Salvage radiotherapy with prostate-specific membrane antigen-directed focal boost: A precision approach for recurrent prostate cancer
Year: 2025
Type: article
Abstract: BACKGROUND: With the advent of novel therapies and advanced imaging modalities, prostate cancer patients are living longer, but biochemical recurrence has become increasingly common. Prostate-specific membrane antigen (PSMA) PET imaging demonstrates high sensitivity in detecting recurrence at low prostate-specific antigen (PSA) levels, surpassing conventional imaging. While salvage radiotherapy traditionally targets the prostate fossa, PSMA PET enables focal dose escalation to PSMA-avid lesions. This study evaluated whether PSMA PET-guided salvage radiotherapy improves disease control compared with androgen deprivation therapy (ADT) alone, while maintaining an acceptable toxicity profile. METHODS: Patients with suspected recurrent prostate cancer underwent PSMA PET, with eligibility defined as a PSMA score >3. Salvage treatment consisted of high-dose radiotherapy to the prostate fossa with focal boost to PSMA-avid lesions (with or without ADT) or ADT alone. The primary endpoint was failure-free survival (FFS). Secondary endpoints included treatment-related toxicities. RESULTS: Fifty-six patients were included (mean age, 70.3 years). The mean initial PSA was 25.2 ng/mL, and the mean PSA before PSMA PET was 2.47 ng/mL. Patients who had previously undergone radical prostatectomy demonstrated significantly longer FFS compared with those initially treated with radiotherapy (41.2 vs 31.5 months, p = 0.045), although baseline PSA was higher in the radiotherapy group. Salvage radiotherapy yielded significantly longer FFS than ADT alone (42.1 vs 23.4 months, p < 0.001). Acute grades 1 and 2 gastrointestinal or genitourinary toxicities occurred in 23 patients (46.9%), late grades 1 and 2 events in 16 patients (32.7%), and grade 3 hematuria requiring intervention in 4 patients (8.2%). CONCLUSION: PSMA PET-guided salvage radiotherapy is an effective and personalized strategy for patients with biochemically recurrent prostate cancer. Compared with ADT alone, it provides superior failure-free survival with manageable toxicity, supporting its role as a standard component of salvage management.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4414523705