Mp14-13 Exploring the Interaction Between the Use of Metastasis Directed Therapy in Patients With Positive Psma Pet and Patterns of Biochemical Recurrence After Radical Prostatectomy. Results of a Large, Single Institution Series

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-13 EXPLORING THE INTERACTION BETWEEN THE USE OF METASTASIS DIRECTED THERAPY IN PATIENTS WITH POSITIVE PSMA PET AND PATTERNS OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY. RESULTS OF A LARGE, SINGLE INSTITUTION SERIES Elio Mazzone, Giorgio Gandaglia, Armando Stabile, Vito Cucchiara, Mattia Longoni, Maria Picchio, Cesare Cozzarini, Arturo Chiti, Giuseppe Ottone Cirulli, Daniele Robesti, Riccardo Leni, Mario de Angelis, Antony Pellegrino, Pierre I. Karakiewicz, Andrea Necchi, Daniele Raggi, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone , Giorgio GandagliaGiorgio Gandaglia , Armando StabileArmando Stabile , Vito CucchiaraVito Cucchiara , Mattia LongoniMattia Longoni , Maria PicchioMaria Picchio , Cesare CozzariniCesare Cozzarini , Arturo ChitiArturo Chiti , Giuseppe Ottone CirulliGiuseppe Ottone Cirulli , Daniele RobestiDaniele Robesti , Riccardo LeniRiccardo Leni , Mario de AngelisMario de Angelis , Antony PellegrinoAntony Pellegrino , Pierre I. KarakiewiczPierre I. Karakiewicz , Andrea NecchiAndrea Necchi , Daniele RaggiDaniele Raggi , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastasis directed therapy (MDT) has been proposed within patients positive uptake at PSMA PET for oligo-recurrent prostate cancer (PCa). However, there is little evidence regarding the prognostic value of MDT according to the pattern of biochemical recurrence (BCR). Thus, we aimed to address the impact of MDT on oncological outcomes in patients with positive PSMA for primary (pBCR) or secondary BCR (sBCR). METHODS: We retrospectively identified 383 men treated with RP between 1998-2022 and evaluated with PSMA PET for BCR between 2016-2023. Among those with a positive PSMA PET (n=247), patients with a pBCR after RP or with sBCR and a first salvage treatment (ST) were selected. Clinical recurrence (CR) was defined as new metastases detected at imaging after PSMA PET. Adverse pathological features (i.e. Grade Group 4-5 with ≥pT3a stage and/or lymph node invasion) and ST were also compared between groups. Cox regression analyses assessed the impact of MDT and its interaction with BCR patterns on CR after adjusting for PSA at PSMA PET, number of positive spots and concomitant ADT. Multivariable (MV) Cox-derived Kaplan-Meier (KM) analyses depicted the time from PSMA PET to CR in men treated with or without MDT after stratification according to BCR pattern. RESULTS: Among men with positive PSMA PET, 114 (46%) and 133 (54%) were pBCR or sBCR, respectively. Median number of positive spots was 1 (IQR 1-5). Median time from surgery to PSMA PET and follow-up for survivors after PET-PSMA were 108 and 30 months. Overall, 90 patients had CR. At MV Cox analyses, MDT was associated with 2-fold reduction in risk of progression vs. no MDT (HR 0.52, p=0.003) after adjusting for confounders. In patients receiving MDT for pBCR, MDT was associated with lower risk of CR vs. no MDT (HR: 0.77; p=0.02) but such benefit was smaller compared to men receiving MDT for sBCR after ST (HR: 0.44, p=0.001). At the Cox derived KM, the 3-year CR-free survival rates were 56 vs. 43% (p=0.02) in MDT vs. no MDT group for primary BCR, respectively, and 70 vs. 30% (p=0.001) in MDT vs. no MDT group for secondary BCR after a first ST after surgery, respectively. CONCLUSIONS: Among patients with PSMA PET positive spots, MDT improved progression-free survival regardless of BCR pattern, but its effect was stronger in oligo-recurrent disease at sBCR after initial ST. Intensification of local approaches is thus effective even in men with sBCR who are instead more prone to be considered as affected by a more disseminated disease. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e225 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 Mattia Longoni 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 Giuseppe Ottone Cirulli More articles by this author Daniele Robesti More articles by this author Riccardo Leni More articles by this author Mario de Angelis More articles by this author Antony Pellegrino More articles by this author Pierre I. Karakiewicz More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...