Impact of [18F]PSMA PET/TC PET in patients with biochemical persistence or recurrence of PSA after radical prostatectomy without salvage adjuvant therapy

Impact of [18F]PSMA PET/TC PET in patients with biochemical persistence or recurrence of PSA after radical prostatectomy without salvage adjuvant therapy

Nicolás Sierrasesúmaga-Martín 1 , Sergio Martín-Martín 1 , Miguel Pascual-Samaniego 1 , Esther Valsero-Herguedas 1 , Juan R. Torrecilla-García-Ripoll 1 , Fátima Castroviejo-Royo 1 , Raúl Calvo-González 1 , María Bedate-Núñez 1 , Noelia Álvarez-Mena 2 , Marta Senovilla-Martínez 3 , M. Consuelo Conde-Redondo 1 , Jesús Calleja-Escudero 1

1 Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España; 2 Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, olid, España; 3 Facultad de Medicina, Universidad de Valladolid. Valladolid, España

*Correspondence: Nicolás Sierrasesúmaga-Martín. Email: nsierrasesu@gmail.com

Abstract

Objective: To evaluate predictive factors for a positive [18F]PSMA PET/TC scan in patients with early biochemical recurrence (PSA 0.2-0.5 ng/mL) after radical prostatectomy, with no prior therapy. Method: An observational, retrospective, single-center study included 79 patients with prostate adenocarcinoma treated with radical prostatectomy and a PSA level between 0.2–0.5 ng/ mL, who underwent [18F]PSMA PET/TC. Clinicopathological variables, PET results, and treatment changes were analyzed. Results: The [18F]PSMA PET/TC was positive in 54.4% (43/79) of patients. The most frequent sites of recurrence were pelvic lymph nodes (30.4%) and the prostate bed (17.7%). The PET result altered the therapeutic plan in 51.9% of cases, leading to optimized radiotherapy planning (45.5%) or the initiation of hormonal therapy (29.1%). Independent predictors of a positive PET scan were: PSADT < 6 months (OR: 3.63; 95% CI: 1.18–11.15) and a high ISUP (3-5 vs. 1-2; OR: 3.72; 95% CI: 1.30-10.64). The model’s area under the curve was 0.764 (95% CI: 0.652-0.876). Conclusions: [18F]PSMA PET/TC is a highly valuable tool in early biochemical recurrence (PSA 0.2-0.5 ng/mL) post-surgery, with a high detection rate (54.4%). It significantly alters treatment planning, optimizing radiotherapy or guiding hormone therapy. These findings support its use for planning targeted treatments with curative intent, although prospective studies are needed to confirm survival benefits.

Keywords: [18F]PSMA PET/TC. Biochemical recurrence. Radical prostatectomy. Salvage radiotherapy. Hormonal therapy.

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