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The significance of metabolic response to neoadjuvant androgen deprivation therapy detected with [68Ga]Ga-PSMA-11-PET/CT in high-risk prostate cancer patients treated with definitive radiotherapy

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Abstract

Purpose

We examined the prognostic significance of early changes in primary tumor SUV measured with Gallium-68-labeled prostate-specific membrane antigen positron emission tomography ([68Ga]Ga-PSMA-11-PET/CT) and serum PSA values after neoadjuvant androgen deprivation treatment (nADT) in high-risk prostate cancer (PCa) patients treated with definitive radiotherapy (RT).

Methods

The clinical data and SUV parameters of 71 PCa patients were reviewed retrospectively. The serum PSA and primary tumor SUV values were calculated before and after the start of ADT. Using univariable and multivariable analyses, the prognostic factors predicting biochemical disease free survival (bDFS) and prostate cancer specific survival (PCSS) were investigated. In addition, logistic regression analysis was used to identify predictors of biochemical failure (BF).

Results

All but one patient responded with a 98.8% reduction in serum PSA (21.8 ng/mL vs. 0.3 ng/mL; p < 0.001), and 64 patients (91.1%) had a median 66.6% decrease in primary tumor SUV after ADT (13.2 vs. 4.8, p < 0.001). The primary tumor SUV response rate was significantly higher in patients with Gleason score (GS) of 7 than in patients with GS > 7 (59.5% vs. 40.5%; p = 0.04), and it was significantly lower in patients with inadequate treatment response than in those with complete (CR) or partial response (PR) (1.1% vs. 66.1%; p < 0.001). There was a strong and significant correlation (Spearman = 0.41, p < 0.001) and a high concordance (91.5%) between PSA response and SUV response after ADT. With a median follow-up time of 76.1 months, the 5-year bDFS and PCSS rates were 77.2% and 92.2%, respectively. Nineteen patients (26.7%) patients had recurrence at a median of 44.6 months after the completion of RT. In multivariate analysis, lymph node metastasis, GS greater than 7, and SD/PD after nADT were independent predictors of worse bDFS. However, no significant factor for PCSS was identified. In the multivariable logistic regression analysis, advanced age, GS of  > 7 disease, lymph node metastasis, and SD or PD after nADT were independent predictors of BF.

Conclusion

These results imply that the metabolic response measured with [68Ga]Ga-PSMA-11-PET/CT after nADT could be used to predict progression in high-risk PCa patients treated with definitive RT.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This project is partially supported by supported by the Başkent University Research Fund.

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Authors and Affiliations

  1. Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, 01120, Turkey

    Cem Onal & Ozan Cem Guler

  2. Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey

    Cem Onal

  3. Department of Nuclear Medicine, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey

    Nese Torun & Mehmet Reyhan

  4. Radiation Oncology Unit, Iskenderun Gelisim Hospital, Hatay, Turkey

    Ezgi Oymak

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ozan Cem Guler, Nese Torun, and Mehmet Reyhan. The first draft of the manuscript was written by Cem Onal, Ezgi Oymak, and Mehmet Reyhan. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Cem Onal.

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This study was conducted according to the guidelines of the Declaration of Helsinki. This study was approved by the Başkent University Institutional Review Board (Project no: KA19/45).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Onal, C., Guler, O.C., Torun, N. et al. The significance of metabolic response to neoadjuvant androgen deprivation therapy detected with [68Ga]Ga-PSMA-11-PET/CT in high-risk prostate cancer patients treated with definitive radiotherapy. Eur J Nucl Med Mol Imaging 50, 3755–3764 (2023). https://doi.org/10.1007/s00259-023-06321-1

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