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PSMA PET/CT in the Evaluation of Initial Response in Candidates Who Underwent Salvage Radiation Therapy after Radical Prostatectomy for Prostate Cancer.

PURPOSE
To assess predictors for the short-term oncological outcome of patients who underwent salvage radiation therapy (SRT) for biochemical recurrence (BCR) after robot-assisted laparoscopic radical prostatectomy (RARP), without evidence of metastases on prostate-specific membrane antigen (PSMA) PET/CT.


MATERIALS AND METHODS
A total of 194 patients with BCR after RARP who underwent a PSMA PET/CT prior to SRT were retrospectively analyzed. Patients with lymph-node or distant metastases on restaging PSMA PET/CT or at the time of extended pelvic lymph-node dissection during RARP were excluded, as were patients who received androgen deprivation therapy during or prior to SRT. A multivariable logistic regression analysis was performed to assess predictors for treatment response, defined as a prostate-specific antigen (PSA)-value ≤0.1 ng/mL after SRT.


RESULTS
Overall treatment response after SRT was 75% (146/194 patients). On multivariable analysis, the PSA-value at initiation of SRT (odds ratio (OR) 0.42 (95%Confidence Interval (CI) 0.27-0.62), p <0.001), pathological T-stage (pT3a vs. pT2: OR 0.28 (95%CI 0.11-0.69)), p=0.006; pT3b vs. pT2: OR 0.26 (95%CI 0.09-0.71), p=0.009) and local recurrent disease on PSMA PET/CT (OR 5.53 (95%CI 1.96-18.52), p=0.003) were predictors of treatment response.


CONCLUSIONS
SRT in patients without evidence of metastases on PSMA PET/CT showed a good overall treatment response of 75%. Higher treatment response rates were observed in patients with lower PSA-values at initiation of SRT, in those with local recurrent disease on PSMA PET/CT imaging, and lower pathological T-stage (pT2 vs. pT3a/b).