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Differential impact of radiation therapy after radical prostatectomy on recurrence patterns: an assessment using [68Ga]Ga-PSMA ligand PET/CT(MRI)

Prostate Cancer and Prostatic Diseases volume 24, pages 439–447 (2021)Cite this article

Subjects

Abstract

Purpose

To evaluate the differential impact of postoperative radiotherapy (RT) on recurrence patterns in patients treated with radical prostatectomy (RP) using [68Ga]Ga-PSMAHBED-CC conjugate 11 positron emission tomography (PSMA 11-PET).

Methods

We assessed 162 consecutive patients who experienced biochemical recurrence (BCR) after RP for nonmetastatic prostate cancer (PC). All had at least one positive lesion on imaging. No patient was on androgen deprivation therapy (ADT). Patients were categorized into those who had received adjuvant/salvage RT ± ADT and those who did not (RP only). Lesion- and patient-based analyses were performed. The impact of the radiation field was assessed.

Results

Overall, 57 BCR patients underwent RP only, 105 received postoperative RT. Median PSA was 1.01 ng/ml (IQR 0.58–2). In the lesion-based analysis, compared to the RP only patients, those who had received postoperative RT, had less lymph node (LN) recurrences distal to the common iliac bifurcation (35.2 vs. 57.9%, p = 0.05), but were more likely to harbor positive LNs proximal to the iliac bifurcation and in the presacral (34.2 vs. 12.3%, p = 0.002) areas as well as bone metastases (25.7 vs. 8.8%, p = 0.01). In the patient-based analysis, the patients with postoperative RT after RP had less recurrence in the pelvis only (pelvic LNs and/or prostate bed) (52.4 vs. 79%, p = 0.002), but were more likely to harbor extrapelvic recurrence (41.9 vs. 15.8%, p = 0.001). Patients who received RT to the prostate bed only had more recurrence to the pelvic LN only (54.2% vs. 23.4%, p = 0.002), but less extrapelvic recurrence (31.3 vs. 53.2%, p = 0.03) and less bone recurrence (16.7 vs. 36.2%, p = 0.031) compared to those patients, who received RT to the prostate bed and pelvic nodes.

Conclusions

Postoperative radiation treatment alters the recurrence pattern in BCR patients after RP. Further prospective studies are needed to establish a decision tree for optimal imaging/management according to previous treatments.

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Fig. 1: A1-A3: a 72-year-old man who had radical prostatectomy in December 2017.

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Author information

Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Vienna, Austria

    Bernhard Grubmüller, Victoria Jahrreiss, Nicolai Huebner, Judith Stangl-Kremser & Shahrokh F. Shariat

  2. Workinggroup of Diagnostic Imaging in Urology, Austrian Society of Urology, Vienna, Austria

    Bernhard Grubmüller

  3. Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria

    Markus Mitterhauser, Marcus Hacker & Sazan Rasul

  4. Ludwig Boltzmann Institute for Applied Diagnostics, Vienna, Austria

    Markus Mitterhauser

  5. Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria

    Karl Hermann Grubmüller

  6. Department of Biomedical Imaging and Image guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria

    Pascal Baltzer

  7. Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria

    Gregor Goldner

  8. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  9. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  10. Department of Urology and Division of Medical Oncology, Weill Medical College of Cornell University, New York, NY, USA

    Shahrokh F. Shariat

  11. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

  12. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Shahrokh F. Shariat

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Correspondence to Shahrokh F. Shariat.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study

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Grubmüller, B., Jahrreiss, V., Huebner, N. et al. Differential impact of radiation therapy after radical prostatectomy on recurrence patterns: an assessment using [68Ga]Ga-PSMA ligand PET/CT(MRI). Prostate Cancer Prostatic Dis 24, 439–447 (2021). https://doi.org/10.1038/s41391-020-00294-0

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