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Site-specific relapse patterns of patients with biochemical recurrence following radical prostatectomy assessed by 68Ga-PSMA-11 PET/CT or 11C-Choline PET/CT: impact of postoperative treatments

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Abstract

Background

Salvage radiotherapy (RT) (± androgen deprivation therapy (ADT)) is often used as a treatment in patients with biochemical recurrence (BCR) following radical prostatectomy (RP). Unfortunately, even after RT ± ADT, a significant number of patients will develop ‘second’ BCR. The aim of this study was to investigate the impact of postoperative treatments (adjuvant/salvage radiotherapy (RT) ± androgen deprivation therapy) on the recurrence pattern in patients with BCR following RP assessed by 11C-Choline PET/CT or 68 Ga-PSMA PET/CT.

Methods

Patients who developed BCR following RP and who had at least one positive lesion on PET/CT were retrospectively assessed. Positive spots were mapped as local, lymph node (LN), skeletal or visceral recurrence. A distinction was made between locoregional (prostate bed and pelvic LN) and extrapelvic recurrence (skeletal, visceral and/or extrapelvic LN). Patients were categorized according to postoperative treatment received in three subgroups (RT, ADT and RT + ADT) and compared with the reference group (RP only). The impact of the radiation field was also investigated.

Results

We identified 200 patients assessed by 68Ga-PSMA-11 (80%) or 11C-Choline PET/CT (20%). Patients who received postoperative RT + ADT had less LN recurrence distal to the common iliac bifurcation (26.7% vs 66.6%; p = 0.0004), but more recurrence to retroperitoneal LN than the reference group (38% vs. 14.4%, p = 0.02). Moreover, the RT + ADT subgroup had more extrapelvic recurrence compared to the reference group (66.2% vs 40.8%, p = 0.02). Patients who received RT to the prostate bed had more recurrence distal to the common iliac bifurcation compared to those who received RT to the prostate bed + pelvic LN (51.6% vs 26.1%, p = 0.0069).

Conclusion

Post-prostatectomy treatments (ADT and/or RT) and the postoperative radiation field (prostate bed vs. prostate bed + pelvis) have a significant impact on the recurrence pattern. This knowledge can help clinicians to counsel their patients on their chances of being eligible for (locoregional) metastasis-directed therapies.

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Acknowledgements

Steven Joniau is a Senior Clinical Investigator of the Research Foundation Flanders (FWO). This work was supported by the ‘Jozef De Wever Fonds voor prostaatkanker preventie’. Figure drawn by Patricia Poels. Figure reused from prior published article https://doi.org/10.1016/j.eururo.2019.04.016 with permission of Elsevier.

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Authors and Affiliations

  1. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Gaëtan Devos, Manuel Witters, Lisa Moris, Thomas Van den Broeck, Wout Devlies, Maarten Albersen, Hendrik Van Poppel, Wouter Everaerts & Steven Joniau

  2. Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium

    Lisa Moris, Thomas Van den Broeck & Wout Devlies

  3. Departement of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium

    Charlien Berghen & Gert De Meerleer

  4. Departement of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium

    Karolien Goffin & Sander Jentjens

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  1. Gaëtan Devos
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  2. Manuel Witters
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  3. Lisa Moris
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Contributions

Protocol/project development: GD, MW, SJ; data collection or management: GD, MW; data analysis: GD, MW, SJ; manuscript writing/editing: GD, GM, HP, KG, WD, LM, CB, TB, MA, WE, SJ, SJ.

Corresponding author

Correspondence to Gaëtan Devos.

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Conflict of interest

Steven Joniau: research grants from Bayer, Ipsen, Ferring, Janssen; Honoraria from Bayer, Astra Zeneca, Ferring, Astellas, Ipsen, Janssen. Travel, Accommodation, Expenses from Bayer, Astra Zeneca, Ferring, Astellas, Ipsen, Janssen.

Ethical standard

The study (S62433) was approved by the Ethics Committee of the UZ/KU Leuven – Leuven (Belgium) on January, 28th, 2019. The study was conducted in compliance with the principles of the Declaration of Helsinki (2013), the principles of Good Clinical Practice and in accordance with all applicable regulatory requirements. This manuscript involves human participants.

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Devos, G., Witters, M., Moris, L. et al. Site-specific relapse patterns of patients with biochemical recurrence following radical prostatectomy assessed by 68Ga-PSMA-11 PET/CT or 11C-Choline PET/CT: impact of postoperative treatments. World J Urol 39, 399–406 (2021). https://doi.org/10.1007/s00345-020-03220-0

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