Comparison of Hormone-Sensitive Oligorecurrent Prostate Cancer Patients Based on Routine Use of Choline and/or PSMA PET/CT to Guide Metastasis-Directed Therapy

Abstract

Background: In hormone-sensitive oligorecurrent prostate cancer (PC), the literature showed [68Ga]Ga-PSMA (PSMA) and [18F]F-choline (FCH) PET/CT can successfully guide metastasis-directed therapies (MDT). This observational retrospective study aimed to explore, in routine use, the impact of FCH or PSMA PET/CT in guiding MDT for hormone-sensitive oligometastatic PC at different recurrences. Methods: In 2017–2020, patients initially treated with radical prostatectomy but, in biochemical recurrence (with PSA ≤ 2 ng/mL), diagnosed as oligometastatic based on FCH or PSMA PET/CT, were identified. MDT was stereotactic body radiotherapy (SBRT), elective nodal or prostate bed radiotherapy ± boost and ± androgen deprivation therapy (ADT). The primary endpoint was biochemical relapse-free survival (BR-FS), defined as a PSA increase ≥ 0.2 ng/mL above the nadir and increasing over two successive samples and the secondaries were ADT-free survival (ADT-FS). Results: 123 patients (70 PSMA and 53 FCH) were included. The median follow-up was 42.2 months. The median BR-FS was 24.7 months in the PSMA group versus 13.0 months in the FCH group (p = 0.008). Similarly, ADT-FS (p = 0.001) was longer in patients in the PSMA group. In multivariate analysis, a short PSA doubling time before imaging (p = 0.005) and MDT with SBRT (p = 0.001) were poor prognostic factors for BR-FS. Conclusions: Routine use of FCH or PSMA PET/CT in hormone-sensitive PC showed an advantage for using PSMA PET/CT to guide MDT in terms of BR-FS and ADT-FS in patients with low PSA value. Prospective studies are needed to confirm these hypotheses.

The Impact of PSMA PET/CT on Modern Prostate Cancer Management and Decision Making—The Urological Perspective

“…Nevertheless, initial PSMA imaging might improve local disease control following radical prostatectomy. Metz et al [ 38 ] evaluated the ability of 68 Ga-PSMA and 18f-choline to detect and affect outcomes in early (PSA ≤ 2 ng/mL) recurrence in 123 patients initially treated with radical prostatectomy. The primary endpoint was biochemical relapse-free survival (PSA recurrence), which was defined as a ≥0.2 ng/mL increase in PSA above the nadir and in two successive samples.…”

Diverse Imaging Methods May Influence Long-Term Oncologic Outcomes in Oligorecurrent Prostate Cancer Patients Treated with Metastasis-Directed Therapy (the PRECISE-MDT Study)

“…There is considerable uncertainty in interpreting and applying clinical trial findings for oligorecurrent PCa, mainly attributable to varied imaging approaches. Table 4 summarizes existing real-world retrospective studies ( 13 – 17 ) comparing the efficacy of different imaging-guided MDT approaches. Beyond providing a larger patient sample, our multiinstitutional observational study contributes additional valuable insights.…”

Emerging Role of Nuclear Medicine in Prostate Cancer: Current State and Future Perspectives

“…CT, MR, and bone scans lack sensitivity and specificity for detecting occult metastatic disease, in particular in the case of low PSA values [11]. When compared to radio-labelled choline, PSMA imaging shows its strength in early PC recurrence detection, with PSA blood dosage lower than 1 ng/mL [94,95]. In addition, PSMA PET/CT imaging can better estimate PC tumor burden [96].…”