Prostate-Specific Membrane Antigen PET Response Associates with Metastasis-Free Survival After Stereotactic Ablative Radiation in Oligometastatic Prostate Cancer.

Autor: Sutera P; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Deek MP; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey., Deek RA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Guler OC; Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey., Hurmuz P; Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey., Reyhan M; Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey., Rowe S; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland., Radwan N; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Dipasquale S; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Hrinivich WT; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Lowe K; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Ren L; Department of Radiation Oncology, University of Maryland, Baltimore, Maryland., Saraiya B; Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey., Ennis R; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey., Hathout L; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey., Mayer T; Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey., Deweese TL; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Song DY; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Kiess A; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland., Oymak E; Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey., Pienta K; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Feng F; Department of Radiation Oncology, University of California San Francisco, San Francisco, California., Pomper M; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Ozyigit G; Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey., Tran PT; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Radiation Oncology, University of Maryland, Baltimore, Maryland.; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland.; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland., Onal C; Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey.; Department of Radiation Oncology, Faculty of Medicine, Baskent University, Ankara, Turkey., Phillips RM; Department of Radiation Oncology, The Mayo Clinic, Rochester, Minnesota.
Jazyk: angličtina
Zdroj: Advances in radiation oncology [Adv Radiat Oncol] 2024 Apr 13; Vol. 9 (7), pp. 101507. Date of Electronic Publication: 2024 Apr 13 (Print Publication: 2024).
DOI: 10.1016/j.adro.2024.101507
Abstrakt: Purpose: Emerging data suggest that metastasis-directed therapy (MDT) improves outcomes in patients with oligometastatic castration-sensitive prostate cancer (omCSPC). Prostate-specific membrane antigen positron emission tomography (PSMA-PET) can detect occult metastatic disease, and PSMA response has been proposed as a biomarker for treatment response. Herein, we identify and validate a PSMA-PET biomarker for metastasis-free survival (MFS) following MDT in omCSPC.
Methods and Materials: We performed an international multi-institutional retrospective study of patients with omCSPC, defined as ≤3 lesions, treated with metastasis-directed stereotactic ablative radiation who underwent PSMA-PET/computed tomography (CT) before and after (median, 6.2 months; range, 2.4-10.9 months) treatment. Pre- and post-MDT PSMA-PET/CT maximum standardized uptake value (SUV max ) was measured for all lesions, and PSMA response was defined as the percent change in SUV max of the least responsive lesion. PSMA response was both evaluated as a continuous variable and dichotomized into PSMA responders, with a complete/partial response (at least a 30% reduction in SUV max ), and PSMA nonresponders, with stable/progressive disease (less than a 30% reduction in SUV max ). PSMA response was correlated with conventional imaging-defined metastasis-free survival (MFS) via Kaplan-Meier and Cox regression analysis.
Results: A total of 131 patients with 261 treated metastases were included in the analysis, with a median follow-up of 29 months (IQR, 18.5-41.3 months). After stereotactic ablative radiation, 70.2% of patients were classified as PSMA responders. Multivariable analysis demonstrated that PSMA response as a continuous variable was associated with a significantly worse MFS (hazard ratio = 1.003; 95% CI, 1.001-1.006; P = .016). Patients classified as PSMA responders were found to have a significantly improved median MFS of 39.9 versus 12 months ( P = .001) compared with PSMA nonresponders. Our study is limited as it is a retrospective review of a heterogenous population.
Conclusions: After stereotactic ablative radiation, PSMA-PET response appears to be a radiographic biomarker that correlates with MFS in omCSPC. This approach holds promise for guiding clinical management of omCSPC and should be validated in a prospective setting.
(© 2024 The Authors.)
Databáze: MEDLINE
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