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Oligometastasis in Prostate Cancer: Can We Learn from Those "Excluded" from a Phase 2 Trial?


ABSTRACT: We conducted and previously published a phase 2 trial of metastasis-directed therapy (MDT) in men with recurrence of prostate cancer at a low prostate-specific antigen level following radical prostatectomy and postoperative radiotherapy. All patients had negative conventional imaging and underwent prostate-specific membrane antigen (PSMA) positron emission tomography (PET). Patients without visible disease (n = 16) or with metastatic disease not amenable to MDT (n = 19) were excluded from the interventional study. The remaining patients with disease visible on PSMA-PET received MDT (n = 37). We analyzed all three groups to identify distinct phenotypes in the era of molecular imaging-based characterization of recurrent disease. Median follow up was 37 mo (interquartile range 27.5-43.0). There was no significant difference in time to the development of metastasis on conventional imaging among the groups; however, castrate-resistant prostate cancer-free survival was significantly shorter for patients with PSMA-avid disease not amenable to MDT (p = 0.047). Our findings suggest that PSMA-PET findings can help in discriminating diverging clinical phenotypes among men with disease recurrence and negative conventional imaging after local therapies with curative intent. There is a pressing need for better characterization of this rapidly growing population of patients with recurrent disease defined by PSMA-PET to derive robust selection criteria and outcome definitions for ongoing and future studies.

Patient summary

In men with prostate cancer with rising PSA levels following surgery and radiation, a newer type of scan called PSMA-PET (prostate-specific membrane antigen positron emission tomography) can be used to characterize and differentiate the patterns of recurrence, and inform future cancer outcomes.

SUBMITTER: Glicksman RM 

PROVIDER: S-EPMC10240507 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Oligometastasis in Prostate Cancer: Can We Learn from Those "Excluded" from a Phase 2 Trial?

Glicksman Rachel M RM   Murad Vanessa V   Santiago Anna T AT   Liu Zhihui Z   Ramotar Matthew M   Metser Ur U   Berlin Alejandro A  

European urology open science 20230502


We conducted and previously published a phase 2 trial of metastasis-directed therapy (MDT) in men with recurrence of prostate cancer at a low prostate-specific antigen level following radical prostatectomy and postoperative radiotherapy. All patients had negative conventional imaging and underwent prostate-specific membrane antigen (PSMA) positron emission tomography (PET). Patients without visible disease (<i>n</i> = 16) or with metastatic disease not amenable to MDT (<i>n</i> = 19) were exclud  ...[more]

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