Abstract :
Keywords: prostate-specific membrane antigen; PSMA; PET/CT; biochemical failure; radical prostatectomy; salvage RT Abstract Objective To assess European Association of Urology (EAU) risk groups for biochemical recurrence (BCR) of prostate cancer relative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) status and oncological outcomes. Patients and Methods A retrospective analysis of a study that incorporated PSMA-PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA-PET findings, and deployment of salvage radiotherapy (SRT). The primary oncological outcome was event-free survival (EFS) and this was analysed relative to clinical and imaging variables. An 'event' occurred if prostate-specific antigen (PSA) level rose 0.2ng/mL above nadir or additional therapies were introduced. Results A total of 137 patients were included, most of whom had EAU high-risk disease (76%) and/or low PSA levels (80% Conclusions In patients with post-RP BCR, PSMA-PET findings and receipt of SRT predicted EFS. In patients receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA-PET. CAPTION(S): AppendixS1 TableS1 Demographic data according to EAU risk groups, PSMA-PET status and radiotherapy (RT) use. RP, radical prostatectomy; IQR, interquartile range. TableS2 PSMA-PET status according to both EAU risk and PSA level (further substratified compared to Table1). Negative PSMA-PET demonstrated no disease sites; local recurrence showed avidity confined to the prostatic fossa. TableS3 Event-free survival (EFS) among the overall population (TableA) and men who did not receive salvage radiotherapy (no SRT; TableB) with Cox regression analysis (TableC) according to EAU risk, PSMA-PET status and their combination. FigureS1 Patient inclusion flow chart considering the original patient cohort (n=260) and the cohort in the present analysis (n=137); PSAdt, PSA doubling time. Byline: Matthew J. Roberts, Mark D. Chatfield, George Hruby, Rohan Nandurkar, Paul Roach, Jo Anne Watts, Thomas Cusick, Andrew Kneebone, Thomas Eade, Bao Ho, Andrew Nguyen, Colin Tang, Michael McCarthy, Roslyn Francis, Phillip Stricker, Louise Emmett