Oncological outcomes after tailored PSMA-PET-guided treatment in biochemical relapse after prostatectomy (PSICHE Trial-NCT 05022914).

IF 4.8 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiologia Medica Pub Date : 2025-10-13 DOI:10.1007/s11547-025-02107-7

Giulio Francolini, Pietro Garlatti, Vanessa Di Cataldo, Saverio Caini, Mauro Loi, Gabriele Simontacchi, Isacco Desideri, Daniela Greto, Luca Burchini, Ilaria Bonaparte, Giulio Frosini, Sergio Serni, Riccardo Campi, Luca Vaggelli, Niccolò Bertini, Michele Aquilano, Nicola Simoni, Federico Colombo, Ciro Franzese, Marta Scorsetti, Arturo Chiti, Livia Ruffini, Maria Rosaria Raspollini, Mack Roach, Richard K Valicenti, Lorenzo Livi

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引用次数: 0

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.

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前列腺切除术后生化复发个体化psma - pet引导治疗的肿瘤预后（PSICHE试验- nct 05022914）。

背景：下一代成像（NGI）（68ga -前列腺特异性膜抗原(PSMA)-PET）是生化治疗复发性前列腺癌的基石。PSICHE是一项多中心前瞻性研究，旨在评估预先定制的成像引导治疗的肿瘤学结果。方法：术后生化复发（BCR）患者（前列腺特异性抗原[PSA] > 0.2≤1 ng/mL）进行PSMA-PET分期。对所有患者提出了预先设定的治疗算法：前列腺床内PET呈阴性或阳性时采用前列腺床保留放疗（SRT），盆腔淋巴结复发或少转移性疾病时采用立体定向体放疗（SBRT），广泛的多转移性疾病采用雄激素剥夺治疗（ADT）。采用卡方检验评价基线特征与PSMA-PET/CT阳性率之间的关系。结果：共纳入159例患者。前列腺床PSMA阴性/阳性107例；盆腔淋巴结疾病或少转移性转移性疾病分别在39例和10例患者中检测到。3例患者患有多转移性疾病。17例患者因术后放疗（RT）或拒绝治疗而接受观察。88例患者接受SRT治疗，49例盆腔或盆腔外少转移性疾病患者接受SBRT治疗。根据EAU标准（低风险：PSA倍增时间bbb12个月和Gleason评分）对患者进行分层结论：针对PSA的治疗策略取得了令人满意的结果，避免了未选择患者接受ADT或标准SRT的不必要毒性。需要在更长的随访后进行分析以明确生存结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.