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Development and Validation of a Multi-institutional Nomogram of Outcomes for PSMA-PET-Based Salvage Radiotherapy for
Constantinos Zamboglou1,2,3,4, Jan C Peeken5,6,7, Ali Janbain8
1Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
JAMA Network Open
|May 23, 2023
Summary
A new nomogram predicts outcomes for prostate cancer patients undergoing PSMA-PET-guided salvage radiotherapy (sRT). This tool aids in estimating freedom from biochemical failure (FFBF) after treatment for recurrent disease.
Area of Science:
- Oncology
- Radiotherapy
- Nuclear Medicine
Background:
- Prostate-specific antigen membrane positron-emission tomography (PSMA-PET) is crucial for guiding salvage radiotherapy (sRT) in recurrent or persistent prostate cancer post-prostatectomy.
- Accurate prediction of treatment outcomes is essential for optimizing patient management and counseling.
Purpose of the Study:
- To develop and validate a nomogram predicting freedom from biochemical failure (FFBF) after PSMA-PET-guided sRT in prostate cancer patients.
- To identify key predictors of FFBF to improve personalized treatment strategies.
Main Methods:
- Retrospective cohort study including 1029 patients with prostate cancer treated with sRT guided by PSMA-PET scans.
- Patients received sRT to the prostatic fossa, with or without pelvic lymphatics irradiation and/or androgen deprivation therapy (ADT).
- A predictive nomogram was developed using training data and validated internally and externally; biochemical relapse was defined as PSA nadir of 0.2 ng/mL.
Main Results:
- Key predictors for FFBF included pre-sRT PSA level, ISUP grade, pT stage, surgical margins, ADT use, sRT dose, and nodal recurrence on PSMA-PET.
- The nomogram demonstrated good predictive performance with concordance indices of 0.72 (internal validation) and 0.67 (external validation).
- Local recurrences were observed in 42.5% and nodal recurrences in 30.4% of patients based on PSMA-PET scans.
Conclusions:
- An internally and externally validated nomogram can accurately estimate individual patient outcomes after PSMA-PET-guided sRT for prostate cancer.
- This tool aids clinicians in predicting FFBF and personalizing treatment decisions for patients with recurrent or persistent prostate cancer.
