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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 4/2018

01-04-2018 | Original Article

Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy

Importance for tailoring and individualizing treatment

Authors: Christoph Henkenberens, MD, Thorsten Derlin, MD, Frank M. Bengel, MD, Tobias L. Ross, PhD, Hans-Jürgen Wester, PhD, Katja Hueper, MD, Markus A. Kuczyk, MD, Hans Christiansen, MD, Christoph A. von Klot, MD

Published in: Strahlentherapie und Onkologie | Issue 4/2018

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Abstract

Purpose

To evaluate the patterns of relapse and impact on the intended treatment when using 68Ga-prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) imaging for restaging of disease in patients with biochemical relapse after radical prostatectomy (RP) before salvage radiotherapy (sRT).

Methods

In all, 39 patients with biochemical recurrence after RP who had no primary indication for adjuvant RT due to the absence of biologically unfavorable disease (e.g., extracapsular extension, seminal vesicle invasion, positive margins, or lymph node involvement) underwent a 68Ga-PSMA ligand PET/CT for planning of sRT.

Results

PET/CT was positive in 84.6% (33/39) of patients. A total of 61 lesions were observed in these patients (on average 1.8 lesions per patient); 30.3% (10/33) of patients had locally recurrent disease in the prostatic bed. The clinical TNM stage (TNM: tumour-lymph nodes-metastasis-classification) was altered in 69.7% (23/33) of patients following PET, resulting in individualized treatment concepts. A prostate-specific antigen (PSA) >1.0 ng/mL was significantly associated with an increased risk of extrapelvic metastatic disease (p = 0.048). The PSA level at the time of PSMA ligand PET/CT correlated with the peak standardized uptake value (SUVpeak; p = 0.002). According to current clinical guidelines, the remaining 15.4% (6/39) of patients without evidence of disease on PET received sRT with a dose of 66.0 Gy.

Conclusion

Our results suggest that in patients with biochemical recurrence who did not receive early sRT, a 68Ga-PSMA ligand PET/CT for restaging of disease allows for tailoring and individualizing treatment. Particularly in patients with PSA levels above 1.0 ng/mL, a 68Ga-PSMA ligand PET/CT should be performed for therapy planning, since patients often have metastases not confined to the pelvis.
Literature
1.
Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P et al (2016) 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 13:1415–1424CrossRef
2.
Leyh-Bannurah SR, Gazdovich S, Budäus L, Zaffuto L, Zaffuto E, Dell’Oglio P et al (2017) Population-based external validation of the updated 2012 Partin tables in contemporary North American prostate cancer patients. Prostate 77:105–113CrossRefPubMed
3.
Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380:2018–2027CrossRefPubMed
4.
Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C et al (2013) Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 190:441–449CrossRefPubMed
5.
Wiegel T, Bartkowiak D, Bottke D, Thamm R, Hinke A, Stöckle M et al (2015) Prostate-specific antigen persistence after radical prostatectomy as a predictive factor of clinical relapse-free survival and overall survival: 10-year data of the ARO 96-02 trial. Int J Radiat Oncol Biol Phys 91:288–294CrossRefPubMed
6.
Carrie C, Hasbini A, de Laroche G, Richaud P, Guerif S, Supiot S et al (2016) Salavge radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a radnomised, multicentre, open-label phase 3 trial. Lancet 17:747–756CrossRefPubMed
7.
Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ et al (2017) Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 376:417–428CrossRefPubMedPubMedCentral
8.
Song C, Kang HC, Kim JS, Eom KY, Kim IA, Chung JB et al (2015) Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy: a propensity score-matched analysis. Strahlenther Onkol 191:801–809CrossRefPubMed
9.
King CR (2012) The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys 84:104–111CrossRefPubMed
10.
11.
12.
Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG et al (2014) Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 41:11–20CrossRefPubMed
13.
Weineisen M, Schottelius J, Simecek J, Baum RP, Yildiz A, Beykan S et al (2015) 68Ga- and 177LU-labeled PSA I&T: optimization of a PSMA-targeted theranostic concept and first proof-of-concept human studies. J Nucl Med 56:1169–1176CrossRefPubMed
14.
Martin R, Jüttler S, Müller M, Wester HJ (2014) Cationic eluate pretreatment for automated synthesis of [68Ga]CPCR4.2. Nucl Med Biol 41:84–89CrossRefPubMed
15.
Henkenberens C, von Klot CA, Ross TL, Bengel FM, Wester HJ, Merseburger AS et al (2016) (68)Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer: early efficacy after primary therapy. Strahlenther Onkol 192:431–439CrossRefPubMed
16.
Schweizer MT, Zhou XC, Whang H, Yang T, Shaukat F, Partin AW et al (2013) Metastasis-free survival is associated with overall survival in men with PSA-recurrent prostate cancer treated with deferred androgen deprivation therapy. Ann Oncol 24:2881–2886CrossRefPubMedPubMedCentral
17.
Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M et al (2015) The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42:197–209CrossRefPubMed
18.
Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G et al (2016) Value of 68 Ga-PSMA HBED-CC PET for the Asessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med 57:1713–1719CrossRefPubMed
19.
Ceci F, Uprimmy C, Nilica B, Geraldo L, Kendler D, Kroiss A et al (2015) (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging 42:1284–1294CrossRefPubMed
20.
Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K et al (2016) (68)Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging 43:34–41CrossRefPubMed
21.
Fonteyne V, Lumen N, Ost P, Van Praet C, Vandecasteele K, De Gersem Ir W et al (2013) Hypofractionated intensity-modulated acr therapy for lymph node metastasized prostate cancer: early late toxicity and 3‑year clinical outcome. Radiother Oncol 109:229–234CrossRefPubMed
22.
23.
Blanchard P, Faivre L, Lesaunier F, Salem N, Mesgouez-Nebout N, Deniau-Alexandre E et al (2016) Outcome according to elective pelvic radiation therapy in patients with high-risk localized prostate cancer: a secondary analysis of the GETUG 12 phase 3 randomized trial. Int J Radiat Oncol Biol Phys 94:85–92CrossRefPubMed
24.
Stish BJ, Pisansky TM, Harmsen WS, Davis BJ, Tzou KS, Choo R et al (2016) Improved metastasis-free and survival outcome with early salvage radiotherapy in men with detectable prostate-specific antigen after prostatectomy for prostate cancer. J Clin Oncol 34:3864–3871CrossRefPubMed
25.
Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M et al (2017) EAU-ESTRO-SIOG Guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629CrossRefPubMed
26.
Spratt DE, Vargas HA, Zumsteg ZS, Golia Pernicka JS, Osborne JR, Pei X et al (2017) Patterns of lymph node failure after dose-escalated radiotherapy: implications for extended pelvic lymph node coverage. Eur Urol 71:37–43CrossRefPubMed
27.
28.
Song C, Khang HC, Kim JS, Eom KY, Kim IA, Chung JB et al (2015) Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy: a propensity score-matched analysis. Strahlenther Onkol 191:801–809CrossRefPubMed
Metadata
Title
Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy
Importance for tailoring and individualizing treatment
Authors
Christoph Henkenberens, MD
Thorsten Derlin, MD
Frank M. Bengel, MD
Tobias L. Ross, PhD
Hans-Jürgen Wester, PhD
Katja Hueper, MD
Markus A. Kuczyk, MD
Hans Christiansen, MD
Christoph A. von Klot, MD
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 4/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-017-1231-9

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