PSMA guided approach for bIoCHEmical relapse after prostatectomy- (PSICHE) trial (NCT05022914). Detection rate and treatment decision after 68Ga-PSMA PET/CT within a prospective study.

Abstract

BACKGROUND:

Ultrasensitive imaging has been demonstrated to influence biochemical relapse treatment. PSICHE is a multicentric prospective study, aimed at exploring detection rate with 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) and outcomes with a predefined treatment algorithm tailored to the imaging.

METHODS:

Patients affected by biochemical recurrence after surgery (prostate specific antigen [PSA] > 0.2 < 1 ng/mL) underwent staging with 68Ga-PSMA PET/CT. Management followed this treatment algorithm accordingly with PSMA results: prostate bed salvage radiotherapy (SRT) if negative or positive within prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease, androgen deprivation therapy (ADT) if nonoligometastatic disease. Chi-square test was used to evaluate the relationship between baseline features and rate of positive PSMA PET/CT.

RESULTS:

One hundred patients were enrolled. PSMA results were negative/positive in the prostate bed in 72 patients, pelvic nodal or extrapelvic metastatic disease were detected in 23 and 5 patients. Twenty-one patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Fifty patients were treated with prostate bed SRT, 23 patients underwent SBRT to pelvic nodal disease, five patients were treated with SBRT to oligometastatic disease. One patient underwent ADT. NCCN high-risk features, stage > pT3 and ISUP score >3 reported a significantly higher rate of positive PSMA PET/CT after restaging (p = 0.01, p = 0.02, and p = 0.002). By quartiles of PSA, rate of positive PSMA PET/CT was 26.9% (>0.2; <0.29 ng/mL), 24% (>0.3; <0.37 ng/mL), 26.9% (>0.38; <0.51 ng/mL), and 34.7% (>0. 52; <0.98 ng/mL).

CONCLUSIONS:

PSICHE trial constitute a useful platform to collect data within a clinical framework where modern imaging and metastasis-directed therapy are integrated.

• Authors: Giulio Francolini, Marco Banini, Vanessa Di Cataldo, Beatrice Detti, Saverio Caini, Mauro Loi, Gabriele Simontacchi, Isacco Desideri, Daniela Greto, Marianna Valzano, Manuele Roghi, Sergio Serni, Luca Vaggelli, Viola Salvestrini, Luca Visani, Carlotta Becherini, Emanuela Olmetto, Ciro Franzese, Davide Baldaccini, Marta Scorsetti, Martina Sollini, Arturo Chiti, Icro Meattini, Richard K Valicenti, Lorenzo Livi
• Journal: The Prostate (Prostate) Vol. 83 Issue 12 Pg. 1201-1206 (09 2023) ISSN: 1097-0045 [Electronic] United States
• PMID: 37290915 (Publication Type: Journal Article)
• Copyright: © 2023 Wiley Periodicals LLC.

Chemical References

• gallium 68 PSMA-11
• Prostate-Specific Antigen
• Androgen Antagonists
• Gallium Radioisotopes

Topics

• Male
• Humans
• Prostate-Specific Antigen
• Positron Emission Tomography Computed Tomography (methods)
• Prospective Studies
• Prostatic Neoplasms (diagnostic imaging, therapy, pathology)
• Androgen Antagonists
• Neoplasm Recurrence, Local (diagnostic imaging, therapy, pathology)
• Gallium Radioisotopes
• Prostatectomy