European Association of Urology Biochemical Recurrence Risk Classification as a Decision Tool for Salvage Radiotherapy—A Multicenter Study

Preißer, Felix; Abrams-Pompe, Raisa S.; Stelwagen, P.J.; Böhmer, Dirk; Zattoni, Fabio; Magli, A.; Rivas, Juan Gómez; Dilme, Roser Vives; Sepulcri, Matteo; Eguibar, Aritz; Heidegger, Isabel; Arnold, C.; Fankhauser, Christian Daniel; Chun, Felix K.‐H.; Poel, Henk van der; Gandaglia, Giorgio; Wiegel, Thomas; Bergh, Roderick C.N. van den; Tilki, Derya

doi:10.1016/j.eururo.2023.05.038

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…Indeed, Preisser et al . analyzed 2379 patients (805 low-risk and 1574 high-risk BCR) with a median follow-up of 54 months 13 . For low-risk BCR, 12-year overall survival was 87% versus 78% ( p = 0.2) and cancer-specific survival was 100% versus 96% ( p = 0.2) for early versus no SRT.…”

Section: Discussionmentioning

confidence: 99%

A bicentric retrospective study of the correlation of EAU BCR risk groups with 18F-PSMA-1007 PET/CT detection in prostate cancer biochemical recurrence

Poterszman,

Merlin,

Margail

et al. 2024

Sci Rep

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The European Association of Urology (EAU) has proposed a risk stratification for patients harboring biochemical recurrence (BCR) after radical prostatectomy: ISUP < 4 and PSA doubling time (PSAdt) > 12 months for low risk, and ISUP ≥ 4 or PSAdt ≤ 12 months for high risk. This dual-center retrospective study aims to investigate the correlation between the EAU risk stratification for BCR following radical prostatectomy and the detection rate of lesions using 18F-PSMA-1007 PET/CT. Among the 71 included patients (58 high-risk, 13 low-risk), with a median PSA level of 1.43 ng/ml, PET/CT demonstrated a significantly higher positivity in the high-risk group compared to the low-risk group (72.4% vs. 38.0%, p = 0.026). Analysis of recurrence sites revealed a similar proportion of pelvic-confined disease in both groups (24.1% vs. 23.1%, p = 0.935), but a significantly higher incidence of metastatic disease in the high-risk group (51.7% vs. 15.4%, p = 0.017), with detailed findings indicating an increased prevalence of bone metastases in the high-risk BCR group (37.8% vs. 7.7%, p = 0.048). Therefore, PSMA PET/CT offers valuable insights for treatment decisions, aligning with the evolving landscape of prostate cancer management.

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Section: Discussionmentioning

confidence: 99%

A bicentric retrospective study of the correlation of EAU BCR risk groups with 18F-PSMA-1007 PET/CT detection in prostate cancer biochemical recurrence

Poterszman,

Merlin,

Margail

et al. 2024

Sci Rep

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“…In contrast, in the validation cohort of Tilki et al, all patients with BCR after RP were included, and EAU BCR risk groups were evenly distributed (low risk: 510/1040, high risk: 530/1040, p = 0.5) [9]. Whilst PSA-DT after RP and high GGG at RP offer guidance in an overall BCR population for prognosis [8] and treatment planning like salvage RT [11], the added predictive value of EAU BCR risk stratification in this pre-selected cohort is minimal. In detail, early oligorecurrent PCA in PSMA-PET/CT may represent high-risk PSA-only recurrence in conventional imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Also, EAU BCR risk stratification has been reported as a valuable decision aid for treatment planning. In detail, men with high-risk BCR showed improved survival by early salvage radiotherapy, while surveillance might be more suitable for low-risk BCR patients [11].…”

Section: Introductionmentioning

confidence: 98%

EAU Biochemical Recurrence Risk Classification and PSA Kinetics Have No Value for Patient Selection in PSMA-Radioguided Surgery (PSMA-RGS) for Oligorecurrent Prostate Cancer

Falkenbach,

Ambrosini,

Tennstedt

et al. 2023

Cancers

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Objective: To assess the influence of biochemical recurrence (BCR) risk groups and PSA kinetics on the outcomes of radioguided surgery against prostate-specific membrane antigen (PSMA-RGS). Currently, neither BCR risk group nor PSA doubling time (PSA-DT), or PSA velocity (PSA-V) are actively assigned or relevant for counseling prior to PSMA-RGS. Methods: We retrospectively analyzed PSMA-RGS cases for oligorecurrent prostate cancer between 2014 and 2023. BCR risk groups, PSA-DT, and PSA-V were analyzed as predictors for complete biochemical response (cBR, PSA < 0.2 ng/mL), BCR-free, and therapy-free survival (BCRFS, TFS). Results: Of 374 included patients, only 21/374 (6%) and 201/374 (54%) were classified as low- and high-risk BCR (no group assignment possible in 152/374, 41%). A total of 13/21 (62%) patients with low- and 120/201 (60%) with high-risk BCR achieved cBR (p = 1.0). BCR classification was no predictor for BCRFS (HR:1.61, CI: 0.70–3.71, p = 0.3) or subsequent TFS (HR:1.07, CI: 0.46–2.47, p = 0.9). A total of 47/76 (62%) patients with PSA-DT ≤ 6 mo and 50/84 (60%) with PSA-DT > 6 mo achieved cBR (p = 0.4). PSA-DT was not associated with cBR (OR: 0.99, CI: 0.95–1.03, p = 0.5), BCRFS (HR: 1.00, CI: 0.97–1.03, p = 0.9), or TFS (HR: 1.02, CI: 0.99–1.04, p = 0.2). Consistent negative findings were recorded for PSA-V. Conclusions: The BCR risk groups and PSA kinetics do not predict the oncological success of PSMA-RGS performed at low absolute PSA values. Indolent low-risk BCR is rarely treated by PSMA-RGS.

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“…In this context, Preisser and colleagues are to be commended for their multi-center retrospective analysis ( 5 ) of the benefit of early SRT, defined therein as SRT while prostate-specific antigen (PSA) <0.5 ng/mL, compared with observation on the basis of the European Association of Urology (EAU) risk stratification for patients with biochemical recurrence (BCR) in the post-prostatectomy setting. Patients are defined as EAU BCR low-risk on the basis of a Gleason score <8 and PSA doubling time (PSADT) >12 months, while high-risk patients have a Gleason score ≥8 or PSADT ≤12 months.…”

mentioning

confidence: 99%

“…In summary, Preisser et al have shown that the EAU risk grouping is one factor for consideration in determining the need for early salvage radiation therapy in the management of patients with BCR following radical prostatectomy ( 5 ). However, the specific application of SRT as well as its timing and delivery remains highly complex and individualized, and future studies should aim to address and refine the incorporation of the numerous clinical, pathological, imaging, and genomic factors now available to ascertain optimal management within the multiple potential variations within this clinical situation.…”

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confidence: 99%

European association of urology biochemical recurrence risk stratification in the context of post-prostatectomy salvage therapy

Lin,

Song

2024

Transl Androl Urol

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European Association of Urology Biochemical Recurrence Risk Classification as a Decision Tool for Salvage Radiotherapy—A Multicenter Study

Cited by 10 publications

References 17 publications

A bicentric retrospective study of the correlation of EAU BCR risk groups with 18F-PSMA-1007 PET/CT detection in prostate cancer biochemical recurrence

A bicentric retrospective study of the correlation of EAU BCR risk groups with 18F-PSMA-1007 PET/CT detection in prostate cancer biochemical recurrence

EAU Biochemical Recurrence Risk Classification and PSA Kinetics Have No Value for Patient Selection in PSMA-Radioguided Surgery (PSMA-RGS) for Oligorecurrent Prostate Cancer

European association of urology biochemical recurrence risk stratification in the context of post-prostatectomy salvage therapy

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