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You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-11 THE ADDED VALUE OF CONCOMITANT WHOLE-PELVIS SALVAGE RADIATION THERAPY IN OLIGO-RECURRENT PROSTATE CANCER PATIENTS TREATED WITH METASTASIS-DIRECTED THERAPY FOR DISTANT POSITIVE UPTAKES AT PSMA PET Elio Mazzone, Giorgio Gandaglia, Armando Stabile, Vito Cucchiara, Francesco Barletta, Simone Scuderi, Daniele Robesti, Mattia Longoni, Mario de Angelis, Pietro Scilipoti, Leonardo Quarta, Maria Picchio, Cesare Cozzarini, Arturo Chiti, Andrea Necchi, Daniele Raggi, Pierre I. Karakiewicz, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Armando StabileArmando Stabile , Vito CucchiaraVito Cucchiara , Francesco BarlettaFrancesco Barletta , Simone ScuderiSimone Scuderi , Daniele RobestiDaniele Robesti , Mattia LongoniMattia Longoni , Mario de AngelisMario de Angelis , Pietro ScilipotiPietro Scilipoti , Leonardo QuartaLeonardo Quarta , Maria PicchioMaria Picchio , Cesare CozzariniCesare Cozzarini , Arturo ChitiArturo Chiti , Andrea NecchiAndrea Necchi , Daniele RaggiDaniele Raggi , Pierre I. KarakiewiczPierre I. Karakiewicz , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastasis directed therapy (MDT) has been shown to reduce risk of progression in recurrent prostate cancer (PCa) patients with positive PET PSMA. Since PSMA PET may miss micro-metastatic local recurrence, we aimed at identifying the optimal candidates for concomitant whole-pelvis salvage radiation therapy (WPRT) in patients with extra-pelvic positive PSMA PET after biochemical recurrence (BCR) and who are candidate for MDT. METHODS: We identified 76 patients treated with MDT for a positive PSMA PET outside the pelvic area for BCR after RP between 2016 and 2022. MDT consisted of stereotactic ablative radiation therapy (SABR) on positive spots, either nodal or bony. The main outcome was clinical recurrence (CR), defined as any new metastases at imaging after a first PSMA PET. We investigated the association between WPRT at the time of MDT and CR using multivariable Cox regression models. To identify the optimal candidates for concomitant WPRT, the individual risk of CR at 3 year after PET PSMA according to PSA at PSMA PET, number of positive spots, location of positive spots (retroperitoneal nodes vs bone) and androgen-deprivation therapy (ADT) use was calculated. Such individual risk was plotted against the observed CR rate after PSMA PET, stratified by the use of WPRT. RESULTS: A total of 39 (51%) patients received WPRT. Overall, 44 (58%) and 40 (52%) had extra-pelvic nodal spots and bony spots, respectively. Median number of spots was 1 (IQR 1-3) and 56 patients (73%) had at least one adverse pathology feature (pN1 or positive margins or pT3b/4). Overall, 31 patients experienced CR. At Cox models, concomitant WPRT was associated with lower CR risk (HR, 0.5; p=0.02). When included in Cox models accounting for individual risk of CR, WPRT was mainly beneficial when CR risk at 3 years was>10% (Figure 1). CONCLUSIONS: Adding WPRT in patients treated with MDT for positive PSMA PET outside pelvis can provide oncological benefit in patients with an estimated risk of 3-yr CR higher than 10%, since sub-optimal accuracy of PSMA PET can miss residual pelvic metastases. On the other hand, MDT alone can be a safe approach in men with extra-pelvic spots at PSMA PET but with low risk of metastatic progression at 3 year. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e224 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information 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 Francesco Barletta More articles by this author Simone Scuderi More articles by this author Daniele Robesti More articles by this author Mattia Longoni More articles by this author Mario de Angelis More articles by this author Pietro Scilipoti More articles by this author Leonardo Quarta 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 Andrea Necchi More articles by this author Daniele Raggi More articles by this author Pierre I. Karakiewicz More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...
Mazzone et al. (Mon,) studied this question.