ESTRO 2024 - Abstract Book

S2607

Clinical - Urology

ESTRO 2024

SRT nadir. BCR, the application of additional androgen deprivation therapy (ADT), clinical evidence of PCa, or death from any reason were events terminating progression-free survival (PFS), while death from any reason justified overall survival (OS). The first detection of any metastases terminated metastases-free survival (MFS). Data analysis was performed with a Kaplan-Meier curve and log-rank tests.

Results:

Comparing patients with PSA Recurrence (post-OP Nadir <0,05 ng/ml and Pre-SRT PSA <2 ng/ml) vs. patients with persisting PSA (post- OP Nadir ≥0,05 ng/ml and post -OP Nadir <2 ng/ml), the patients with PSA Recurrence showed an advantage regarding BCR (p=0.00064) and PFS (p=0.00025). There was no difference in these groups for OS or MFS. Regarding patients with PSA Recurrence (post-OP Nadir <0,05 ng/ml and Pre-SRT PSA <2 ng/ml) in comparison to favorable PSA persisters (0.05 ng/ml ≤ Post -OP Nadir < threshold of 0.1 ng/ml, 0.2 ng/ml or 0.3 ng/ml, respectively), the patients with PSA Recurrence showed a significant advantage regarding BCR and PFS at the threshold of 0.2 ng/ml or 0.3 ng/ml (BCR: p=0.008 or p=0.0016, PFS: p=0.0022 or 0.00066). There was no difference at the threshold of 0.1 ng/ml or for OS and MFS, respectively. Overviewing the four subgroups (favorable PSA Recurrence vs. unfavorable PSA Recurrence vs. favorable PSA persisters vs. unfavorable PSA persisters), the probability for biochemical progression and clinical progression increases significantly in the same order of the named subgroups, regardless of the chosen threshold. Again, no difference was found for OS or MFS.

Conclusion:

In this analysis, only patients with post-OP Nadir levels from >0.03 ng/ml to the 0.1 ng/ml threshold have no significant difference in BCR or PFS from patients reaching undetectable PSA levels after RP for PCa. Above the PSA thresholds of 0.2 ng/ml or 0.3 ng/ml, the risk for BCR and PFS rises significantly, which can indicate that this subgroup might have a beneficial effect of additional therapy, such as ADT in addition to salvage radiotherapy or early initiation of SRT. This finding supports the EAU recommendations for early aggressive multimodality treatment in patients who have failed to achieve a post-OP PSA of less than 0.1 ng/ml. Further prospective studies are needed to confirm these results.

Keywords: salvage radiotherapy, prostate cancer, PSA

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