The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. PSMA-PET Procedure and Interpretation Criteria
2.3. Patients’ Management and Treatments
2.4. Outcomes Measurements
2.5. Statistical Analyses
3. Results
3.1. Pre-Salvage Setting (n = 134)
3.2. Pre-Salvage Setting (n = 190)
4. Discussion
5. Limitation
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall | Pre-Salvage Setting, n = 134 (41.4%) | Post-Salvage Setting, n = 190 (58.6%) | |||||
---|---|---|---|---|---|---|---|
Positive PSMA-PET | Negative PSMA-PET | p Value | Positive PSMA-PET | Negative PSMA-PET | p Value | ||
Patients, n (%) | 324 (100) | 69 (52) | 65 (48) | - | 124 (65) | 66 (35) | - |
Age Median (IQR) | 63 (57–68) | 64 (59–70) | 63 (56–68) | 0.4 | 62 (56–66) | 65 (59–70) | 0.02 |
PSA level at RP (ng/mL) Median (IQR) | 8.34 (5.51–12.88) | 7.45 (6–13.22) | 8.54 (4.33–12) | 0.4 | 7.34 (2.33–13.85) | 7.07 (4.85–9.97) | 0.8 |
pT stage, n (%) pT2 pT3a pT3b-pT4 | 102 (31.5) 108 (33.3) 114 (35.2) | 12 (17.4) 23 (33.3) 34 (49.3) | 31 (47.7) 17 (26.2) 17 (26.2) | 0.01 | 40 (32.3) 41 (33.1) 43 (34.7) | 19 (28.8) 27 (40.9) 20 (30.3) | 0.6 |
pN stage, n (%) pNx pN0 pN1 | 69 (21.3) 178 (54.9) 77 (23.8) | 9 (13) 34 (49.3) 26 (37.7) | 15 (23.1) 38 (58.5) 12 (18.5) | 0.03 | 30 (24.2) 64 (51.6) 30 (24.2) | 15 (22.7) 42 (63.6) 9 (13.6) | 0.2 |
Pathologic ISUP group, n (%) ISUP 1–3 ISUP 4–5 | 157 (48) 167 (52) | 24 (34.8) 45 (65.2) | 45 (69.2) 20 (30.8) | ≤0.001 | 58 (46.8) 66 (53.2) | 30 (45.5) 36 (54.5) | 0.9 |
Adjuvant Radiotherapy, n (%) Yes No | 88 (27.2) 236 (72.8) | 50 (72.5) 19 (7.5) | 51 (78.5) 14 (21.5) | 0.4 | 38 (30.6) 86 (69.4) | 17 (25.8) 49 (4.2) | 0.5 |
PSA level at PET PSMA, ng/mL Median (IQR) | 0.5 (0.28–1.2) | 0.8 (0.31–1.99) | 0.33 (0.25–0.56) | ≤0.001 | 0.66 (0.31–1.45) | 0.48 (0.28–1) | 0.06 |
Overall | Pre-Salvage Setting, n = 134 (41.4%) | Post-Salvage Setting, n = 190 (58.6%) | |||||
---|---|---|---|---|---|---|---|
Positive PSMA-PET | Negative PSMA-PET | p Value | Positive PSMA-PET | Negative PSMA-PET | p Value | ||
Patients, n (%) | 324 (100) | 69 (51) | 65 (49) | - | 124 | 66 | - |
Treatment performed after PSMA-PET, n (%) Prostate bed RT/whole pelvis RT sLND Lymph node SRBT Bone SRBT sLND + SBRT Pelvic RT + bone SBRT Cyberknife Cryotherapy Metastases resection ADT ADT + ARTA/Chemo Observation | 88 (27.2) 45 (13.9) 9 (2.8) 18 (5.6) 6 (1.9) 19 (5.9) 2 (0.6) 4 (1.2) 1 (0.3) 69 (21.3) 4 (1.2) 59 (18.2) | 18 (26.1) 7 (10.1) 1 (1.4) 4 (5.8) 3 (4.3) 17 (24.6) 0 (0) 0 (0) 0 (0) 8 (11.6) 1 (1.4) 10 (14.5) | 26 (40) 1 (1.5) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 14 (21.5) 0 (0) 24 (36.9) | ≤0.001 | 26 (21) 37 (29.8) 8 (6.5) 14 (11.3) 3 (2.4) 2 (1.6) 2 (1.6) 4 (3.2) 1 (0.8) 15 (12.1) 3 (2.4) 9 (7.3) | 18 (27.3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 32 (48.5) 0 (0) 16 (24.2) | ≤0.001 |
PSA at recurrence after PSMA-PET, ng/mL Median (IQR) | 0.85 (0.43–1.95) | 0.85 (0.23–1.85 | 0.58 (0.17–2.9) | 0.9 | 0.98 (0.5–2.54) | 1.17 (0.48–1.88) | 0.5 |
Time to PSA recurrence, months Median (IQR) | 9 (3–23) | 11.5 (5–24) | 6 (3–25) | 0.9 | 8 (3–17) | 14 (4–24) | 0.3 |
Metastatic recurrence, n (%) Yes No | 47 (14.5) 277 (85.5) | 4 (5.8) 65 (94.2) | 3 (4.6) 62 (95.4) | 0.8 | 35 (28.2) 89 (71.8) | 5 (7.6) 61 (92.4) | 0.001 |
Time to metastatic recurrence, months Median (IQR) | 21 (8–32) | 11 (3–32) | 22 (8–35) | ≤0.001 | 17 (8–25) | 24 (11–34) | 0.003 |
CRPC, n (%) Yes No | 26 (8) 298 (92) | 4 (5.8) 65 (94.2) | 3 (4.6) 62 (95.4) | 0.8 | 18 (14.5) 106 (85.5) | 1 (1.5) 65 (85.5) | 0.004 |
Time to CRPC, months Median (IQR) | 23 (9–33) | 7.5 (3–37) | 22 (8–36) | 0.001 | 29 (8–40) | 27 (26–33) | 0.3 |
Overall Mortality, n (%) Yes No | 9 (2.8) 315 (97.2) | 0 69 (100) | 1 (1.5) 64 (98.5) | 0.3 | 7 (95.6) 117 (94.4) | 1 (1.5) 65 (85.5) | 0.2 |
Cancer specific mortality, n (%) Yes No | 3 (0.9) 321 (99.1) | 0 69 (100) | 0 65 (100) | - | 3 (2.4) 121 (97.6) | 0 66 (100) | 0.2 |
Follow up (months) from PSMA-PET Median (IQR) | 23 (10–34) | 8 (3–21) | 23 (9–37) | ≤0.001 | 27 (15–40) | 27 (23–33) | 0.6 |
Follow up (months) from RP Median (IQR) | 62 (30–108) | 35 (16–74) | 63 (45–100) | ≤0.001 | 68 (0–118) | 74 (50–141) | 0.02 |
Variables | Progression | Metastasis | ||
---|---|---|---|---|
HR (95% C.I.) | p Value | HR (95% C.I.) | p Value | |
Age (years) | 0.97 (0.95–0.99) | 0.04 | - | - |
Clinical setting for PSMA-PET Pre-salvage setting Post-salvage setting | 1.0 (Ref) 1.31 (0.86–1.98) | 0.2 | 1.0 (Ref) 1.40 (0.93–2.10) | 0.1 |
Pathologic stage pT2 pT3a pT3b-pT4 | 1.0 (Ref) 1.47 (0.90–2.39) 1.84 (1.10–3.09) | 0.1 0.02 | 1.0 (Ref) 1.49 (0.93–2.41) 2.03 (1.26–3.26) | 0.09 0.003 |
Pathologic ISUP group ISUP 1– 3ISUP 4–5 | 1.0 (Ref) 0.92 (0.60–1.46) | 0.7 | 1.0 (Ref) 0.87 (0.93–1.28) | 0.5 |
pN stage, n (%) pNx/pN0 pN1 | (Ref) 1.04 (0.66–1.65) | 0.8 | - | - |
ADT at salvage treatment | 0.58 (0.40–0.85) | 0.005 | 0.54 (0.37–0.78) | 0.001 |
PSA at PSMA-PET (ng/mL) | 0.99 (0.97–1-02) | 0.4 | - | - |
PSMA-PET result Negative Positive | 1.0 (Ref) 2.15 (1.42–3.25) | <0.001 | 1.0 (Ref) 2.37 (1.60–3.50) | <0.001 |
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Bianchi, L.; Ceci, F.; Costa, F.; Balestrazzi, E.; Droghetti, M.; Piazza, P.; Pissavini, A.; Mei, R.; Farolfi, A.; Castellucci, P.; et al. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence. Cancers 2023, 15, 247. https://doi.org/10.3390/cancers15010247
Bianchi L, Ceci F, Costa F, Balestrazzi E, Droghetti M, Piazza P, Pissavini A, Mei R, Farolfi A, Castellucci P, et al. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence. Cancers. 2023; 15(1):247. https://doi.org/10.3390/cancers15010247
Chicago/Turabian StyleBianchi, Lorenzo, Francesco Ceci, Francesco Costa, Eleonora Balestrazzi, Matteo Droghetti, Pietro Piazza, Alessandro Pissavini, Riccardo Mei, Andrea Farolfi, Paolo Castellucci, and et al. 2023. "The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence" Cancers 15, no. 1: 247. https://doi.org/10.3390/cancers15010247