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Article Abstract
Purpose: PSMA-PET/CT is frequently used for staging patients with de-novo or recurrent prostate cancer (PCa). In patients with oligometastatic PCa PSMA-PET/CT guided stereotactic ablative body radiotherapy (SABR) is a common treatment option. Follow-up is regularly performed via measurement of prostate-specific-antigen (PSA) level. Response assessment based on follow-up PSMA-PET/CTs is poorly studied. Therefore, we report on long-term local tumor response using repeated PSMA-PET/CTs of patients with oligometastatic PCa after PSMA-PET/CT guided SABR.
Methods/patients: Patients with de-novo oligometastatic or oligoprogressive PCa who received PSMA-PET/CT-directed SABR with 5 × 7 Gy of at least one bone or lymph node lesion between 2015 and 2019 and had one or more follow-up PSMA-PET/CT were included in this retrospective single center analysis. PSMA response was evaluated by visual and quantitative assessment of local PSMA uptake pre- and post-SABR.
Results: Overall, 48 patients with 97 irradiated lesions and a total of 145 PSMA-PET/CT-scans were analyzed. 26 patients received androgen-deprivation-therapy (ADT) at any time. Median SUV per lesion was 10.88 (range 1.59-122.11) before SABR with a median CTV of 4.75 cm (Range 0.68-60.4 cm). In the first follow-up PET/CT after a median of 13 months (range 3-42) after SABR, median SUV per lesion declined to 2.2 (range 0.13-26.09). Complete remission (CR) was observed in 49 lesions, partial remission in 32 and stable disease in 12 lesions. Four lesions were non-responders. Over the course of up to five follow-up PSMA-PET/CTs a maximum of 90 % of the lesions showed CR. Median time to SUV was 19 months (range 3-50). 5-year local control was 86 %. No short-term or long-term toxicities were reported.
Conclusion: PSMA-PET/CT directed SABR provides excellent long-term local tumor control of 90% in bone and lymph node metastasis of oligometastatic PCa and is well tolerated. PSMA activity may further decrease after initial re-imaging with PSMA-PET/CT.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328682 | PMC |
| http://dx.doi.org/10.1016/j.ctro.2025.101021 | DOI Listing |
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