In a subset of patients with oligorecurrent prostate cancer (PCa), salvage surgery with prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) seems to be of value.
To evaluate whether a lower level of postoperative prostate-specific antigen (PSA; <0. 1 ng/ml) is predictive of therapy-free survival (TFS) following salvage PSMA-RGS.
This cohort study evaluated patients with biochemical recurrence after radical prostatectomy and oligorecurrent PCa on PSMA positron emission tomography treated with PSMA-RGS in three tertiary care centers (2014-2022).
PSMA-RGS.
Postsalvage surgery PSA response was categorized as <0.1, 0.1-<0.2, or >0.2 ng/ml. Kaplan-Meier and multivariable Cox regression models evaluated TFS according to PSA response.
Among 553 patients assessed, 522 (94%) had metastatic soft tissue lesions removed during PSMA-RGS. At 2-16 wk after PSMA-RGS, 192, 62, and 190 patients achieved PSA levels of <0.1, 0.1-<0.2, and >0.2 ng/ml, respectively. At 2 yr of follow-up, TFS rate was 81.1% versus 56.1% versus 43.1% (p < 0.001) for patients with PSA <0.1 versus 0.1-<0.2 versus >0.2 ng/ml. In multivariable analyses, PSA levels of 0.1-0.2 ng/ml (hazard ratio [HR]: 1.9, confidence interval [CI]: 1.1-3.1) and ≥0.2 ng/ml (HR: 3.2, CI: 2.2-4.6, p < 0.001) independently predicted the need for additional therapy after PSMA-RGS. The main limitation is the lack of a control group.
For patients after salvage PSMA-RGS, a lower biochemical response (PSA <0.1 ng/ml) seems to predict longer TFS. This insight may help in counseling patients postoperatively as well as guiding the timely selection of additional therapy.
We studied what happened to prostate cancer patients in three European centers who had salvage surgery using a special method called prostate-specific membrane antigen-targeted radioguidance. We found that patients who had low prostate-specific antigen levels soon after surgery were less likely to need further treatment for a longer time.
European urology oncology. 2024 May 09 [Epub ahead of print]
Sophie Knipper, Flemming Lischewski, Daniel Koehler, Matthias Eiber, Fijs W B van Leeuwen, Hilda de Barros, Anne-Claire Berrens, Lotte Zuur, Pim J van Leeuwen, Henk van der Poel, Francesca Ambrosini, Fabian Falkenbach, Lars Budäus, Thomas Steuber, Markus Graefen, Pierre Tennstedt, Jürgen E Gschwend, Thomas Horn, Matthias M Heck, Tobias Maurer
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany., Department of Urology, Technical University of Munich, Munich, Germany., Department of Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Nuclear Medicine, Technical University of Munich, Munich, Germany., Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Department of Urology, Antoni van Leeuwenhoek Hospital - the Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Antoni van Leeuwenhoek Hospital - the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: .