Page 2 - CUA 2020_Onco_Prostate

Podium 2: Oncology – Prostate

Canada; Department of Oncology, Western University, London, ON, therapy (RT). At the time of salvage surgery, 14 patients (67%) underwent
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Canada. pelvic sLND and seven patients (33%) underwent retroperitoneal sLND.
Support: Cancer Care Ontario and the Ontario Ministry of Health and Median PSA at sLND was 1.85. Median node yield was 10, with a median
Long-Term Care of one positive node on pathology. Eight patients (38%) achieved PSA
Introduction: The prostate specific membrane antigen-positron emission <0.2, with six (29%) remaining with PSA <0.2 at a median followup of
tomography (PSMA-PET) Registry for Recurrent Prostate Cancer (PREP) 113 days. Six (29%) had an initial PSA decline, but nadired above 0.2, and
was launched in Ontario in 2018 and is intended to record real-world in six (29%), the PSA rose immediately after sLND. Five patients relapsed
outcomes with the PSMA tracer F-DCFPyL used for restaging men with on repeat PSMA-PET. Overall, ADT was started in six patients (29%) at
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suspected recurrent prostate cancer after primary treatment. a median of 257 days post-sLND. Four patients had complications (two
Methods: PREP was organized through Cancer Care Ontario as a registry with Clavien-Dindo ≤2 and two with Clavien-Dindo 3b).
study (NCT03718260), with six participating sites throughout Ontario and Conclusions: While there is a rationale to treat oligometastatic pros-
a target accrual of 1500 men. Eligibility included biochemical failure tate cancer with sLND, it is important for clinicians to provide realistic
with no or limited (≤4 sites) disease on conventional imaging (CI: com- expectations. It appears only approximately one-third of patients have a
puted tomography [CT] of the abdomen and pelvis and bone scintography) meaningful PSA response. Long-term benefits of treating oligometastatic
and biochemical failure after primary prostatectomy (plus or minus adju- disease remain unknown.
vant or salvage radiotherapy) or primary radiotherapy. Following PSMA
PET/CT, frequency of disease detection, anatomic sites of disease, and POD-2.5
changes in management compared to CI were collected using standard-
ized questionnaires. Detectable prostate-specific antigen value between 0.01 and
Results: From December 1, 2018 to October 31, 2019, a total of 410 0.1 ng/ml following robotic-assisted radical prostatectomy: Does
men were enrolled on PREP and had PSMA PET/CT after CI. Overall, it correlate with future biochemical recurrence? 1
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261/410 (64%) had PET-detected disease. PET detection rates among Russell Schwartz , Ahmed S. Zakaria , Amr Hodhod , Hanna Shahine ,
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men with negative conventional imaging was 174/310 (56%). Among Felix Couture , David-Dan Nguyen , Côme Tholomier , Cristina Negrean ,
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men with lesions on CI, new lesions were seen on PET in 63/100 (63%). Kyle Law , Pierre Karakiewicz , Assaad El-Hakim , Kevin C. Zorn
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Among men with either positive or negative CI, PSMA-PET detection Urology, Centre hospitalier de l’Université de Montréal, Montreal, QC,
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rates stratified by prostate-specific antigen (PSA) on study entry were Canada; Urology, McGill University, Montreal, QC, Canada; Urology,
54/139 (39%) PSA <0.5; 49/78 (63%) PSA 0.5–1.0; and 157/191 (82%) Centre hospitalier de l’Université Sherbrooke, Sherbrooke , QC, Canada
PSA >1.0. On PSMA-PET, 144/410 (35%) had recurrent disease localized Introduction: Ultrasensitive prostate-specific antigen (PSA) assay is widely
to the pelvis. Changes in management as a consequence of the PSMA- used in the early detection of biochemical recurrence (BCR) after robotic-
PET/CT findings were noted in 66% (226/341) of men with completed assisted radical prostatectomy (RARP), setting a value of <0.01 ng/ml
post-PET/CT questionnaires. rather than the regular value of <0.1ng/ml. Yet, the impact on future BCR
Conclusions: Access to the PSMA-PET imaging in Ontario has been facili- of having a nadir and persistently detectable followup PSA between 0.01
tated by the introduction of the PREP registry study. A high detection rate and 0.1ng/ml, is still unclear. Our aim was to characterize PSA changes
and frequent impact on management suggests F-DCFPyL PET adds value over time in this setting and to assess for further progression.
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to CI for men with suspected recurrent prostate cancer. Methods: We conducted a retrospective review of a prospectively main-
tained cohort of 1359 men who underwent RARP in three high-volume
centers between 2006 and 2019. Patients were followed with PSA at
POD-2.4 one, three, six, nine,12, 18, 24, 30, and 36 months, and then annually
Salvage lymph node dissection for prostate-specific membrane thereafter. We included patients with PSA nadir value between 0.01 and
antigen (PSMA) positron emission tomography-identified 0.1ng/ml within six months of surgery and with at least two followup
oligometastatic disease measurements within the same range. Within our cohort, we divided
Adam Bobrowski , Ur Metser , Antonio Finelli , Neil E. Fleshner , Alejandro patients based on their BCR status and analyzed oncological outcomes
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Berlin , Nathan Perlis , Girish S. Kulkarni , Peter Chung , Kopika Kuhathaas , and PSA evolution. Multivariable Cox (MVC) hazard models were used
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Robert J. Hamilton 3 to analyze variables predicting BCR-free survival (BCR-FS).
1 Faculty of Medicine, University of Toronto, Toronto, ON, Results: A total of 167 (12.3%) subjects were identified for analyses, with
Canada; Department of Diagnostic Radiology, Princess Margaret a mean followup time of 60.2±31.4 months (Table 1). In our cohort, five-
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Hospital, University Health Network, University of Toronto, Toronto, year BCR-FS rate was 91.6%; 32 (19.1%) patients had BCR, with a mean
ON, Canada; Departments of Surgery and Surgical Oncology (Urology), time to BCR of 43.7±24.3 months (Table 2). Subsequently, 26 (15.5%)
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Princess Margaret Hospital, University Health Network, University of patients received salvage radiotherapy. During followup, BCR-free patients
Toronto, Toronto, ON, Canada; Department of Radiation Oncology, had stable mean PSA values ≤0.03 ng/ml, while patients who developed
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Princess Margaret Hospital, University Health Network, University of BCR showed a slowly rising trend over time, with a significant difference
Toronto, Toronto, ON, Canada between groups starting at nine months (p<0.023), even when values ≥
Introduction: The availability of prostate-specific membrane antigen- 0.10 ng/ml were excluded (Fig.1). In the MVC model, rising PSA (continu-
positron emission tomography (PSMA-PET) imaging, particularly in the ous) starting at nine months was a significant predictor of BCR (hazard
setting of rising prostate-specific antigen (PSA) after definitive treatment,
has led to oligometastatic disease being increasingly identified. However,
despite the enthusiasm for identifying and treating oligometastatic disease, 0.09
it has been relatively understudied. We sought to review our salvage 0.08 BCR-free BCR-positive 0.079 0.081 0.081
lymphadenectomy (sLND) experience in the PSMA-PET era at Princess 0.07
Margaret Hospital. Mean PSA value (ng/dl) 0.06 0.051 0.054 0.054 0.051
Methods: We performed a retrospective review of patients undergo- 0.05 0.041 0.044
0.04
ing sLND after curative-intent primary therapy with rising PSA who 0.03 0.021 0.025 0.029 0.033 0.031 0.031 0.030 0.029 0.031 0.033 0.030 0.031 0.031
had undergone a F-DCFPyL (PSMA)-PET/computed tomography (CT) 0.02 0.019 0.023
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identifying oligometastatic disease (defined as ≤5 PSMA avid lesions) 0.01
between January 2009 and July 2019. The primary endpoint was complete 0.00 1 month 3 months 6 months 9 months 12 months 18 months 24 months 30 months 36 months 48 months 60 months 72 months
response, defined as achieving a PSA <0.2 without the use of concomitant Followup time (months)
androgen deprivation therapy (ADT). POD-2.5. Fig. 1. Average PSA value per month of followup for the two study
Results: Twenty-one patients were included. Eighteen (86%) had prior
radical prostatectomy, while three (14%) had received primary radiation groups (excluding values ≥0.10 ng/ml) (p<0.001).
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S29