Prostate-Specific Membrane Antigen PET Response Associates with Metastasis-Free Survival After Stereotactic Ablative Radiation in Oligometastatic Prostate Cancer

Philip Sutera, MD; Matthew P. Deek, MD; Rebecca A. Deek, MS; Ozan Cem Guler, MD; Pervin Hurmuz, MD; Mehmet Reyhan, MD; Steven Rowe, MD, PhD; Noura Radwan, MD; Shirl Dipasquale, MSRN; William T. Hrinivich, PhD; Kathryn Lowe, MA; Lei Ren, PhD; Biren Saraiya, MD; Ronald Ennis, MD; Lara Hathout, MD; Tina Mayer, MD; Theodore L. Deweese, MD; Daniel Y. Song, MD; Ana Kiess, MD; Ezgi Oymak, MD; Kenneth Pienta, MD; Felix Feng, MD; Martin Pomper, MD, PhD; Gokhan Ozyigit, MD; Phuoc T. Tran, MD, PhD; Cem Onal, MD; Ryan M. Phillips, MD, PhD

Advances in Radiation Oncology (Jul 2024)

Prostate-Specific Membrane Antigen PET Response Associates with Metastasis-Free Survival After Stereotactic Ablative Radiation in Oligometastatic Prostate Cancer

Philip Sutera, MD,
Matthew P. Deek, MD,
Rebecca A. Deek, MS,
Ozan Cem Guler, MD,
Pervin Hurmuz, MD,
Mehmet Reyhan, MD,
Steven Rowe, MD, PhD,
Noura Radwan, MD,
Shirl Dipasquale, MSRN,
William T. Hrinivich, PhD,
Kathryn Lowe, MA,
Lei Ren, PhD,
Biren Saraiya, MD,
Ronald Ennis, MD,
Lara Hathout, MD,
Tina Mayer, MD,
Theodore L. Deweese, MD,
Daniel Y. Song, MD,
Ana Kiess, MD,
Ezgi Oymak, MD,
Kenneth Pienta, MD,
Felix Feng, MD,
Martin Pomper, MD, PhD,
Gokhan Ozyigit, MD,
Phuoc T. Tran, MD, PhD,
Cem Onal, MD,
Ryan M. Phillips, MD, PhD

Affiliations

Philip Sutera, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Matthew P. Deek, MD: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
Rebecca A. Deek, MS: Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ozan Cem Guler, MD: Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
Pervin Hurmuz, MD: Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Mehmet Reyhan, MD: Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
Steven Rowe, MD, PhD: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
Noura Radwan, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Shirl Dipasquale, MSRN: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
William T. Hrinivich, PhD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kathryn Lowe, MA: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lei Ren, PhD: Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
Biren Saraiya, MD: Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
Ronald Ennis, MD: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
Lara Hathout, MD: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
Tina Mayer, MD: Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
Theodore L. Deweese, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Daniel Y. Song, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Ana Kiess, MD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Ezgi Oymak, MD: Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
Kenneth Pienta, MD: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Felix Feng, MD: Department of Radiation Oncology, University of California San Francisco, San Francisco, California
Martin Pomper, MD, PhD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Gokhan Ozyigit, MD: Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Phuoc T. Tran, MD, PhD: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiation Oncology, University of Maryland, Baltimore, Maryland; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland; James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Cem Onal, MD: Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey; Department of Radiation Oncology, Faculty of Medicine, Baskent University, Ankara, Turkey; Corresponding authors: Cem Onal, MD
Ryan M. Phillips, MD, PhD: Department of Radiation Oncology, The Mayo Clinic, Rochester, Minnesota; Ryan M. Phillips, MD, PhD

Journal volume & issue: Vol. 9, no. 7
p. 101507

Abstract

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Purpose: Emerging data suggest that metastasis-directed therapy (MDT) improves outcomes in patients with oligometastatic castration-sensitive prostate cancer (omCSPC). Prostate-specific membrane antigen positron emission tomography (PSMA-PET) can detect occult metastatic disease, and PSMA response has been proposed as a biomarker for treatment response. Herein, we identify and validate a PSMA-PET biomarker for metastasis-free survival (MFS) following MDT in omCSPC. Methods and Materials: We performed an international multi-institutional retrospective study of patients with omCSPC, defined as ≤3 lesions, treated with metastasis-directed stereotactic ablative radiation who underwent PSMA-PET/computed tomography (CT) before and after (median, 6.2 months; range, 2.4-10.9 months) treatment. Pre- and post-MDT PSMA-PET/CT maximum standardized uptake value (SUVmax) was measured for all lesions, and PSMA response was defined as the percent change in SUVmax of the least responsive lesion. PSMA response was both evaluated as a continuous variable and dichotomized into PSMA responders, with a complete/partial response (at least a 30% reduction in SUVmax), and PSMA nonresponders, with stable/progressive disease (less than a 30% reduction in SUVmax). PSMA response was correlated with conventional imaging-defined metastasis-free survival (MFS) via Kaplan-Meier and Cox regression analysis. Results: A total of 131 patients with 261 treated metastases were included in the analysis, with a median follow-up of 29 months (IQR, 18.5-41.3 months). After stereotactic ablative radiation, 70.2% of patients were classified as PSMA responders. Multivariable analysis demonstrated that PSMA response as a continuous variable was associated with a significantly worse MFS (hazard ratio = 1.003; 95% CI, 1.001-1.006; P = .016). Patients classified as PSMA responders were found to have a significantly improved median MFS of 39.9 versus 12 months (P = .001) compared with PSMA nonresponders. Our study is limited as it is a retrospective review of a heterogenous population. Conclusions: After stereotactic ablative radiation, PSMA-PET response appears to be a radiographic biomarker that correlates with MFS in omCSPC. This approach holds promise for guiding clinical management of omCSPC and should be validated in a prospective setting.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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