Influence of molecular imaging on patient selection for treatment intensification prior to salvage radiation therapy for prostate cancer: a post hoc analysis of the PROPS trial

Samuel Tremblay, Mofarej Alhogbani, Andrew Weickhardt, Ian D. Davis, Andrew M. Scott, Rodney J. Hicks, Ur Metser, Sue Chua, Reena Davda, Shonit Punwani, Heather Payne, Nina Tunariu, Bao Ho, Sympascho Young, Mahukpe Narcisse Ulrich Singbo, Glenn Bauman, Louise Emmett, Frédéric Pouliot

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The impact of molecular imaging (MI) on patient management after biochemical recurrence (BCR) following radical prostatectomy has been described in many studies. However, it is not known if MI-induced management changes are appropriate. This study aimed to determine if androgen deprivation therapy (ADT) management plan is improved by MI in patients who are candidates for salvage radiation therapy. Methods: Data were analyzed from the multicenter prospective PROPS trial evaluating PSMA/Choline PET in patients being considered for salvage radiotherapy (sRT) with BCR after prostatectomy. We compared the pre- and post-MI ADT management plans for each patient and cancer outcomes as predicted by the MSKCC nomogram. A higher percentage of predicted BCR associated with ADT treatment intensification after MI was considered as an improvement in a patient’s management. Results: Seventy-three patients with a median PSA of 0.38 ng/mL were included. In bivariate analysis, a positive finding on MI (local or metastatic) was associated with decision to use ADT with an odds ratio of 3.67 (95% CI, 1.25 to 10.71; p = 0.02). No factor included in the nomogram was associated with decision to use ADT. Also, MI improved selection of patients to receive ADT based on predicted BCR after sRT : the predicted nomogram 5-year biochemical-free survivals were 52.5% and 43.3%, (mean difference, 9.2%; 95% CI 0.8 to 17.6; p = 0.03) for sRT alone and ADT±sRT subgroups, while there was no statistically significant difference between subgroups before MI. Conclusions: PSMA and/or Choline PET/CT before sRT can potentially improve patient ADT management by directing clinicians towards more appropriate intensification.

Original languageEnglish
Article number57
Number of pages7
JournalCancer Imaging
Volume23
Issue number1
DOIs
Publication statusPublished - Dec 2023

Keywords

  • Biochemical recurrence
  • Choline
  • Molecular imaging
  • Prostate cancer
  • PSMA

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