyses assessed PFS, MFS and CRPC-FS. Multivariable Cox regression models identified predictors of progression and metastatic disease.

Results: Overall, 91 (80%) and 22 (20%) patients were treated with MDT and the conventional approach, respectively. The median follow-up after PSMA-PET was 31 months. Patients who underwent MDT had a similar PFS compared to the conventional approach (p = 0.3). Individuals referred to MDT had significantly higher MFS and CRPC-FS compared to those who were treated with the conventional approach (73.5% and 94.7% vs. 30.5% and 79.5%; all p ≤ 0.001). In patients undergoing MDT, no significant differences were found for PFS and MFS according to N1 vs. M1a-b disease, while CRPC-FS estimates were significantly higher in patients with N1 vs. M1a-b (100% vs. 86.1%; p = 0.02). At multivariable analyses, age (HR = 0.96) and ADT during second line salvage treatment (HR = 0.5) were independent predictors of PFS; MDT (HR 0.27) was the only independent predictor of MFS (all p ≤ 0.04) Conclusion: Patients who underwent second-line PSMA-guided MDT experienced higher MFS and CRPC-FS compared to men who received conventional management.

Keywords: PSMA-PET; hormone sensitive prostate cancer; metastasis-directed therapy; oligorecurrent prostate cancer; survival.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Figure 1**
Flow chart of participants in the study.

**Figure 2**
Localization of oligorecurrent disease detected by PSMA-PET according to miTNM.

**Figure 3**
(a) Kaplan-Meier curve depicting Progression Free Survival (PFS) rates in the overall population (n = 113) according to type of treatment performed (MDT approach vs. conventional approach); (b) Kaplan-Meier curve depicting Metastases Free Survival (MPFS) rates in the overall population (n = 113) according to type of treatment performed (MDT approach vs. conventional approach); (c) Kaplan-Meier curve depicting Castration Resistant Prostate Cancer Free Survival (CRPC-FS) rates in the overall population (n = 113) according to type of treatment performed (MDT approach vs. conventional approach).

**Figure 4**
(a) Kaplan-Meier curve depicting Progression Free Survival (PFS) rates in patients treated with the MDT approach (n = 91) according to miTNM stage at PSMA-PET (miN1 vs. miM1a-M1b); (b) Kaplan-Meier curve depicting Metastases Free Survival (PFS) rates in patients treated with the MDT approach (n = 91) according to miTNM stage at PSMA-PET (miN1 vs. miM1a-M1b); (c) Kaplan-Meier curve depicting Castration Resistant Prostate Cancer Free Survival (CRPC-FS) rates in patients treated with the MDT approach (n = 91) according to miTNM stage at PSMA-PET (miN1 vs. miM1a-M1b).

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PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment

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PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment

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