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Patterns of Progression After

Alexander Soldatov1, Christoph A J von Klot2, Daniel Walacides1

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Summary
This summary is machine-generated.

This study shows that 68Ga-PSMA-ligand PET/CT-guided radiation therapy (RT) effectively controls recurrent oligometastatic prostate cancer (PCa), with most relapses occurring outside the treated area. Repeated RT may benefit select patients.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiation Oncology

Background:

  • Prostate cancer (PCa) recurrence, particularly oligometastatic disease, presents treatment challenges.
  • 68Gallium-prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET)/computed tomography (CT) aids in precise disease localization.
  • Radiation therapy (RT) is a key modality for managing recurrent PCa.

Purpose of the Study:

  • To investigate the patterns of disease progression following 68Ga-PSMA-ligand PET/CT-guided RT in patients with recurrent oligometastatic PCa.
  • To evaluate the efficacy of this treatment approach in terms of biochemical and distant disease control.

Main Methods:

  • 108 patients with recurrent oligometastatic PCa after primary therapy received 68Ga-PSMA-ligand PET/CT-guided RT.
  • Biochemical progression-free survival (bPFS) and distant disease-free survival (dDFS) were assessed.
  • Patterns of progression were analyzed using repeat 68Ga-PSMA-ligand PET/CT, comparing relapse sites to the radiation therapy clinical target volume.

Main Results:

  • 97.2% of patients responded biochemically post-RT.
  • Median bPFS was 16 months; median dDFS was 11 months.
  • Out of 33 patients with progression, 87.9% had outfield relapses, while only 12.1% had infield relapses. Skeletal and distant lymph node metastases became more common.

Conclusions:

  • 68Ga-PSMA-ligand PET/CT-guided RT offers effective local control and prolonged bPFS for recurrent oligometastatic PCa.
  • The observed progression patterns suggest that repeated PET/CT-guided RT could be a viable option for carefully selected patients with relapsed disease.