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Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer

INTRODUCTION: The National Comprehensive Cancer Network recommends external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT) as the preferred treatment option for newly diagnosed node-positive (cN1) prostate cancer (PCa) patients. However, implementation of positron emission...

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Autores principales: Spohn, Simon K.B., Birkenmaier, Viktoria, Ruf, Juri, Mix, Michael, Sigle, August, Haehl, Erik, Adebahr, Sonja, Sprave, Tanja, Gkika, Eleni, Rühle, Alexander, Nicolay, Nils H., Kirste, Simon, Grosu, Anca L., Zamboglou, Constantinos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209705/
https://www.ncbi.nlm.nih.gov/pubmed/35747822
http://dx.doi.org/10.3389/fonc.2022.898774
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author Spohn, Simon K.B.
Birkenmaier, Viktoria
Ruf, Juri
Mix, Michael
Sigle, August
Haehl, Erik
Adebahr, Sonja
Sprave, Tanja
Gkika, Eleni
Rühle, Alexander
Nicolay, Nils H.
Kirste, Simon
Grosu, Anca L.
Zamboglou, Constantinos
author_facet Spohn, Simon K.B.
Birkenmaier, Viktoria
Ruf, Juri
Mix, Michael
Sigle, August
Haehl, Erik
Adebahr, Sonja
Sprave, Tanja
Gkika, Eleni
Rühle, Alexander
Nicolay, Nils H.
Kirste, Simon
Grosu, Anca L.
Zamboglou, Constantinos
author_sort Spohn, Simon K.B.
collection PubMed
description INTRODUCTION: The National Comprehensive Cancer Network recommends external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT) as the preferred treatment option for newly diagnosed node-positive (cN1) prostate cancer (PCa) patients. However, implementation of positron emission tomography targeting prostate-specific membrane antigen (PSMA-PET) in the staging of primary PCa patients has a significant impact on RT treatment concepts. This study aims to evaluate outcomes and their respective risk factors on patients with PSMA-PET-based cN1 and/or cM1a PCa receiving primary RT and ADT. METHODS: Forty-eight patients with cN0 and/or cM1a PCa staged by [(18)F]PSMA-1007-PET (n = 19) or [(68)Ga]PSMA-11-PET (n = 29) were retrospectively included. All patients received EBRT to the pelvis ± boost to positive nodes, followed by boost to the prostate. The impact of different PET-derived characteristics such as maximum standard uptake value (SUVmax) and number of PET-positive lymph nodes on biochemical recurrence-free survival (BRFS) (Phoenix criteria) and metastasis-free survival (MFS) was determined using Kaplan–Meier and Cox proportional hazard regression analyses. RESULTS: Median follow-up was 24 months. Median initial serum prostate-specific antigen was 20.2 ng/ml (IQR 10.2–54.2). Most patients had cT stage ≥ 3 (63%) and ISUP grade ≥ 3 (85%). Median dose to the prostate, elective nodes, and PET-positive nodes was 75 Gy, 45 Gy, and 55 Gy, respectively. Ninety percent of patients received ADT with a median duration of 9 months (IQR 6–18). In univariate analysis, cM1a stage (p = 0.03), number of >2 pelvic nodes (p = 0.01), number of >1 abdominal node (p = 0.02), and SUVmax values ≥ median (8.1 g/ml for (68)Ga-PSMA-11 and 7.9 g/ml for (18)F-PSMA-1007) extracted from lymph nodes were significantly associated with unfavorable BRFS, but classical clinicopathological features were not. Number of >2 pelvic nodes (n = 0.03), number of >1 abdominal node (p = 0.03), and SUVmax values ≥ median extracted from lymph nodes were associated with unfavorable MFS. In multivariate analysis, number of >2 pelvic lymph nodes was significantly associated with unfavorable BRFS (HR 5.2, p = 0.01) and SUVmax values ≥ median extracted from lymph nodes had unfavorable MFS (HR 6.3, p = 0.02). CONCLUSION: More than 2 PET-positive pelvic lymph nodes are associated with unfavorable BRFS, and high SUVmax values are associated with unfavorable MFS. Thus, the number of PET-positive lymph nodes and the SUVmax value might be relevant prognosticators to identify patients with favorable outcomes.
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spelling pubmed-92097052022-06-22 Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer Spohn, Simon K.B. Birkenmaier, Viktoria Ruf, Juri Mix, Michael Sigle, August Haehl, Erik Adebahr, Sonja Sprave, Tanja Gkika, Eleni Rühle, Alexander Nicolay, Nils H. Kirste, Simon Grosu, Anca L. Zamboglou, Constantinos Front Oncol Oncology INTRODUCTION: The National Comprehensive Cancer Network recommends external beam radiotherapy (EBRT) combined with androgen deprivation therapy (ADT) as the preferred treatment option for newly diagnosed node-positive (cN1) prostate cancer (PCa) patients. However, implementation of positron emission tomography targeting prostate-specific membrane antigen (PSMA-PET) in the staging of primary PCa patients has a significant impact on RT treatment concepts. This study aims to evaluate outcomes and their respective risk factors on patients with PSMA-PET-based cN1 and/or cM1a PCa receiving primary RT and ADT. METHODS: Forty-eight patients with cN0 and/or cM1a PCa staged by [(18)F]PSMA-1007-PET (n = 19) or [(68)Ga]PSMA-11-PET (n = 29) were retrospectively included. All patients received EBRT to the pelvis ± boost to positive nodes, followed by boost to the prostate. The impact of different PET-derived characteristics such as maximum standard uptake value (SUVmax) and number of PET-positive lymph nodes on biochemical recurrence-free survival (BRFS) (Phoenix criteria) and metastasis-free survival (MFS) was determined using Kaplan–Meier and Cox proportional hazard regression analyses. RESULTS: Median follow-up was 24 months. Median initial serum prostate-specific antigen was 20.2 ng/ml (IQR 10.2–54.2). Most patients had cT stage ≥ 3 (63%) and ISUP grade ≥ 3 (85%). Median dose to the prostate, elective nodes, and PET-positive nodes was 75 Gy, 45 Gy, and 55 Gy, respectively. Ninety percent of patients received ADT with a median duration of 9 months (IQR 6–18). In univariate analysis, cM1a stage (p = 0.03), number of >2 pelvic nodes (p = 0.01), number of >1 abdominal node (p = 0.02), and SUVmax values ≥ median (8.1 g/ml for (68)Ga-PSMA-11 and 7.9 g/ml for (18)F-PSMA-1007) extracted from lymph nodes were significantly associated with unfavorable BRFS, but classical clinicopathological features were not. Number of >2 pelvic nodes (n = 0.03), number of >1 abdominal node (p = 0.03), and SUVmax values ≥ median extracted from lymph nodes were associated with unfavorable MFS. In multivariate analysis, number of >2 pelvic lymph nodes was significantly associated with unfavorable BRFS (HR 5.2, p = 0.01) and SUVmax values ≥ median extracted from lymph nodes had unfavorable MFS (HR 6.3, p = 0.02). CONCLUSION: More than 2 PET-positive pelvic lymph nodes are associated with unfavorable BRFS, and high SUVmax values are associated with unfavorable MFS. Thus, the number of PET-positive lymph nodes and the SUVmax value might be relevant prognosticators to identify patients with favorable outcomes. Frontiers Media S.A. 2022-06-07 /pmc/articles/PMC9209705/ /pubmed/35747822 http://dx.doi.org/10.3389/fonc.2022.898774 Text en Copyright © 2022 Spohn, Birkenmaier, Ruf, Mix, Sigle, Haehl, Adebahr, Sprave, Gkika, Rühle, Nicolay, Kirste, Grosu and Zamboglou https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Spohn, Simon K.B.
Birkenmaier, Viktoria
Ruf, Juri
Mix, Michael
Sigle, August
Haehl, Erik
Adebahr, Sonja
Sprave, Tanja
Gkika, Eleni
Rühle, Alexander
Nicolay, Nils H.
Kirste, Simon
Grosu, Anca L.
Zamboglou, Constantinos
Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title_full Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title_fullStr Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title_full_unstemmed Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title_short Risk Factors for Biochemical Recurrence After PSMA-PET-Guided Definitive Radiotherapy in Patients With De Novo Lymph Node-Positive Prostate Cancer
title_sort risk factors for biochemical recurrence after psma-pet-guided definitive radiotherapy in patients with de novo lymph node-positive prostate cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209705/
https://www.ncbi.nlm.nih.gov/pubmed/35747822
http://dx.doi.org/10.3389/fonc.2022.898774
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