We investigated the impact of prostate-specific membrane antigen (PSMA) PET/CT compared with conventional imaging on treatment outcomes for node-positive prostate cancer (PCa) patients who underwent androgen deprivation therapy (ADT) and external radiotherapy (RT).
A multicentric, retrospective study recruited patients with node-positive PCa patients who underwent conventional radiological evaluation or PSMA PET/CT and received ADT and RT at 3 hospitals from 2009 to 2021 were enrolled. Patients underwent prostate and pelvis RT, accompanied by a minimum of 6 months of ADT. The primary endpoints were progression-free survival (PFS) and PCa-specific survival (PCSS). Cox regression analyzed the association of survival with potential prognostic factors, whereas logistic regression identified the predictors of bone and lymph node metastasis.
The median follow-up time was 64.0 months. The majority of patients (64.1%) underwent PSMA PET/CT for staging. The 5-year rates of PFS and PCSS were 63.7% and 83.7%, respectively. Disease progression was observed in 90 patients (36.3%). In multivariable analysis, ADT duration of less than 24 months and post-RT prostate-specific antigen (PSA) nadir were prognostic for PFS. Early clinical T stage and PSMA PET/CT predicted better PCSS. Patients staged with PSMA PET/CT had exhibited significantly higher 5-year PCSS rates than compared with those staged with conventional imaging (95.1% vs 76.9%; P = 0.01). Shorter ADT duration and higher PSA levels after RT independently predicted bone metastasis in multivariable logistic regression. Advanced T stage, shorter ADT duration, and higher PSA levels after neoadjuvant ADT predicted nonregional lymph node recurrence.
ADT with pelvis RT is an effective treatment option for node-positive PCa patients. The PSMA PET/CT outperformed conventional imaging in PCSS, emphasizing the importance of precise clinical staging for patients undergoing definitive RT.
Clinical nuclear medicine. 2024 Jun 03 [Epub ahead of print]
Cem Onal, Ozan Cem Guler, Petek Erpolat, Pervin Hurmuz, Philip Sutera, Matthew P Deek, Aysenur Elmali, Melek Tugce Yilmaz, Ummu Habibe Koken, Melek Yavuz, Gokhan Ozyigit, Phuoc T Tran
From the Department of Radiation Oncology, Adana Dr Turgut Noyan Research and Treatment Center, Faculty of Medicine, Baskent University, Adana, Turkey., Department of Radiation Oncology, Gazi University Faculty of Medicine, Ankara, Turkey., Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey., Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD., Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ., Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey., Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.