Prostate-specific membrane antigen positron emission tomography (PSMA-PET) may unintentionally delay treatment and increase the risk of death in prostate cancer patients.
Using a multinational database, researchers identified 25,551 patients with pT2-4N0 or NXM0 prostate cancer and up to one high-risk factor (prostatectomy Gleason score 8–10 or pT3 or pT4). bottom.
A recent study published in Journal of Clinical Oncology In patients with only one high-risk factor, initiation of salvage radiation therapy (sRT) after radical prostatectomy (RP) can be delayed until prostate-specific antigen (PSA) levels are >0.25 ng/mL. A higher risk of all-cause mortality (ACM) suggests that it is associated.1
In current practice, many physicians may wait until PSA levels are above 0.25 ng/mL before starting sRT. This is because the performance characteristics of PSMA-PET improve with increasing PSA levels, and insurance companies will not reimburse PSMA-PET scans until PSA levels exceed a certain level. threshold. However, data from this study suggest that waiting to initiate sRT until PSA failure (≥ 0.20 ng/mL) may increase the risk of ACM in patients.
“Our previous study showed that patients with two or more of these risk factors should receive sRT immediately after surgery when they have undetectable PSA levels. [ie, < 0.02 ng/mL], because they are at the highest risk of dying from the disease. This new study sought to address the risk of death in patients who had only one He risk factor. Is it safe to wait for PSA to rise? ” Lead study author Anthony Victor D’Amico, M.D., Ph.D., explained in his release news of the findings.2 D’Amico is Director of Genitourinary Radiation Oncology at Dana-Farber Brigham Cancer Center in Boston, Massachusetts.
For this study, D’Amico and his team used a multinational database to identify 25,551 patients with pT2-4N0 or NXM0 prostate cancer and high-risk factors (prostatectomy Gleason score 8–10 or identified at most one pT3 or pT4). Of a total of 25,551 patients, 1,556 received sRT when PSA levels were ≤0.25 ng/mL and 1,677 received sRT when PSA levels were >0.25 ng/mL. Adjuvant RT (aRT) was provided to 673 patients and salvage androgen deprivation therapy (no RT) to his 1,489 patients. Median follow-up was 6 years.
The team used multivariate Cox regression analysis starting at 0.10 ng/mL. Increments were in 0.05 ng/mL increments up to 0.50 ng/mL. Factors such as patient age at surgery, year of surgery, established prognostic factors, institution, and time-dependent use of androgen deprivation therapy were considered for the analysis.
Data showed that patients with PSA levels of 0.25 ng/mL or higher had an approximately 50% increased risk of death (P. = .008). This suggests that delaying her sRT after radical prostatectomy in a patient with only one high-risk factor may have unintended negative consequences for the patient. In addition, there was no significant difference in ACM risk between using sRT and aRT when PSA levels were ≤0.25 ng/mL.
“Initiation of salvage radiation therapy after prostatectomy before PSA >0.25 ng/mL is made more clear in this report. , individuals can transition to salvage therapy before new imaging modalities can identify the site of persistent disease. Journal of Clinical Oncologyin a news release.
Further studies on these findings will include investigation of the same effect in patients without risk factors or at low risk of recurrence or death.
1. Tilki D, Chen MH, Wu J, et al. Prostate-specific antigen levels and mortality risk during salvage therapy after radical prostatectomy for prostate cancer. J Clin OnkolPublished online March 1, 2023. Accessed March 8, 2023. doi: 10.1200/JCO.22.02489.
2. Delay in salvage therapy increases the risk of death in some prostate cancer patients. news release. Brigham and Women’s Hospital. Accessed March 8, 2023. =email&msg=Failed