Single-fraction image-guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical...

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• Radical prostatectomy (RP) is a primary treatment for prostate cancer (PC).
• Local recurrence after RP can occur, necessitating further treatment.
• Accurate imaging like PSMA PET/CT and mpMRI is crucial for detecting recurrence.

Purpose of the Study:

• To evaluate the efficacy and safety of single-fraction robotic stereotactic ablative body radiotherapy (SABR) for locally recurrent prostate cancer (PC) post-radical prostatectomy (RP).
• To assess SABR's potential as a therapeutic option for patients with localized recurrence and no distant metastases.

Main Methods:

• 35 patients with single-site local PC recurrence post-RP were treated with SABR.
• Diagnosis was confirmed using PSMA PET/CT and multiparametric MRI (mpMRI).
• SABR was delivered in a single fraction (20-22 Gy) using CyberKnife, with follow-up PSA monitoring.

Main Results:

• A significant PSA drop was observed in 27/35 patients at 3 months post-SABR.
• Biochemical response was noted in 30/35 patients by 6 months.
• Low toxicity rates were reported: 9% Grade 1 genitourinary and 6% Grade 1 gastrointestinal.

Conclusions:

• Single-fraction SABR is an effective treatment for localized recurrent PC post-RP without distant disease.
• SABR offers a low-toxicity alternative to re-surgery or other focal therapies.
• This approach can delay the need for androgen deprivation therapy (ADT) in patients with biochemical failure.