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. 2025 Jan 17;15(1):2234.
doi: 10.1038/s41598-024-83074-3.

Biochemical failure-free survival of 18F-rhPSMA-7 and 18F-flotufolastat PET-guided salvage radiotherapy for patients with recurrent prostate cancer

Marco M E Vogel  1   2   3 , Isabel Rauscher  4 , Jürgen E Gschwend  5 , Türkay Hekimsoy  4 , Nicola Gabler  4 , Charlotte Olufs  4 , Calogero D'Alessandria  4 , Jan C Peeken  6   7   8 , Stephanie E Combs  6   7   8   9 , Matthias Eiber  4   9
Affiliations

Biochemical failure-free survival of 18F-rhPSMA-7 and 18F-flotufolastat PET-guided salvage radiotherapy for patients with recurrent prostate cancer

Marco M E Vogel et al. Sci Rep. .

Abstract

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has improved localization of prostate cancer (PC) lesions in biochemical recurrence (BCR) for salvage radiotherapy (SRT). We conducted a retrospective review of patients undergoing 18F-rhPSMA-7 or 18F-flotufolastat (18F-rhPSMA-7.3)-PET-guided SRT compared with conventional-SRT (C-SRT) without PET. We evaluated biochemical failure-free survival (bFS) and overall rates of bFS in 110 evaluable patients with recurrent PC after radical prostatectomy who received SRT. 82 patients received 18F-rhPSMA-7/18F-flotufolastat-PET-guided SRT and 28 received C-SRT. Median bFS for patients with 18F-rhPSMA-7/18F-flotufolastat-PET-guided SRT was not reached while median bFS was 45.6 months for patients with C-SRT (p = 0.101). %bFS were 95% (52/55) vs 87% (20/23), 90% (27/30) vs 75% (15/20), 89% (16/18) vs 68% (13/19) and 100% (3/3) vs 57% (8/14) for PET-guided vs C-SRT at 12, 24, 36, and 48 months, respectively. Among patients treated in the prostate bed only, median bFS was not reached for PSMA-PET-guided SRT (n = 52) vs 55.1 months in the C-SRT group (n = 25; p = 0.063). %bFS was greater for PSMA-PET-guided SRT than C-SRT at all evaluated timepoints. 18F-rhPSMA-7/18F-flotufolastat-guided SRT yielded favorable disease outcomes. Although statistical significance was not reached, likely due to the limited sample size in this preliminary analysis, our data illustrate potential for 18F-flotufolastat-PET-guided SRT.

Keywords: 18F-flotufolastat; 18F-rhPSMA-7; PSMA-PET; Prostate cancer; Salvage radiotherapy.

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Conflict of interest statement

Declarations. Competing interests: Matthias Eiber reports fees from Blue Earth Diagnostics Ltd. (consultant, research funding), Novartis/AAA (consultant, speaker), Telix (consultant), Bayer (consultant, research funding), RayzeBio (consultant), Point Biopharma (consultant), Eckert-Ziegler (speaker) and Janssen Pharmaceuticals (consultant, speakers bureau), Parexel (image review) and Bioclinica (image review) outside the submitted work and a patent application for rhPSMA. He and other inventors are entitled to royalties on sales of POSLUMA®. Isabel Rauscher reports research funding and travel support from Blue Earth Diagnostics. All other authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Patient flow diagram.
Fig. 2
Fig. 2
ADT-adjusted Cox regression of biochemical failure-free survival (left) and overall rates of biochemical failure-free survival at 12, 24, 36 and 48 months (right) for 18F-rhPSMA-7/18F-flotufolastat-guided salvage radiotherapy vs conventional salvage radiotherapy.
Fig. 3
Fig. 3
ADT-adjusted Cox regression of biochemical failure-free survival (left) and overall rates of biochemical failure-free survival at 12, 24, 36 and 48 months (right) for 18F-flotufolastat-guided salvage radiotherapy vs conventional salvage radiotherapy.
Fig. 4
Fig. 4
ADT-adjusted Cox regression of biochemical failure-free survival (left) and overall rates of biochemical failure-free survival at 12, 24, 36 and 48 months (right) for 18F-rhPSMA-7/18F-flotufolastat-guided salvage radiotherapy, vs conventional salvage radiotherapy in a subgroup of patients receiving SRT to the prostate bed only.
Fig. 5
Fig. 5
ADT-adjusted Cox regression of biochemical failure-free survival (left) and overall rates of biochemical failure-free survival at 12, 24, 36 and 48 months (right) for 18F-flotufolastat-guided salvage radiotherapy, vs conventional salvage radiotherapy in a subgroup of patients receiving SRT to the prostate bed only.
Fig. 6
Fig. 6
Example of a patient with 18F-flotufolastat-guided salvage radiotherapy for local recurrence located caudally to the bladder. The Figure shows an axial (A), coronal (B) and sagittal (C) plane of the PET/CT-fusion, PET sequence, and the resulting radiotherapy contouring (red = planning target volume, orange = simultaneous-integrated boost, pink = gross tumor volume).
See this image and copyright information in PMC

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