Can PSMA PET/CT help in dose-tailoring in post-prostatectomy radiotherapy?

Ambroise Champion; Daniel Rudolf Zwhalen; Christoph Oehler; Daniel Taussky; Stephanie G C Kroeze; Irene A Burger; David Benzaquen

doi:10.3389/fonc.2023.1268309

Can PSMA PET/CT help in dose-tailoring in post-prostatectomy radiotherapy?

Front Oncol. 2023 Sep 20:13:1268309. doi: 10.3389/fonc.2023.1268309. eCollection 2023.

Authors

Ambroise Champion¹, Daniel Rudolf Zwhalen², Christoph Oehler², Daniel Taussky^{1

3}, Stephanie G C Kroeze⁴, Irene A Burger^{5

6}, David Benzaquen¹

Affiliations

¹ Radiation Oncology, Hôpital de La Tour, Meyrin, Switzerland.
² Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland.
³ Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
⁴ Department of Radiation Oncology Kantonsspital Aarau and Baden, Kantonsspital Aarau, Aarau, Switzerland.
⁵ Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland.
⁶ Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Zurich, Switzerland.

Abstract

There are few randomized trials to evaluate the use of PSMA-PET in the planning of post-prostatectomy radiotherapy. There are two unresolved questions 1) should we increase the dose to lesions visible on PSMA-PET 2) can we reduce dose in the case of a negative PSMA-PET. In this review, we summarize and discuss the available evidence in the literature. We found that in general, there seems to be an advantage for dose-increase, but ta large recent study from the pre-PSMA era didn't show an advantage for dose escalation. Retrospective studies have shown that conventional doses to PSMA-PET-positive lesions seem sufficient. On the other hand, in the case of a negative PSMA-PET, there is no evidence that dose-reduction is possible. In the future, the combination of PSMA-PET with genomic classifiers could help in better identify patients who might benefit from either dose- de-or -increase. We further need to identify intraindividual references to help identify lesions with higher aggressiveness.

Keywords: PSA; PSMA-PET; dose ecalation; postoperative radiotherapy; prostate cancer.

Grants and funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.