Biochemical failure-free survival of 18F-rhPSMA-7 and 18F-flotufolastat PET-guided salvage radiotherapy for patients with recurrent prostate cancer

  • Sci Rep. 2025 Jan 17;15(1):2234. doi: 10.1038/s41598-024-83074-3.
Marco M E Vogel  1  2  3 ,  Isabel Rauscher  4 ,  Jürgen E Gschwend  5 ,  Türkay Hekimsoy  4 ,  Nicola Gabler  4 ,  Charlotte Olufs  4 ,  Calogero D'Alessandria  4 ,  Jan C Peeken  6  7  8 ,  Stephanie E Combs  6  7  8  9 ,  Matthias Eiber  4  9
Affiliations
  • 1. Department of Radiation Oncology, TUM University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany. [email protected].
  • 2. Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany. [email protected].
  • 3. Department of Radiation Oncology, TUM University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany. [email protected].
  • 4. Department of Nuclear Medicine, TUM University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany.
  • 5. Department of Urology, TUM University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany.
  • 6. Department of Radiation Oncology, TUM University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany.
  • 7. Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.
  • 8. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
  • 9. BZKF (Bavarian Cancer Research Center), Munich, Germany.
PMID: 39824988 DOI: 10.1038/s41598-024-83074-3
Abstract

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has improved localization of prostate Cancer (PC) lesions in biochemical recurrence (BCR) for salvage radiotherapy (SRT). We conducted a retrospective review of patients undergoing 18F-rhPSMA-7 or 18F-flotufolastat (18F-rhPSMA-7.3)-PET-guided SRT compared with conventional-SRT (C-SRT) without PET. We evaluated biochemical failure-free survival (bFS) and overall rates of bFS in 110 evaluable patients with recurrent PC after radical prostatectomy who received SRT. 82 patients received 18F-rhPSMA-7/18F-flotufolastat-PET-guided SRT and 28 received C-SRT. Median bFS for patients with 18F-rhPSMA-7/18F-flotufolastat-PET-guided SRT was not reached while median bFS was 45.6 months for patients with C-SRT (p = 0.101). %bFS were 95% (52/55) vs 87% (20/23), 90% (27/30) vs 75% (15/20), 89% (16/18) vs 68% (13/19) and 100% (3/3) vs 57% (8/14) for PET-guided vs C-SRT at 12, 24, 36, and 48 months, respectively. Among patients treated in the prostate bed only, median bFS was not reached for PSMA-PET-guided SRT (n = 52) vs 55.1 months in the C-SRT group (n = 25; p = 0.063). %bFS was greater for PSMA-PET-guided SRT than C-SRT at all evaluated timepoints. 18F-rhPSMA-7/18F-flotufolastat-guided SRT yielded favorable disease outcomes. Although statistical significance was not reached, likely due to the limited sample size in this preliminary analysis, our data illustrate potential for 18F-flotufolastat-PET-guided SRT.

Keywords
18F-flotufolastat; 18F-rhPSMA-7; PSMA-PET; Prostate cancer; Salvage radiotherapy.
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