Mp14-04 the Role of Psa Doubling Time in the Stratification of Patients With a Negative Psma Pet After Biochemical Recurrence of Prostate Cancer: Implications for Tailored Salvage Treatment Strategies

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-04 THE ROLE OF PSA DOUBLING TIME IN THE STRATIFICATION OF PATIENTS WITH A NEGATIVE PSMA PET AFTER BIOCHEMICAL RECURRENCE OF PROSTATE CANCER: IMPLICATIONS FOR TAILORED SALVAGE TREATMENT STRATEGIES Daniele Robesti, Elio Mazzone, Giorgio Gandaglia, Armando Stabile, Vito Cucchiara, Maria Picchio, Cesare Cozzarini, Arturo Chiti, Francesco Montorsi, and Alberto Briganti Daniele RobestiDaniele Robesti , Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Armando StabileArmando Stabile , Vito CucchiaraVito Cucchiara , Maria PicchioMaria Picchio , Cesare CozzariniCesare Cozzarini , Arturo ChitiArturo Chiti , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with biochemical recurrence (BCR) after radical prostatectomy, it is still unclear whether a negative PSMA PET can rule out clinically meaningful recurrent disease and, in consequence, whether the use of salvage treatments can be safely postponed. Here, we tested which clinical parameters may predict early clinical progression after a negative PSMA PET for BCR. METHODS: We relied on 136 patients with a negative PSMA PET for BCR after RP between 2016 and 2022 at a single institution. Patients treated with salvage radiation therapy (n=60) were excluded. The outcome was early clinical progression (CP), defined as any new metastasis detected at imaging within 12 months after a negative PSMA PET. Multivariable Cox regressions (MCR) tested for early CP. Covariates were ISUP grade (≤7 vs 8-10), PSA at PSMA PET, PSA doubling time (PSADT) and pN status (pN0/x vs pN1). PSA and PSADT cut-offs were explored through cubic splines analyses. Regression tree analysis stratified patients into risk groups. Accuracy and net-benefit of risk groups were assessed using area-under-the-curve (AUC) and decision curve analysis (DCA). RESULTS: Overall, 34 (45%) and 14 (18%) had ISUP grade 8-10 and pN1 disease at final pathology, respectively. At cubic splines analysis, non-linearity in predicting CP was recorded at 6 months of PSADT. At MCR, PSADT<6 months (HR 3.1, p=0.01) and ISUP 8-10 (HR 2.4, p=0.01) correlated with higher early CP risk. At regression tree analysis, patients were stratified in three risk groups (Figure 1). The model depicted good discrimination (AUC 74%) and higher net-benefit at DCA compared to the EAU BCR risk groups (AUC 68%). CONCLUSIONS: PSADT and ISUP grade can optimize the identification of patients at higher risk for early metastatic progression after a negative PSMA PET for BCR. These patients would be the ideal candidate for treatment intensification, despite negative imaging. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e220 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Daniele Robesti More articles by this author Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Maria Picchio More articles by this author Cesare Cozzarini More articles by this author Arturo Chiti More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...