Biochemical Response of <0.1 ng/ml Predicts Therapy-free Survival of Prostate Cancer Patients following Prostate-specific Membrane Antigen-targeted Salvage Surgery

Sophie Knipper; Flemming Lischewski; Daniel Koehler; Matthias Eiber; Fijs W B van Leeuwen; Hilda de Barros; Anne-Claire Berrens; Lotte Zuur; Pim J van Leeuwen; Henk van der Poel; Francesca Ambrosini; Fabian Falkenbach; Lars Budäus; Thomas Steuber; Markus Graefen; Pierre Tennstedt; Jürgen E Gschwend; Thomas Horn; Matthias M Heck; Tobias Maurer

doi:10.1016/j.euo.2024.04.019

Biochemical Response of <0.1 ng/ml Predicts Therapy-free Survival of Prostate Cancer Patients following Prostate-specific Membrane Antigen-targeted Salvage Surgery

Eur Urol Oncol. 2024 May 9:S2588-9311(24)00112-3. doi: 10.1016/j.euo.2024.04.019. Online ahead of print.

Authors

Sophie Knipper¹, Flemming Lischewski², Daniel Koehler³, Matthias Eiber⁴, Fijs W B van Leeuwen⁵, Hilda de Barros⁶, Anne-Claire Berrens⁶, Lotte Zuur⁶, Pim J van Leeuwen⁶, Henk van der Poel⁷, Francesca Ambrosini⁸, Fabian Falkenbach⁹, Lars Budäus⁹, Thomas Steuber¹⁰, Markus Graefen⁹, Pierre Tennstedt⁹, Jürgen E Gschwend², Thomas Horn², Matthias M Heck², Tobias Maurer¹¹

Affiliations

¹ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany.
² Department of Urology, Technical University of Munich, Munich, Germany.
³ Department of Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Nuclear Medicine, Technical University of Munich, Munich, Germany.
⁵ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Department of Urology, Antoni van Leeuwenhoek Hospital - the Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁷ Department of Urology, Antoni van Leeuwenhoek Hospital - the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁹ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹¹ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: t.maurer@uke.de.

PMID: 38729805
DOI: 10.1016/j.euo.2024.04.019

Abstract

Background: In a subset of patients with oligorecurrent prostate cancer (PCa), salvage surgery with prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) seems to be of value.

Objective: To evaluate whether a lower level of postoperative prostate-specific antigen (PSA; <0.1 ng/ml) is predictive of therapy-free survival (TFS) following salvage PSMA-RGS.

Design, setting, and participants: This cohort study evaluated patients with biochemical recurrence after radical prostatectomy and oligorecurrent PCa on PSMA positron emission tomography treated with PSMA-RGS in three tertiary care centers (2014-2022).

Intervention: PSMA-RGS.

Outcome measurements and statistical analysis: Postsalvage surgery PSA response was categorized as <0.1, 0.1-<0.2, or >0.2 ng/ml. Kaplan-Meier and multivariable Cox regression models evaluated TFS according to PSA response.

Results and limitations: Among 553 patients assessed, 522 (94%) had metastatic soft tissue lesions removed during PSMA-RGS. At 2-16 wk after PSMA-RGS, 192, 62, and 190 patients achieved PSA levels of <0.1, 0.1-<0.2, and >0.2 ng/ml, respectively. At 2 yr of follow-up, TFS rate was 81.1% versus 56.1% versus 43.1% (p < 0.001) for patients with PSA <0.1 versus 0.1-<0.2 versus >0.2 ng/ml. In multivariable analyses, PSA levels of 0.1-0.2 ng/ml (hazard ratio [HR]: 1.9, confidence interval [CI]: 1.1-3.1) and ≥0.2 ng/ml (HR: 3.2, CI: 2.2-4.6, p < 0.001) independently predicted the need for additional therapy after PSMA-RGS. The main limitation is the lack of a control group.

Conclusions: For patients after salvage PSMA-RGS, a lower biochemical response (PSA <0.1 ng/ml) seems to predict longer TFS. This insight may help in counseling patients postoperatively as well as guiding the timely selection of additional therapy.

Patient summary: We studied what happened to prostate cancer patients in three European centers who had salvage surgery using a special method called prostate-specific membrane antigen-targeted radioguidance. We found that patients who had low prostate-specific antigen levels soon after surgery were less likely to need further treatment for a longer time.

Keywords: Biochemical recurrence; Imaging-guided surgery; Prostate-specific membrane antigen positron emission tomography; Salvage surgery.