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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-01-2021 | Prostate Cancer | Original Article

Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer

Authors: Stefan A. Koerber, Katharina Sprute, Clemens Kratochwil, Erik Winter, Matthias F. Haefner, Sonja Katayama, Ingmar Schlampp, Klaus Herfarth, Klaus Kopka, Ali Afshar-Oromieh, Stefanie Zschaebitz, Tim Holland-Letz, Peter L. Choyke, Dirk Jaeger, Markus Hohenfellner, Uwe Haberkorn, Juergen Debus, Frederik L. Giesel

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2021

Abstract

Purpose

First-line treatment of patients with recurrent, metastatic prostate cancer involves hormone therapy with or without additional systemic therapies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) allows the detection of oligometastatic disease that may be amenable to image-guided radiotherapy. The current study classifies the type and localization of metastases and the clinical outcome of PSMA-PET/CT-guided radiotherapy to selected metastases.

Materials and methods

Between 2011 and 2019, 86 patients with recurrent, oligometastatic prostate carcinoma were identified by PSMA-PET/CT and were treated with image-guided radiotherapy of their metastases. Sites of relapse were characterized, and the primary endpoint overall survival (OS), biochemical progression-free survival (bPFS), and androgen deprivation therapy (ADT)-free survival were tabulated.

Results

In total, 37% of the metastases were bone metastases, 48% were pelvic nodal metastases, and 15% were nodal metastases outside of the pelvis. After PSMA-guided radiotherapy, a biochemical response was detected in 83% of the cohort. A statistically significant decrease in the standard uptake value (SUV) was seen in irradiated metastases. After a median follow-up of 26 months, the 3-year OS and bPFS were 84% and 55%, respectively. The median time of ADT-free survival was 13.5 months. A better clinical outcome was observed for patients receiving concomitant ADT or more than 24 fractions of radiation.

Conclusion

PSMA-guided radiotherapy is a promising therapeutic approach with excellent infield control for men with oligorecurrent prostate carcinoma. However, prospective, randomized trials are necessary to determine if this approach confers a survival advantage.

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Title: Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer
Authors: Stefan A. Koerber
Katharina Sprute
Clemens Kratochwil
Erik Winter
Matthias F. Haefner
Sonja Katayama
Ingmar Schlampp
Klaus Herfarth
Klaus Kopka
Ali Afshar-Oromieh
Stefanie Zschaebitz
Tim Holland-Letz
Peter L. Choyke
Dirk Jaeger
Markus Hohenfellner
Uwe Haberkorn
Juergen Debus
Frederik L. Giesel
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Computed Tomography
Metastasis
Computed Tomography
Prostate Cancer
Radiotherapy
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-020-04777-z

At a glance: The STEP trials

Springer Medicine

Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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