Changes of Radiation Treatment Concept Based on 68Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy

Dirk Bottke; Jonathan Miksch; Reinhard Thamm; Thomas Krohn; Detlef Bartkowiak; Meinrad Beer; Christian Bolenz; Ambros J Beer; Vikas Prasad; Thomas Wiegel

doi:10.3389/fonc.2021.665304

Changes of Radiation Treatment Concept Based on ⁶⁸Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy

Front Oncol. 2021 Jun 1:11:665304. doi: 10.3389/fonc.2021.665304. eCollection 2021.

Authors

Affiliations

¹ Xcare Praxis für Strahlentherapie, Trier, Germany.
² Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany.
³ Department of Radiation Oncology and Radiotherapy, University Hospital Ulm, Ulm, Germany.
⁴ Radiologie Aachen Land, Würselen, Germany.
⁵ Department of Radiology, University Hospital of Ulm, Ulm, Germany.
⁶ Department of Urology, University Hospital of Ulm, Ulm, Germany.

Abstract

Background and purpose: Salvage radiotherapy (SRT) is the main potentially curative treatment option for prostate cancer patients with post-prostatectomy PSA progression. Improved diagnostics by positron emission tomography/computed tomography (PET/CT) can lead to adjustments in treatment procedures (e.g. target volume of radiotherapy, androgen deprivation therapy). We analyzed the impact of ⁶⁸Ga-PSMA-11-PET/CT on the target volume in early biochemical recurrence (PSA up to 0.5 ng/ml).

Patients and methods: We retrospectively analyzed 76 patients with biochemical recurrence after radical prostatectomy in whom SRT was planned after ⁶⁸Ga-PSMA-11-PET/CT. All patients had a PSA ≤0.5 ng/ml. An experienced radiation oncologist determined the radiotherapy concept, first with consideration of the PET/CT, second hypothetically based on the clinical and pathological features excluding PET/CT results.

Results: Without considering the PET/CT, all 76 patients would have been assigned to RT, 60 (79%) to the bed of the prostate and seminal vesicles alone, and 16 (21%) also to the pelvic lymph nodes because of histopathologic risk factors. Uptake indicative for tumor recurrence in ⁶⁸Ga-PSMA-11-PET/CT was found in 54% of the patients. The median pre-PET/CT PSA level was 0.245 ng/ml (range 0.07-0.5 ng/ml). The results of the PET/CT led to a change in the radiotherapeutic target volume in 21 patients (28%). There were major changes in the target volume including the additional irradiation of lymph nodes or the additional or exclusive irradiation of bone metastases in 13 patients (17%). Minor changes including the additional irradiation of original seminal vesicle (base) position resulted in eight patients (11%).

Conclusion: Using ⁶⁸Ga-PSMA-11-PET/CT for radiation planning, a change in the treatment concept was indicated in 28% of patients. With PET/CT, the actual extent of the tumor can be precisely determined even with PSA values of ≤0.5 ng/ml. Thus, the treatment concept can be improved and individualized. This may have a positive impact on progression free survival. Our results warrant further prospective studies.

Keywords: PSMA; biochemical recurrence; early salvage radiotherapy; positron emission tomography (PET); prostate cancer.