Comparison of Hormone-Sensitive Oligorecurrent Prostate Cancer Patients Based on Routine Use of Choline and/or PSMA PET/CT to Guide Metastasis-Directed Therapy

Author:

Metz Raphaël1ORCID,Rauscher Aurore1,Vaugier Loïg2ORCID,Supiot Stéphane23ORCID,Drouet Franck4,Campion Loic56ORCID,Rousseau Caroline16ORCID

Affiliation:

1. Nuclear Medicine Department, Institut de Cancérologie de l’Ouest, Boulevard J. Monod, F-44800 St-Herblain, France

2. Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Boulevard J. Monod, F-44800 St-Herblain, France

3. Laboratoire US2B, Unité en Sciences Biologiques et Biotechnologies, UMR CNRS 6286, UFR SCIENCES ET TECHNIQUES, 2, Rue de la Houssinière, F-44322 Nantes, France

4. Radiation Oncology Department, Clinique Mutualiste de l’Estuaire, F-44600 Saint-Nazaire, France

5. Biostatistics Department, Institut de Cancérologie de l’Ouest, Boulevard J. Monod, F-44800 St-Herblain, France

6. Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000 Nantes, France

Abstract

Background: In hormone-sensitive oligorecurrent prostate cancer (PC), the literature showed [68Ga]Ga-PSMA (PSMA) and [18F]F-choline (FCH) PET/CT can successfully guide metastasis-directed therapies (MDT). This observational retrospective study aimed to explore, in routine use, the impact of FCH or PSMA PET/CT in guiding MDT for hormone-sensitive oligometastatic PC at different recurrences. Methods: In 2017–2020, patients initially treated with radical prostatectomy but, in biochemical recurrence (with PSA ≤ 2 ng/mL), diagnosed as oligometastatic based on FCH or PSMA PET/CT, were identified. MDT was stereotactic body radiotherapy (SBRT), elective nodal or prostate bed radiotherapy ± boost and ± androgen deprivation therapy (ADT). The primary endpoint was biochemical relapse-free survival (BR-FS), defined as a PSA increase ≥ 0.2 ng/mL above the nadir and increasing over two successive samples and the secondaries were ADT-free survival (ADT-FS). Results: 123 patients (70 PSMA and 53 FCH) were included. The median follow-up was 42.2 months. The median BR-FS was 24.7 months in the PSMA group versus 13.0 months in the FCH group (p = 0.008). Similarly, ADT-FS (p = 0.001) was longer in patients in the PSMA group. In multivariate analysis, a short PSA doubling time before imaging (p = 0.005) and MDT with SBRT (p = 0.001) were poor prognostic factors for BR-FS. Conclusions: Routine use of FCH or PSMA PET/CT in hormone-sensitive PC showed an advantage for using PSMA PET/CT to guide MDT in terms of BR-FS and ADT-FS in patients with low PSA value. Prospective studies are needed to confirm these hypotheses.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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