Biochemical Failure-free Survival of F-rhPSMA-7 and F-flotufolastat PET-guided Salvage Radiotherapy for Patients with Recurrent Prostate Cancer

Overview

Journal Sci Rep

Date 2025 Jan 17

PMID 39824988

Authors

Marco M E Vogel

Isabel Rauscher

Jurgen E Gschwend

Turkay Hekimsoy

Nicola Gabler

Charlotte Olufs

Calogero DAlessandria

Jan C Peeken

Stephanie E Combs

Matthias Eiber

Affiliations

Soon will be listed here.

Abstract

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has improved localization of prostate cancer (PC) lesions in biochemical recurrence (BCR) for salvage radiotherapy (SRT). We conducted a retrospective review of patients undergoing F-rhPSMA-7 or F-flotufolastat (F-rhPSMA-7.3)-PET-guided SRT compared with conventional-SRT (C-SRT) without PET. We evaluated biochemical failure-free survival (bFS) and overall rates of bFS in 110 evaluable patients with recurrent PC after radical prostatectomy who received SRT. 82 patients received F-rhPSMA-7/F-flotufolastat-PET-guided SRT and 28 received C-SRT. Median bFS for patients with F-rhPSMA-7/F-flotufolastat-PET-guided SRT was not reached while median bFS was 45.6 months for patients with C-SRT (p = 0.101). %bFS were 95% (52/55) vs 87% (20/23), 90% (27/30) vs 75% (15/20), 89% (16/18) vs 68% (13/19) and 100% (3/3) vs 57% (8/14) for PET-guided vs C-SRT at 12, 24, 36, and 48 months, respectively. Among patients treated in the prostate bed only, median bFS was not reached for PSMA-PET-guided SRT (n = 52) vs 55.1 months in the C-SRT group (n = 25; p = 0.063). %bFS was greater for PSMA-PET-guided SRT than C-SRT at all evaluated timepoints. F-rhPSMA-7/F-flotufolastat-guided SRT yielded favorable disease outcomes. Although statistical significance was not reached, likely due to the limited sample size in this preliminary analysis, our data illustrate potential for F-flotufolastat-PET-guided SRT.

References

Houshmand S, Lawhn-Heath C, Behr S . PSMA PET imaging in the diagnosis and management of prostate cancer. Abdom Radiol (NY). 2023; 48(12):3610-3623. PMC: 10682054. DOI: 10.1007/s00261-023-04002-z. View

Michalski J, Lawton C, El Naqa I, Ritter M, OMeara E, Seider M . Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2009; 76(2):361-8. PMC: 2847420. DOI: 10.1016/j.ijrobp.2009.02.006. View

Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I . Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer-Updated Diagnostic Utility, Sensitivity, Specificity, and Distribution of Prostate-specific Membrane Antigen-avid Lesions: A Systematic Review and.... Eur Urol. 2019; 77(4):403-417. DOI: 10.1016/j.eururo.2019.01.049. View

Vogel M, Dewes S, Sage E, Devecka M, Gschwend J, Eiber M . A survey among German-speaking radiation oncologists on PET-based radiotherapy of prostate cancer. Radiat Oncol. 2021; 16(1):82. PMC: 8088662. DOI: 10.1186/s13014-021-01811-8. View

Fendler W, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S . Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017; 44(6):1014-1024. DOI: 10.1007/s00259-017-3670-z. View

Tolvanen T, Kalliokoski K, Malaspina S, Kuisma A, Lahdenpohja S, Postema E . Safety, Biodistribution, and Radiation Dosimetry of F-rhPSMA-7.3 in Healthy Adult Volunteers. J Nucl Med. 2020; 62(5):679-684. PMC: 8844263. DOI: 10.2967/jnumed.120.252114. View

Kroenke M, Schweiger L, Horn T, Haller B, Schwamborn K, Wurzer A . Validation of F-rhPSMA-7 and F-rhPSMA-7.3 PET Imaging Results with Histopathology from Salvage Surgery in Patients with Biochemical Recurrence of Prostate Cancer. J Nucl Med. 2022; 63(12):1809-1814. PMC: 9730917. DOI: 10.2967/jnumed.121.263707. View

Knorr K, Oh S, Kronke M, Wurzer A, DAlessandria C, Herz M . Preclinical biodistribution and dosimetry and human biodistribution comparing F-rhPSMA-7 and single isomer F-rhPSMA-7.3. EJNMMI Res. 2022; 12(1):8. PMC: 8816989. DOI: 10.1186/s13550-021-00872-w. View

Vogelius I, Bentzen S . Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news?. Int J Radiat Oncol Biol Phys. 2012; 85(1):89-94. PMC: 3556929. DOI: 10.1016/j.ijrobp.2012.03.004. View

10.

Wurzer A, Parzinger M, Konrad M, Beck R, Gunther T, Felber V . Preclinical comparison of four [F, Ga]rhPSMA-7 isomers: influence of the stereoconfiguration on pharmacokinetics. EJNMMI Res. 2020; 10(1):149. PMC: 7721954. DOI: 10.1186/s13550-020-00740-z. View

11.

Poortmans P, Bossi A, Vandeputte K, Bosset M, Miralbell R, Maingon P . Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group. Radiother Oncol. 2007; 84(2):121-7. DOI: 10.1016/j.radonc.2007.07.017. View

12.

Eiber M, Kroenke M, Wurzer A, Ulbrich L, Jooss L, Maurer T . F-rhPSMA-7 PET for the Detection of Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy. J Nucl Med. 2019; 61(5):696-701. PMC: 7198386. DOI: 10.2967/jnumed.119.234914. View

13.

Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T . EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol. 2016; 71(4):630-642. DOI: 10.1016/j.eururo.2016.08.002. View

14.

Kuo P, Hermsen R, Penny R, Postema E . Quantitative and Qualitative Assessment of Urinary Activity of F-Flotufolastat-PET/CT in Patients with Prostate Cancer: a Post Hoc Analysis of the LIGHTHOUSE and SPOTLIGHT Studies. Mol Imaging Biol. 2023; 26(1):53-60. PMC: 10827967. DOI: 10.1007/s11307-023-01867-w. View

15.

King C . The dose-response of salvage radiotherapy following radical prostatectomy: A systematic review and meta-analysis. Radiother Oncol. 2016; 121(2):199-203. DOI: 10.1016/j.radonc.2016.10.026. View

16.

Calais J, Czernin J, Fendler W, Elashoff D, Nickols N . Randomized prospective phase III trial of Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]. BMC Cancer. 2019; 19(1):18. PMC: 6322287. DOI: 10.1186/s12885-018-5200-1. View

17.

Jani A, Schreibmann E, Goyal S, Halkar R, Hershatter B, Rossi P . F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial. Lancet. 2021; 397(10288):1895-1904. PMC: 8279109. DOI: 10.1016/S0140-6736(21)00581-X. View

18.

Rauscher I, Karimzadeh A, Schiller K, Horn T, DAlessandria C, Franz C . Detection efficacy of F-rhPSMA-7.3 PET/CT and impact on patient management in patients with biochemical recurrence of prostate cancer after radical prostatectomy and prior to potential salvage treatment. J Nucl Med. 2021; . PMC: 8612184. DOI: 10.2967/jnumed.120.260091. View

19.

Paller C, Antonarakis E . Management of biochemically recurrent prostate cancer after local therapy: evolving standards of care and new directions. Clin Adv Hematol Oncol. 2013; 11(1):14-23. PMC: 3624708. View

20.

Wurzer A, Di Carlo D, Schmidt A, Beck R, Eiber M, Schwaiger M . Radiohybrid Ligands: A Novel Tracer Concept Exemplified by F- or Ga-Labeled rhPSMA Inhibitors. J Nucl Med. 2019; 61(5):735-742. PMC: 7198388. DOI: 10.2967/jnumed.119.234922. View