New analysis revealed the detection of prostate-specific membrane antigen (PSMA)-avid lesions in over 75 p.c of males with < 2 ng/ml prostate-specific antigen (PSA) degree will increase above nadir after radiotherapy remedy for prostate most cancers (PCa)
For the retrospective examine, just lately printed in European Urology Oncology, researchers reviewed follow-up knowledge from 568 sufferers who had healing intent radiotherapy for PCa. The examine authors famous that 346 sufferers within the cohort had optimistic Phoenix standards (Ph+) for biochemical PCa recurrence, outlined as PSA rise > 2 ng/ml above the PSA nadir, and 222 sufferers had < 2 ng/ml PSA improve above the PSA nadir (Ph–).
The researchers detected PSMA-avid lesions in 76.6 p.c of Ph- sufferers and 93.1 p.c of Ph+ sufferers. Nonetheless, over 30 p.c extra of the Ph– sufferers with PSMA-avid lesions had been eligible for native salvage remedy in distinction to these within the Ph+ cohort (75.9 p.c vs. 45 p.c), in accordance with the examine authors. Amongst sufferers with PSMA-avid lesions, the researchers discovered that eligibility for metastasis-directed remedy (MDT) was 14 p.c larger within the Ph– cohort compared to the Ph+ group (42.9 p.c vs. 28.9 p.c).
Current analysis revealed that over 30 p.c extra of the Ph– sufferers (these with < 2 ng/ml PSA rise above nadir) with PSMA-avid lesions had been eligible for native salvage remedy in distinction to these within the Ph+ (> 2 ng/ml PSA rise above nadir) cohort (75.9 p.c vs. 45 p.c). Amongst sufferers with PSMA-avid lesions, the researchers discovered that eligibility for metastasis-directed remedy (MDT) was 14 p.c larger within the Ph– cohort compared to the Ph+ group (42.9 p.c vs. 28.9 p.c).
“Early PSMA PET/CT imaging detected PCa recurrence at a much less superior illness stage which may be eligible for salvage remedy or metastasis-directed remedy,” wrote lead examine writer Evelien J.E. van Altena, M.D., who’s affiliated with the Division of Urology at Amsterdam College Medical Facilities in Amsterdam, the Netherlands, and colleagues.
(Editor’s be aware: For added content material on prostate most cancers imaging, click on right here.)
5-year follow-up knowledge revealed that 33 p.c of sufferers within the Ph– group required re-initiation of androgen deprivation remedy (ADT) in distinction to 67.6 p.c within the Ph+ group. The researchers additionally famous that greater than twice as many Ph+ sufferers progressed to castration-resistant prostate most cancers (CRPC) compared to these within the Ph– group (27.9 p.c vs. 13.6 p.c).
Three Key Takeaways
1. Greater detection of recurrence utilizing early PSMA PET/CT imaging. The examine revealed that PSMA-avid lesions had been detected in over 75 p.c of sufferers with < 2 ng/ml PSA improve above the nadir after radiotherapy for prostate most cancers (PCa), demonstrating that early PSMA PET/CT imaging can detect PCa recurrence at a much less superior stage.
2. Higher salvage remedy eligibility in decrease PSA will increase. Sufferers with a PSA rise of < 2 ng/ml (Ph– group) confirmed larger eligibility for native salvage remedy in comparison with these with PSA will increase > 2 ng/ml (Ph+ group) after detecting PSMA-avid lesions (75.9 p.c vs. 45 p.c).
3. Improved outcomes in Ph– sufferers. Sufferers within the Ph– group skilled a delay within the want for androgen deprivation remedy (ADT) and development to castration-resistant prostate most cancers (CRPC), together with longer total survival, in comparison with the Ph+ group.
The examine authors additionally decided that the restricted imply survival time from main radiotherapy to dying was 22 months longer within the Ph– cohort in distinction to the Ph+ group (243 months vs. 221 months).
“Early PSMA PET/CT after radiotherapy was related to a delay to (re)initiation of ADT and development to CRPC, and with longer total survival,” emphasised van Altena and colleagues.
(Editor’s be aware: For associated content material, see “PSMA PET/CT or mpMRI: Which is Higher for Diagnosing Biochemical Recurrence of PCa?,” “Rising Analysis at SNMMI Examines 18F-Flotufolastat in Managing Main and Recurrent Prostate Most cancers” and “Rising AI Platform Reveals Promise for Prostate Most cancers Detection on mpMRI.”)
Past the inherent limitations of a non-randomized retrospective examine, the authors famous the potential of affected person choice bias given the dearth of a uniform indication for PSMA PET/CT within the examine and no normal standards for using ADT in sufferers with PCa recurrence. As a result of a ignorance on the reason for dying throughout the cohort, the researchers famous they might in a roundabout way attribute modifications in PCa illness administration to survival charges.
