Simple Summary PSMA-PET is currently recommended to restage PCa and to guide salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. PSMA-PET may be a prognostic tool in BCR patients after PR. In recurrent PCa patients who never received previous salvage therapies, men with positive PSMA-PET had similar oncologic outcomes compared to those with negative PSMA-PET. PCa patients who already had previous salvage therapies with positive PSMA-PET experienced worse oncologic outcomes compared to those with negative PSMA-PET. In a PSMA-PET positive population no significant differences were found in terms of progression and metastasis between patients with oligometastatic vs. polimetastatic disease and local/N1 vs. M1 at PSMA-PET. Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (<= 3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. 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). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p >= 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p <= 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p <= 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.

The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence / Bianchi, Lorenzo; Ceci, Francesco; Costa, Francesco; Balestrazzi, Eleonora; Droghetti, Matteo; Piazza, Pietro; Pissavini, Alessandro; Mei, Riccardo; Farolfi, Andrea; Castellucci, Paolo; Puliatti, Stefano; Larcher, Alessandro; Gandaglia, Giorgio; Robesti, Daniele; Mottrie, Alexandre; Briganti, Alberto; Morganti, Alessio Giuseppe; Fanti, Stefano; Montorsi, Francesco; Schiavina, Riccardo; Brunocilla, Eugenio. - In: CANCERS. - ISSN 2072-6694. - STAMPA. - 15:1(2023), pp. 247.1-247.12. [10.3390/cancers15010247]

The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence

Bianchi, Lorenzo
;
Ceci, Francesco;Costa, Francesco;Balestrazzi, Eleonora;Droghetti, Matteo;Piazza, Pietro;Pissavini, Alessandro;Mei, Riccardo;Farolfi, Andrea;Morganti, Alessio Giuseppe;Fanti, Stefano;Schiavina, Riccardo;Brunocilla, Eugenio
2023

Abstract

Simple Summary PSMA-PET is currently recommended to restage PCa and to guide salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. PSMA-PET may be a prognostic tool in BCR patients after PR. In recurrent PCa patients who never received previous salvage therapies, men with positive PSMA-PET had similar oncologic outcomes compared to those with negative PSMA-PET. PCa patients who already had previous salvage therapies with positive PSMA-PET experienced worse oncologic outcomes compared to those with negative PSMA-PET. In a PSMA-PET positive population no significant differences were found in terms of progression and metastasis between patients with oligometastatic vs. polimetastatic disease and local/N1 vs. M1 at PSMA-PET. Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (<= 3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. 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). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p >= 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p <= 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p <= 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
2023
The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence / Bianchi, Lorenzo; Ceci, Francesco; Costa, Francesco; Balestrazzi, Eleonora; Droghetti, Matteo; Piazza, Pietro; Pissavini, Alessandro; Mei, Riccardo; Farolfi, Andrea; Castellucci, Paolo; Puliatti, Stefano; Larcher, Alessandro; Gandaglia, Giorgio; Robesti, Daniele; Mottrie, Alexandre; Briganti, Alberto; Morganti, Alessio Giuseppe; Fanti, Stefano; Montorsi, Francesco; Schiavina, Riccardo; Brunocilla, Eugenio. - In: CANCERS. - ISSN 2072-6694. - STAMPA. - 15:1(2023), pp. 247.1-247.12. [10.3390/cancers15010247]
Bianchi, Lorenzo; Ceci, Francesco; Costa, Francesco; Balestrazzi, Eleonora; Droghetti, Matteo; Piazza, Pietro; Pissavini, Alessandro; Mei, Riccardo; Farolfi, Andrea; Castellucci, Paolo; Puliatti, Stefano; Larcher, Alessandro; Gandaglia, Giorgio; Robesti, Daniele; Mottrie, Alexandre; Briganti, Alberto; Morganti, Alessio Giuseppe; Fanti, Stefano; Montorsi, Francesco; Schiavina, Riccardo; Brunocilla, Eugenio
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