TY - JOUR
T1 - Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer
AU - Horn, Thomas
AU - Kroenke, Markus
AU - Rauscher, Isabel
AU - Haller, Bernhard
AU - Robu, Stephanie
AU - Wester, Hans Juergen
AU - Schottelius, Margret
AU - van Leeuwen, Fijs W. B.
AU - van der Poel, Henk G.
AU - Heck, Matthias
AU - Gschwend, Juergen E.
AU - Weber, Wolfgang
AU - Eiber, Matthias
AU - Maurer, Tobias
N1 - Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2019/10
Y1 - 2019/10
N2 - BACKGROUND: Prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET) allows detection of metastatic prostate cancer (PC) lesions at low prostate-specific antigen (PSA) values. To facilitate their intraoperative detection during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (RGS).OBJECTIVE: To describe the outcome of a large cohort of patients treated with PSMA-targeted RGS and to establish prognostic factors.DESIGN, SETTING, AND PARTICIPANTS: A total of 121 consecutive patients with recurrent PC as defined by PSMA-ligand PET (median PSA: 1.13ng/ml) underwent PSMA-targeted RGS.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The frequency of a complete biochemical response (cBR; PSA <0.2ng/ml) without additional treatment and the duration of biochemical recurrence-free survival (bRFS, time from PSMA-targeted RGS with PSA <0.2ng/ml without further treatment) were evaluated and correlated with preoperatively available clinical variables.RESULTS AND LIMITATIONS: In almost all patients (120/121, 99%) metastatic tissue could be removed. A cBR was achieved in 77 patients (66%). The chance of cBR was highest in patients with both low preoperative PSA and a single lesion (38/45: 84%). Median bRFS was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR. Significantly longer median bRFS was observed in patients with a low preoperative PSA value (p=0.004, hazard ratio 1.48, 95% confidence interval 1.13-1.93) and with a single lesion in preoperative PSMA-ligand PET (14.0 vs 2.5mo, p=0.002).CONCLUSIONS: PSMA-targeted RGS leads to a remarkable interval of bRFS in a subset of patients. The frequency of cBR and the duration of bRFS were highest in patients with a low preoperative PSA value and a single lesion on PSMA-ligand PET.PATIENT SUMMARY: Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome.
AB - BACKGROUND: Prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET) allows detection of metastatic prostate cancer (PC) lesions at low prostate-specific antigen (PSA) values. To facilitate their intraoperative detection during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (RGS).OBJECTIVE: To describe the outcome of a large cohort of patients treated with PSMA-targeted RGS and to establish prognostic factors.DESIGN, SETTING, AND PARTICIPANTS: A total of 121 consecutive patients with recurrent PC as defined by PSMA-ligand PET (median PSA: 1.13ng/ml) underwent PSMA-targeted RGS.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The frequency of a complete biochemical response (cBR; PSA <0.2ng/ml) without additional treatment and the duration of biochemical recurrence-free survival (bRFS, time from PSMA-targeted RGS with PSA <0.2ng/ml without further treatment) were evaluated and correlated with preoperatively available clinical variables.RESULTS AND LIMITATIONS: In almost all patients (120/121, 99%) metastatic tissue could be removed. A cBR was achieved in 77 patients (66%). The chance of cBR was highest in patients with both low preoperative PSA and a single lesion (38/45: 84%). Median bRFS was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR. Significantly longer median bRFS was observed in patients with a low preoperative PSA value (p=0.004, hazard ratio 1.48, 95% confidence interval 1.13-1.93) and with a single lesion in preoperative PSMA-ligand PET (14.0 vs 2.5mo, p=0.002).CONCLUSIONS: PSMA-targeted RGS leads to a remarkable interval of bRFS in a subset of patients. The frequency of cBR and the duration of bRFS were highest in patients with a low preoperative PSA value and a single lesion on PSMA-ligand PET.PATIENT SUMMARY: Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome.
KW - Biochemical recurrence
KW - Prostate-specific antigen
KW - Prostate-specific membrane antigen
KW - Radioguided surgery
KW - Salvage surgery
UR - http://www.scopus.com/inward/record.url?scp=85064245148&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2019.03.045
DO - 10.1016/j.eururo.2019.03.045
M3 - Article
C2 - 30987843
SN - 0302-2838
VL - 76
SP - 517
EP - 523
JO - European Urology
JF - European Urology
IS - 4
ER -