New study (Oct 2021)
jnm.snmjournals.org/content...
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Patients and Methods:
Patients with BCR/BCP* were enrolled under the same prospective clinical trial protocol conducted at three sites (n = 1777, 91%; UCLA n = 662, NCT02940262; UCSF n = 508, NCT03353740; Michigan, n = 607, NCT03396874); 183 patients with BCP from Universities of Essen, Bologna, and Munich (TUM) were included retrospectively. Patients with BCR had to have sufficient data to determine EAU risk score. Multivariate, binomial logistic regression models were applied to assess independent predictors of M1 disease.
Results:
A total of 1960 patients were included. Post-RP EAU BCR low risk, EAU BCR high risk, and BCP groups yield distant metastatic (M1) detection in 43/176 (24%), 342/931 (37%), and 154/386 (40%) of patients. For post-RT EAU BCR low risk and EAU BCR high risk groups, M1 detection rate was 113/309 (37%) and 110/158 (70%), respectively. BCP, high risk BCR and higher levels of serum PSA were significantly associated with PSMA PET M1 disease in multivariate regression analysis. PSMA-PET revealed no disease in 25% and locoregional only disease in 33% of patients with post-RP or post-RT EAU BCR high risk.
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* BCP = BioChemical Persistance
Take home messages:
1) Distant Metastases (M1) were more frequent on BCR patients after RT than RP for both risk groups:
Low EAU risk: 37% > 24%
High EAU risk: 70% > 37% almost double
This indicates that the post-RP BCR definition is more sensitive than its counterpart post-RT.
2) Blind salvage RT after BCR has, at least, an 24% to 37% failure rate as distant metastases have already occurred. In general, it has at least a 33% success rate. The remaining ~1/3 is indeterminable, although a portion of the "no disease 25%" may be accounted as over-treatment.
