[18F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer

Abstract

Background In the last years, functional imaging has given a significant contribution to the clinical decision-making of biochemically relapsed prostate cancer (PCa). Hereby, we present a prospective study aiming to validate the role of [ 18 F]Fluoro-Methyl Choline ([ 18 F]FMCH) PET/CT in the selection of PCa patients suitable for stereotactic body radiotherapy (SBRT). Methods Patients with biochemical recurrence limited up to three lesions revealed by [ 18 F]FMCH PET/CT were enrolled in the present study and treated with SBRT on all active lesions. Systemic therapy-free survival since the [ 18 F]FMCH PET/CT was considered as the primary endpoint. Results Forty-six patients were evaluated, and a total of 67 lesions were treated. After a median follow-up of 28.9 months, systemic therapy was started in 30 patients (65.2%) and median systemic therapy-free survival was 39.1 months (95% CI 6.5-68.6); 6, 12, and 24-month ratios were 93.5%, 73.9%, and 63.1%, respectively. At univariate Cox regression analysis, Delta PSA demonstrated an impact on systemic therapy-free survival (p < 0.001). Conclusions Based on our findings, [ 18 F]FMCH PET/CT can identify oligometastatic prostate cancer patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months.

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature

“…A total of 23 articles were selected on the use of PET imaging with [ 68 Ga]PSMA-11 (16 articles/1123 patients) or choline (7 articles/356 patients) for the prediction of radiotherapy response and survival outcomes. Among these studies, 6 articles described the prognostic role of PET after salvage RT ([ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]), while 12 studies assessed the prognostic use of molecular imaging for the treatment of oligometastatic or oligo-recurrent PCa ([ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]). The remaining studies ( n = 5) were variably based on the prognostic evaluation of PET-guided RT in case of localized PCa [ 28 ], newly diagnosed lymph-node-positive PCa [ 29 ], and in a mixed population [ 30 ].…”

“…However, PCa patient cohorts are heterogeneous, including only hormone-sensitive patients ([ 21 , 22 , 24 , 27 ]), only castrate-resistant subjects [ 22 ], or both ([ 19 , 20 , 25 ]). Pasqualetti and co-authors [ 16 ], in a group of 46 patients with biochemical recurrence PCa limited up to three lesions, defined the ability of [ 18 F]Choline PET/CT to identify patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months. Additionally, Bouman-Wammes et al [ 17 ] and Kalinauskaite et al [ 19 ] showed that SBRT based on PSMA-PET can reach an excellent local control, with a reduction in the PSA level, minimal toxicity, and long survival.…”

Outcome after PSMA-PET/CT-based salvage radiotherapy for nodal recurrence after radical prostatectomy

“…Another possible treatment strategy is SBRT. There is growing evidence for SBRT in patients with LN metastases coming from trials which evaluated SBRT as metastasis-directed therapy (MDT) in oligometastatic PCa and which included patients with nodal oligometastases [27][28][29][30]. Moreover, there is a retrospective analysis of SBRT in patients with nodal oligorecurrence [31].…”

Positron Emission Tomography and Whole-body Magnetic Resonance Imaging for Metastasis-directed Therapy in Hormone-sensitive Oligometastatic Prostate Cancer After Primary Radical Treatment: A Systematic Review

“…Eight of 24 (33%) studies were on choline PET-directed SBRT: one trial [12], one prospective study [13], and six retrospective studies [14][15][16][17][18]. The Surveillance or Metastasis-directed Therapy for Oligometastatic Prostate Cancer Recurrence (STOMP) trial is the first prospective, randomized, phase II trial to assess the potential of MDT, primarily SBRT, to forestall initiation of ADT in men with hormonesensitive metastatic PC with three or fewer detectable extracranial metastases on choline PET [12].…”