PSMA PET Supports EAU Risk Groups for Biochemically Recurrent Prostate Cancer

Prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) findings support risk groups based on the European Association of Urology (EAU) Prostate Cancer Guidelines Panel for biochemically recurrent (BCR) prostate cancer, according to a study published in the Journal of Nuclear Medicine.

Justin Ferdinandus, MD, from the University of Duisburg-Essen in Germany, and colleagues examined local and metastatic disease in recurrent and persistent prostate cancer, as stratified by the EAU BCR risk groups and biochemical persistence (BCP). A total of 1,960 patients were enrolled: 1,777 patients in a trial conducted at three sites and 183 patients with BCP who were included retrospectively. Independent predictors of metastatic disease were examined.

The researchers found that distant metastatic (M1) detection occurred in 24, 37, and 40 percent of patients in the post-radical prostatectomy EAU BCR low-risk, EAU BCR high-risk, and BCP groups, respectively. The M1 detection rate was 37 and 70 percent for postradiotherapy EAU BCR low-risk and EAU BCR high-risk groups, respectively. In a multivariate analysis, there were significant associations seen for BCP, high-risk BCR, and higher levels of serum prostate-specific antigen with PSMA PET M1 disease. Among patients with post-radical prostatectomy or postradiotherapy EAU BCR high-risk disease, PSMA-PET indicated no disease in 25 percent and locoregional-only disease in 33 percent.

“Men with high risk BCR according to EAU Prostate Cancer Guidelines Panel and BCP have higher rates of metastatic disease,” the authors write. “Discordant subgroups, including metastatic disease in low-risk and no disease in high-risk patients, warrant inclusion of PSMA PET stage to refine risk assessment.”

Several authors disclosed financial ties to the biopharmaceutical industry.

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