Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent PCa.

[pjoshea13]

New German study below.

Full title: "Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer."

"Median bRFS {biochemical recurrence-free survival} was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR {complete biochemical response}. Significantly longer median bRFS was observed in patients with a low preoperative PSA value ... and with a single lesion in preoperative PSMA-ligand PET"

"Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome."

-Patrick

ncbi.nlm.nih.gov/pubmed/309...

Eur Urol. 2019 Apr 12. pii: S0302-2838(19)30278-7. doi: 10.1016/j.eururo.2019.03.045. [Epub ahead of print]

Single Lesion on Prostate-specific Membrane Antigen-ligand Positron Emission Tomography and Low Prostate-specific Antigen Are Prognostic Factors for a Favorable Biochemical Response to Prostate-specific Membrane Antigen-targeted Radioguided Surgery in Recurrent Prostate Cancer.

Horn T1, Krönke M2, Rauscher I2, Haller B3, Robu S2, Wester HJ4, Schottelius M4, van Leeuwen FWB5, van der Poel HG6, Heck M1, Gschwend JE1, Weber W2, Eiber M2, Maurer T7.

Author information

1

Department of Urology, Technical University of Munich, Munich, Germany.

2

Department of Nuclear Medicine, Technical University of Munich, Munich, Germany.

3

Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany.

4

Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Munich, Germany.

5

Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.

6

Department of Urology, Antoni van Leeuwenhoek Hospital-The Netherlands Cancer Institute, Amsterdam, The Netherlands.

7

Department of Urology, Technical University of Munich, Munich, Germany; Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: [e-mail].

Abstract

BACKGROUND:

Prostate-specific membrane antigen (PSMA)-ligand positron emission tomography (PET) allows detection of metastatic prostate cancer (PC) lesions at low prostate-specific antigen (PSA) values. To facilitate their intraoperative detection during salvage surgery, we recently introduced PSMA-targeted radioguided surgery (RGS).

OBJECTIVE:

To describe the outcome of a large cohort of patients treated with PSMA-targeted RGS and to establish prognostic factors.

DESIGN, SETTING, AND PARTICIPANTS:

A total of 121 consecutive patients with recurrent PC as defined by PSMA-ligand PET (median PSA: 1.13ng/ml) underwent PSMA-targeted RGS.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

The frequency of a complete biochemical response (cBR; PSA <0.2ng/ml) without additional treatment and the duration of biochemical recurrence-free survival (bRFS, time from PSMA-targeted RGS with PSA <0.2ng/ml without further treatment) were evaluated and correlated with preoperatively available clinical variables.

RESULTS AND LIMITATIONS:

In almost all patients (120/121, 99%) metastatic tissue could be removed. A cBR was achieved in 77 patients (66%). The chance of cBR was highest in patients with both low preoperative PSA and a single lesion (38/45: 84%). Median bRFS was 6.4mo in the whole patient cohort and 19.8mo for patients with cBR. Significantly longer median bRFS was observed in patients with a low preoperative PSA value (p=0.004, hazard ratio 1.48, 95% confidence interval 1.13-1.93) and with a single lesion in preoperative PSMA-ligand PET (14.0 vs 2.5mo, p=0.002).

CONCLUSIONS:

PSMA-targeted RGS leads to a remarkable interval of bRFS in a subset of patients. The frequency of cBR and the duration of bRFS were highest in patients with a low preoperative PSA value and a single lesion on PSMA-ligand PET.

PATIENT SUMMARY:

Prostate-specific membrane antigen radioguided surgery delays disease progression in selected patients with recurrent prostate cancer after radical prostatectomy. Patients with a single lesion of recurrence and a low prostate-specific antigen value had the best outcome.

Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

KEYWORDS:

Biochemical recurrence; Prostate-specific antigen; Prostate-specific membrane antigen; Radioguided surgery; Salvage surgery

PMID: 30987843 DOI: 10.1016/j.eururo.2019.03.045

[GP24]

I would only have Dr. Maurer do this. He is one of the authors. You need experience to do that successfully. Here is a video demonstration of this type of surgery:

youtube.com/watch?v=KxhgJLA...(Not working as expected?)

[Tommyj2]

Perhaps I am dense but I don't know what "lesion" it is that they are removing??

[j-o-h-n in reply to Tommyj2]

Since you don't know, lets call it the "foreign lesion".

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/18/2019 6:10 PM DST

[Tommyj2 in reply to j-o-h-n]

Well THAT is certainly helpful : )

[j-o-h-n in reply to Tommyj2]

Hey, I'm here to serve.....🤷‍♂️

A Mexican, a Cuban, and a Chinese guy are riding in a truck. Who's driving? Immigration.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 04/18/2019 9:47 PM DST

[pjoshea13 in reply to Tommyj2]

'Lesion' & 'tumor' (or 'met') are often used interchangeably, but lesion has a broader meaning that includes other forms of abnormality. Obviously, in this group, we are concerned mostly with 'mets' (metastases), so automatically make the translation.

-Patrick

[Tommyj2 in reply to pjoshea13]

Helpful....thanks

[Blackpatch]

On the whole, I think this is a pretty depressing read. What it says is that by undertaking quite invasive surgery, they have bought men perhaps a year or two of additional time before needing to undertake the next form of anti-PCa therapy, whatever that may be.

There was no evidence, and indeed no claim, that this treatment was in any sense curative. Conversely, significant side effects were reported, albeit these may largely have been the result of earlier radiation treatment of these patients. I would like to have seen more discussion of the impact of removal of non-cancerous lymph nodes (average ten per patient) on QoL, and consideration of this impact vs. that of competing alternatives such as node-directed SBRT or even systemic treatment (ADT).

It's not clear if taking out these metastatic LNs adds a day to the life of these patients, despite the invasive nature of the treatment.

Don't get me wrong, I might end up going down this or the SBRT route myself if/when the time comes (and judging by the patient profile of this paper, I am right in the target zone) - the instinct to 'get this out of me' is surely one of the most potent forces in PCa therapy. But I would really like to see researchers being up front on whether or not their experimental treatments actually add to survival.

Stuart

[Tommyj2 in reply to Blackpatch]

Stuart...

You make a good point.... frankly I am getting more and more confused as to the utility of ANY of these "life prolonging" treatments as there appears to be little definitive data that is contemporary as to how many months/years can be added to ones life ( post bone mets) by any of these methods..... It appears that many of the folks in this forum are exceeding published expectations by a wide margin and it becomes exceedingly difficult to make a choice in the absence of definitive data...... If I were to make my determinations just by what I read outside of this group I would be MOST depressed if I were Stage 4... but many in this group give reason to be hopeful....

[Jbooml]

Gruesome...I cannot imagine myself enrolling in something that subjects my anatomy to something this crude. What am I missing....?