The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence

Simple Summary PSMA-PET is currently recommended to restage PCa and to guide salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. PSMA-PET may be a prognostic tool in BCR patients after PR. In recurrent PCa patients who never received previous salvage therapies, men with positive PSMA-PET had similar oncologic outcomes compared to those with negative PSMA-PET. PCa patients who already had previous salvage therapies with positive PSMA-PET experienced worse oncologic outcomes compared to those with negative PSMA-PET. In a PSMA-PET positive population no significant differences were found in terms of progression and metastasis between patients with oligometastatic vs. polimetastatic disease and local/N1 vs. M1 at PSMA-PET. Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (<= 3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p >= 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p <= 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p <= 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.

Automated summary

This study aims to evaluate the oncologic outcomes of patients with recurrent prostate cancer who received PSMA-PET. The results of PSMA-PET had no significant impact on the oncologic outcomes of recurrent prostate cancer patients who never received previous salvage therapies. However, for recurrent prostate cancer patients who had previous salvage therapies, positive PSMA-PET results were associated with worse oncologic outcomes.