Recurrence rate after radical prostatectomy following primary staging of high-risk prostate cancer with 68Ga-PSMA PET/CT

Abstract

Background

Accurate primary staging is one of the most important issues for initial management of prostate cancer (PCa) patients to perform an optimal selection of patients for curative intended treatment. ⁶⁸Ga-Prostate-Specific-Membrane-Antigen (PSMA) PET/CT was found superior to conventional imaging both for detection of recurrence after curative intended treatment and for primary staging. We studied the recurrence rate after radical prostatectomy in high-risk PCa patients primary staged with ⁶⁸Ga-PSMA PET/CT compared with conventional imaging.

Material and methods

The study included 247 D’Amico high-risk PCa patients treated with radical prostatectomy (RP) after primary staging with ⁶⁸Ga-PSMA PET/CT and a reference group of 137 high-risk patients with RP after conventional imaging (^99mTc bone scintigraphy and CT). Recurrence rates were assessed by Cox regression and Kaplan-Meier analysis.

Results

The 5-year recurrence-free survival rate was 71.1% in the ⁶⁸Ga-PSMA PET/CT cohort compared with 56.4% in the conventional imaging cohort. Primary staging by ⁶⁸Ga-PSMA PET/CT reduced biochemical recurrence (BCR) risk by 42% (HR = 0.58 (0.41–0.83), p = .004).

Conclusion

The present data could indicate a lower recurrence rate after RP following primary staging with ⁶⁸Ga-PSMA PET/CT compared to conventional imaging, likely due to improved selection of patients for surgery.