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68Ga-PSMA PET/CT-based metastasis-directed radiotherapy for oligometastatic prostate cancer recurrence after radical prostatectomy

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Abstract

Purpose

The aim of this communication was to assess the efficacy of directed oligometastatic radiotherapy (RT) based on 68Ga-PSMA PET/CT in patients with prostate cancer (PCa) biochemical relapse (BCR) after primary treatment with curative intent.

Methods

This is a retrospective analysis of a monocentric cohort of PCa patients diagnosed with oligometastatic disease on 68Ga-PSMA PET/CT and treated with metastasis-directed RT. Inclusion criteria were: histologically proven PCa, BCR after primary treatment with curative intent, oligometastatic disease defined as ≤ 3 metastatic lesions. To evaluate the efficacy of the therapy, biochemical response defined as a decrease of > 50% of PSA (PSA50) was measured at 1 and 4 months. Patients were followed up until progression and start of androgen deprivation therapy (ADT). BCR-free survival and ADT-free survival were calculated.

Results

20 patients met the inclusion criteria. Median PSA value: 1.4 ng/ml (IQR, 0.3–2.3 ng/ml). A total of 30 PSMA-positive lesions were treated: 18 lymph nodes (60%), nine bone (30%) and three visceral lesions (10%). Median follow-up was 15 months (range 4–33 months). Biochemical response at 1 and 4 months was found in 3/20 patients (15%) and 14/20 (70%), respectively. BCR-free survival rate at 1 year was 79% and 53% at 2 years. ADT-free survival at 2 years was 74%.

Conclusion

This retrospective study suggests that metastasis-directed RT based on 68Ga-PSMA PET/CT may be a valuable treatment in patients with PCa oligometastatic disease, providing promising BCR-free survival rates and potentially postponing ADT for at least 2 years in 74% of the patients. Response assessment should not be measured before 4 months after treatment.

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Authors and Affiliations

  1. Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet, 1, 1000, Brussels, Belgium

    C. Artigas, P. Flamen, H. Levillain & Z. Wimana

  2. Radiotherapy Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    F. Charlier, D. Van Gestel & F.-X. Otte

  3. Urology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    R. Van Velthoven & A. Peltier

  4. Urology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

    R. Diamand, S. Albisinni & T. Roumeguere

  5. Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    T. Gil

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  1. C. Artigas
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  2. P. Flamen
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Correspondence to C. Artigas.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Artigas, C., Flamen, P., Charlier, F. et al. 68Ga-PSMA PET/CT-based metastasis-directed radiotherapy for oligometastatic prostate cancer recurrence after radical prostatectomy. World J Urol 37, 1535–1542 (2019). https://doi.org/10.1007/s00345-019-02701-1

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  • DOI: https://doi.org/10.1007/s00345-019-02701-1

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