Journal of the National Comprehensive Cancer Network : JNCCN · 2026
Five-Year Outcomes After Prostate-Specific Membrane Antigen PET/CT-Guided Salvage Radiotherapy Following Radical Prostatectomy.
СтатьяНазвание и аннотация: Перевод в очереди
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Nikitas John, Smith Clayton P, Armstrong Wesley R, Murthy Vishnu, Grogan Tristan, Clark Kevyn, Moore Jonathan, Roberts Makayla, Farolfi Andrea, Reiter Robert E, Rettig Matthew B, Shen John, Valle Luca F, Nickols Nicholas G, Steinberg Michael L, Czernin Johannes, Kishan Amar U, Calais Jeremie
Аннотация
BACKGROUND: Salvage radiotherapy (sRT) is the standard of care for biochemical recurrence of prostate cancer following radical prostatectomy (RP). In this context, prostate-specific membrane antigen (PSMA) PET/CT offers superior sensitivity and specificity for the detection of recurrent disease. We aimed to evaluate the impact of PSMA PET/CT-guided management on clinical outcomes following sRT.
PATIENTS AND METHODS: We retrospectively screened 5 prospective PSMA PET/CT studies conducted between 2016 and 2021. Eligible patients underwent PSMA PET/CT for restaging at first biochemical recurrence after RP, received sRT, and had ≥24 months of follow-up. Progression-free survival (PFS), freedom from distant progression, and overall survival (OS) were calculated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) for PFS were derived using Cox proportional hazards regression, adjusting for age, pre-sRT prostate-specific antigen (PSA) level, use of androgen deprivation therapy (ADT), and receipt of whole-pelvis radiotherapy (WPRT).
RESULTS: Of the total cohort, 113 patients met the inclusion criteria. Median follow-up was 59.4 months (IQR, 47.4-69.5). Median PSA was 0.4 ng/mL (IQR, 0.3-1.1), and the median time from RP was 19.9 months (IQR, 5.6-51.8). On PSMA PET/CT, 19 (16.8%) patients were staged as TrN0M0, 32 (28.3%) as N1M0, 16 (14.2%) as M1, and 46 (40.7%) as T0N0M0 (no visible disease). ADT was administered to 76 (67.3%) patients, and 63 (55.8%) patients received WPRT. Disease progression occurred in 57 (50.4%) patients. Median PFS was 49.2 months (95% CI, 24.1-74.3), and median freedom from distant progression was 76.4 months (95% CI, 62.9-89.9). The 5-year OS rate was 97.1% (95% CI, 94.1%-100%). Receipt of WPRT was significantly associated with improved PFS among patients staged as TrN0M0 (aHR, 0.12; P=.035), whereas ADT was significantly associated with improved PFS in patients staged as N1/M1 (aHR, 0.37; P=.024).
CONCLUSIONS: In this 5-year follow-up study from an institution that was an early adopter of PSMA PET/CT, PSMA PET/CT-guided sRT was associated with favorable oncologic outcomes. Exploratory analyses suggest a potential benefit of WPRT following a positive PSMA PET/CT and of ADT in patients with N1/M1 disease.
PATIENTS AND METHODS: We retrospectively screened 5 prospective PSMA PET/CT studies conducted between 2016 and 2021. Eligible patients underwent PSMA PET/CT for restaging at first biochemical recurrence after RP, received sRT, and had ≥24 months of follow-up. Progression-free survival (PFS), freedom from distant progression, and overall survival (OS) were calculated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) for PFS were derived using Cox proportional hazards regression, adjusting for age, pre-sRT prostate-specific antigen (PSA) level, use of androgen deprivation therapy (ADT), and receipt of whole-pelvis radiotherapy (WPRT).
RESULTS: Of the total cohort, 113 patients met the inclusion criteria. Median follow-up was 59.4 months (IQR, 47.4-69.5). Median PSA was 0.4 ng/mL (IQR, 0.3-1.1), and the median time from RP was 19.9 months (IQR, 5.6-51.8). On PSMA PET/CT, 19 (16.8%) patients were staged as TrN0M0, 32 (28.3%) as N1M0, 16 (14.2%) as M1, and 46 (40.7%) as T0N0M0 (no visible disease). ADT was administered to 76 (67.3%) patients, and 63 (55.8%) patients received WPRT. Disease progression occurred in 57 (50.4%) patients. Median PFS was 49.2 months (95% CI, 24.1-74.3), and median freedom from distant progression was 76.4 months (95% CI, 62.9-89.9). The 5-year OS rate was 97.1% (95% CI, 94.1%-100%). Receipt of WPRT was significantly associated with improved PFS among patients staged as TrN0M0 (aHR, 0.12; P=.035), whereas ADT was significantly associated with improved PFS in patients staged as N1/M1 (aHR, 0.37; P=.024).
CONCLUSIONS: In this 5-year follow-up study from an institution that was an early adopter of PSMA PET/CT, PSMA PET/CT-guided sRT was associated with favorable oncologic outcomes. Exploratory analyses suggest a potential benefit of WPRT following a positive PSMA PET/CT and of ADT in patients with N1/M1 disease.