Journal
EUROPEAN UROLOGY
Volume 83, Issue 1, Pages 62-69Publisher
ELSEVIER
DOI: 10.1016/j.eururo.2022.05.031
Keywords
Prostate cancer; Prostate-specific membrane; antigen positron emission; tomography; antigen-radioguided surgery; Oligometastatic disease; Biochemical recurrence
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This study evaluated the oncological outcomes of salvage PSMA-RGS in patients with recurrent oligometastatic prostate cancer and identified predictive preoperative factors for improved outcomes. The results showed that the 3-month and 2-year tumor survival rates were 32% and 58%, respectively. Preoperative PSA, number of PSMA-avid lesions, and localization of lesions were independent predictors of biochemical recurrence after PSMA-RGS.
Background: In a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguid-ance (PSMA-RGS) might be of value. Objective: To evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes. Design, setting, and participants: A cohort study of oligorecurrent PCa patients with bio-chemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014- 2020), was conducted. Intervention: PSMA-RGS. Outcome measurements and statistical analysis: Kaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo. Results and limitations: Overall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2-16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of <0.2 ng/ml. Within 3 mo, 24 (6.6%) patients suffered from Clavien-Dindo complications grade III-IV. At 2 yr, BFS and TFS rates were 32% and 58%, respectively. In multivariable analyses, higher preoperative PSA (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02-1.12), higher number of PSMA-avid lesions (HR: 1.23, CI: 1.08-1.40), multiple (pelvic plus retroperitoneal) localizations (HR: 1.90, CI: 1.23-2.95), and retroperitoneal localization (HR: 2.04, CI: 1.31-3.18) of lesions in preoperative imag-ing were independent predictors of BCR after PSMA-RGS. The main limitation is the lack of a control group. Conclusions: As salvage surgery in oligorecurrent PCa currently constitutes an experi-mental treatment approach, careful patient selection is mandatory based on life expec-tancy, low PSA values, and low number of PSMA PET-avid lesions located in the pelvis. Patient summary: We looked at the outcomes from prostate cancer patients with recur-rent disease after radical prostatectomy. We found that surgery may be an opportunity to prolong treatment-free survival, but patient selection criteria need to be very narrow. (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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