Oncological outcomes after tailored PSMA-PET-guided treatment in biochemical relapse after prostatectomy (PSICHE Trial-NCT 05022914).
[BACKGROUND] Next-generation imaging (NGI) (68 Ga-prostate-specific membrane antigen (PSMA)-PET) represents a cornerstone in biochemical recurrent prostate cancer management.
- 추적기간 19 months
APA
Francolini G, Garlatti P, et al. (2026). Oncological outcomes after tailored PSMA-PET-guided treatment in biochemical relapse after prostatectomy (PSICHE Trial-NCT 05022914).. La Radiologia medica, 131(1), 158-166. https://doi.org/10.1007/s11547-025-02107-7
MLA
Francolini G, et al.. "Oncological outcomes after tailored PSMA-PET-guided treatment in biochemical relapse after prostatectomy (PSICHE Trial-NCT 05022914).." La Radiologia medica, vol. 131, no. 1, 2026, pp. 158-166.
PMID
41081978
Abstract
[BACKGROUND] Next-generation imaging (NGI) (68 Ga-prostate-specific membrane antigen (PSMA)-PET) represents a cornerstone in biochemical recurrent prostate cancer management. PSICHE is a multicentric prospective study, aimed to assess oncological outcomes of a predefined tailored imaging-guided treatment.
[METHODS] Patients with biochemical recurrence (BCR) after surgery (prostate-specific antigen [PSA] > 0.2 ≤ 1 ng/mL) underwent staging with PSMA-PET. A predefined treatment algorithm was proposed to all patients: prostate bed salvage radiotherapy (SRT) in case of negative or positive PET within the prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease were detected, and androgen deprivation therapy (ADT) was proposed in widespread polymetastatic disease. Chi-square test was used to evaluate the relationship between baseline features and the rate of positive PSMA-PET/CT.
[RESULTS] One hundred and fifty-nine patients were enrolled. One hundred and seven patients had a PSMA negative/positive in the prostate bed; pelvic nodal disease or oligometastatic metastatic disease was detected in 39 and 10 patients, respectively. Three patients had a polymetastatic disease. Seventeen patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Eighty-eight patients were treated with SRT, and SBRT was performed in 49 patients with pelvic or extrapelvic oligometastatic disease. Stratifying patients according to EAU criteria (low risk: PSA doubling time > 12 months and Gleason score < 8; high risk: PSA doubling time ≤ 12 months or Gleason score ≥ 8) after a median follow-up of 19 months in the overall population, median BRFS and MFS were not significantly different between the two risk subgroups (p = 0.58 and p = 0.21, respectively). Median metastasis-free and ADT-free survival were not reached.
[CONCLUSIONS] A PSMA-targeted treatment strategy led to promising results, avoiding unnecessary toxicity from ADT or standard SRT administered in unselected patients. Analysis after longer follow-up is needed to clarify survival outcomes.
[METHODS] Patients with biochemical recurrence (BCR) after surgery (prostate-specific antigen [PSA] > 0.2 ≤ 1 ng/mL) underwent staging with PSMA-PET. A predefined treatment algorithm was proposed to all patients: prostate bed salvage radiotherapy (SRT) in case of negative or positive PET within the prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease were detected, and androgen deprivation therapy (ADT) was proposed in widespread polymetastatic disease. Chi-square test was used to evaluate the relationship between baseline features and the rate of positive PSMA-PET/CT.
[RESULTS] One hundred and fifty-nine patients were enrolled. One hundred and seven patients had a PSMA negative/positive in the prostate bed; pelvic nodal disease or oligometastatic metastatic disease was detected in 39 and 10 patients, respectively. Three patients had a polymetastatic disease. Seventeen patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Eighty-eight patients were treated with SRT, and SBRT was performed in 49 patients with pelvic or extrapelvic oligometastatic disease. Stratifying patients according to EAU criteria (low risk: PSA doubling time > 12 months and Gleason score < 8; high risk: PSA doubling time ≤ 12 months or Gleason score ≥ 8) after a median follow-up of 19 months in the overall population, median BRFS and MFS were not significantly different between the two risk subgroups (p = 0.58 and p = 0.21, respectively). Median metastasis-free and ADT-free survival were not reached.
[CONCLUSIONS] A PSMA-targeted treatment strategy led to promising results, avoiding unnecessary toxicity from ADT or standard SRT administered in unselected patients. Analysis after longer follow-up is needed to clarify survival outcomes.
MeSH Terms
Humans; Male; Prostatic Neoplasms; Prostatectomy; Aged; Prospective Studies; Neoplasm Recurrence, Local; Middle Aged; Positron Emission Tomography Computed Tomography; Treatment Outcome; Prostate-Specific Antigen; Glutamate Carboxypeptidase II; Gallium Radioisotopes; Radiosurgery; Radiopharmaceuticals; Gallium Isotopes; Salvage Therapy; Antigens, Surface
같은 제1저자의 인용 많은 논문 (3)
- Re: Carlo Andrea Bravi, Sophie Knipper, Axel Heidenreich, et al. Oncologic Outcomes of Template Versus Radioguided Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography Scan: Results from a Multi-institutional Collaboration. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.05.019.
- Re-irradiation in patients affected by prostate cancer and relapsing after previous definitive or postoperative radiotherapy. An international registry based study on behalf of Italian association of radiotherapy and clinical oncology (AIRO). (RE-START).
- Impact of stereotactic body radiotherapy after progression in castrate resistant prostate cancer patients undergoing first line abiraterone treatment. A subgroup analysis from ARTO trial (NCT03449719).