Event-free survival after radical prostatectomy according to prostate-specific membrane antigen-positron emission tomography and European Association of Urology biochemical recurrence risk groups

Matthew J Roberts; Mark D Chatfield; George Hruby; Rohan Nandurkar; Paul Roach; Jo Anne Watts; Thomas Cusick; Andrew Kneebone; Thomas Eade; Bao Ho; Andrew Nguyen; Colin Tang; Michael McCarthy; Roslyn Francis; Phillip Stricker; Louise Emmett

doi:10.1111/bju.15762

Event-free survival after radical prostatectomy according to prostate-specific membrane antigen-positron emission tomography and European Association of Urology biochemical recurrence risk groups

BJU Int. 2022 Nov;130 Suppl 3(Suppl 3):32-39. doi: 10.1111/bju.15762. Epub 2022 Jul 12.

Authors

Matthew J Roberts^{1

2}, Mark D Chatfield², George Hruby^{3

4

5}, Rohan Nandurkar⁶, Paul Roach^{5

7}, Jo Anne Watts^{8

9}, Thomas Cusick¹⁰, Andrew Kneebone^{3

4

5}, Thomas Eade^{3

4

5}, Bao Ho¹¹, Andrew Nguyen^{6

11}, Colin Tang¹², Michael McCarthy¹³, Roslyn Francis^{9

13}, Phillip Stricker^{5

6

14}, Louise Emmett^{6

11}

Affiliations

¹ Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
² Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia.
³ Department of Radiation Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
⁴ Genesis Cancer Care, Sydney, NSW, Australia.
⁵ Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
⁶ Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
⁷ Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
⁸ Department of Nuclear Medicine/WA PET Services, Sir Charles Gairdner Hospital, Perth, WA, Australia.
⁹ Faculty of Health and Medical Science, University of Western Australia, Perth, WA, Australia.
¹⁰ Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Sydney, NSW, Australia.
¹¹ Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
¹² Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
¹³ Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, WA, Australia.
¹⁴ Department of Urology, St Vincent's Hospital, Sydney, NSW, Australia.

Abstract

Objective: To assess European Association of Urology (EAU) risk groups for biochemical recurrence (BCR) of prostate cancer relative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) status and oncological outcomes.

Patients and methods: A retrospective analysis of a study that incorporated PSMA-PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA-PET findings, and deployment of salvage radiotherapy (SRT). The primary oncological outcome was event-free survival (EFS) and this was analysed relative to clinical and imaging variables. An 'event' occurred if prostate-specific antigen (PSA) level rose >0.2 ng/mL above nadir or additional therapies were introduced.

Results: A total of 137 patients were included, most of whom had EAU high-risk disease (76%) and/or low PSA levels (80% <0.5 ng/mL) at the time of PSMA-PET. EAU risk group was not associated with regional nodal/distant metastasis on PSMA-PET. Regional nodal/distant metastasis on PSMA PET (compared to negative/local recurrence: hazard ratio [HR] 2.2; P = 0.002) and SRT use (vs no SRT: HR 0.44; P = 0.004) were associated with EFS. EAU high-risk status was not significantly associated with worse EFS (HR 1.7, P = 0.12) compared to EAU low-risk status. Among patients who received SRT, both regional/distant metastasis on PSMA-PET (HR 3.1; P < 0.001) and EAU high-risk status (HR 2.9; P = 0.04) were independently associated with worse EFS, which was driven by patients in the EAU high-risk group with regional/distant metastases (38%; HR 3.1, P = 0.001).

Conclusions: In patients with post-RP BCR, PSMA-PET findings and receipt of SRT predicted EFS. In patients receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA-PET.

Keywords: PET/CT; PSMA; biochemical failure; prostate-specific membrane antigen; radical prostatectomy; salvage RT.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Gallium Radioisotopes
Humans
Male
Neoplasm Recurrence, Local / pathology
Positron Emission Tomography Computed Tomography / methods
Positron-Emission Tomography
Progression-Free Survival
Prostate / diagnostic imaging
Prostate / pathology
Prostate / surgery
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Prostatic Neoplasms* / surgery
Retrospective Studies
Urology*

Substances

Prostate-Specific Antigen
Gallium Radioisotopes