Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy

PurposeWith the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP).MethodsWe retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA <0.5ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determinechanges in management decisions following PSMA-PET/CT scans.ResultsThe mean age of patients was 65.6years (range: 50-76.2years); median PSA was 0.22ng/ml (interquartile range: 0.15ng/ml to 0.34ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (>3 sites); the remainder either had prostatectomy bed recurrence (n=2), pelvic oligometastasis (n=10), or extra-pelvic oligometastasis (n=4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n=6), salvage radiotherapy (n=4), and systemic treatment (n=2).ConclusionsOur findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.