Metastasis-directed therapy (MDT) has been tested in clinical trials as a treatment option for oligorecurrent prostate cancer (PCa). However, there is an ongoing debate regarding the impact of using different imaging techniques interchangeably for defining lesions and guiding MDT within clinical trials. Methods: We retrospectively identified oligorecurrent PCa patients who had 5 or fewer nodal, bone, or visceral metastases detected by choline or prostate-specific membrane antigen (PSMA) PET/CT and who underwent MDT stereotactic body radiotherapy with or without systemic therapy in 8 tertiary-level cancer centers. Imaging-guided MDT was assessed as progression-free survival (PFS), time to systemic treatment change due to polymetastatic conversion (PFS2), and overall survival predictor. Propensity score matching was performed to account for clinical differences between groups. Results: Of 402 patients, 232 (57.7%) and 170 (42.3%) underwent MDT guided by [18F]fluorocholine and PSMA PET/CT, respectively. After propensity score matching, patients treated with PSMA PET/CT-guided MDT demonstrated longer PFS (hazard ratio [HR], 0.49 [95% CI, 0.36-0.67]; P < 0.0001), PFS2 (HR, 0.42 [95% CI, 0.28-0.63]; P < 0.0001), and overall survival (HR, 0.39 [95% CI, 0.15-0.99]; P < 0.05) than those treated with choline PET/CT-guided MDT. Additionally, we matched patients who underwent [68Ga]Ga-PSMA-11 versus [18F]F-PSMA-1007 PET/CT, observing longer PFS and PFS2 in the former subgroup (PFS: HR, 0.51 [95% CI, 0.26-1.00]; P < 0.05; PFS2: HR, 0.24 [95% CI, 0.09-0.60]; P < 0.05). Conclusion: Diverse imaging methods may influence outcomes in oligorecurrent PCa patients undergoing MDT. However, prospective, head-to-head studies, ideally incorporating a randomized design, are necessary to provide definitive evidence and facilitate the practical application of these findings.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2024 Jun 21 [Epub ahead of print]
Matteo Bauckneht, Francesco Lanfranchi, Domenico Albano, Luca Triggiani, Flavia Linguanti, Luca Urso, Rosario Mazzola, Alessio Rizzo, Elisa D'Angelo, Francesco Dondi, Eneida Mataj, Gloria Pedersoli, Elisabetta Maria Abenavoli, Luca Vaggelli, Beatrice Detti, Naima Ortolan, Antonio Malorgio, Alessia Guarneri, Federico Garrou, Matilde Fiorini, Serena Grimaldi, Pietro Ghedini, Giuseppe Carlo Iorio, Antonella Iudicello, Guido Rovera, Giuseppe Fornarini, Diego Bongiovanni, Michela Marcenaro, Filippo Maria Pazienza, Giorgia Timon, Matteo Salgarello, Manuela Racca, Mirco Bartolomei, Stefano Panareo, Umberto Ricardi, Francesco Bertagna, Filippo Alongi, Salvina Barra, Silvia Morbelli, Gianmario Sambuceti, Liliana Belgioia
Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy; ., Department of Health Sciences, University of Genova, Genova, Italy., Nuclear Medicine, ASST Spedali Civili di Brescia, Brescia, Italy., University of Brescia, Brescia, Italy., Nuclear Medicine, Careggi University Hospital, Florence, Italy., Nuclear Medicine, Oncological Medical and Specialist Department, University Hospital of Ferrara, Ferrara, Italy., Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy., Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy., Radiation Oncology, University Hospital of Modena, Modena, Italy., Radiation Oncology, Careggi University Hospital, Florence, Italy., Radiotherapy, University Hospital of Ferrara, Ferrara, Italy., Radiation Oncology, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy., Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy., Nuclear Medicine, Oncology, and Haematology Department, University Hospital of Modena, Modena, Italy., Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy., Medical Oncology 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy., Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy; and., Nuclear Medicine, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy., Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy.