Prostate-Specific Membrane Antigen PET for Patients With Postoperative Recurrence of Prostate Cancer
Mené sur 128 patients atteints d'un cancer de la prostate et présentant une récidive biochimique après prostatectomie radicale (âge médian : 71 ans), cet essai randomisé de phase II évalue l'intérêt, du point de vue de la survie sans progression, d'une intensification de la radiothérapie guidée par TEP-PSMA (technologie hybride du TEP-scan avec radiotraceur PSMA)
When it comes to prostate cancer, we have long been torn between the Charybdis and Scylla of overtreatment and undertreatment. The study by Belliveau et al, published in JAMA Oncology, attempts to navigate such a path forward in the postoperative space.The study randomized patients with biochemical recurrence after surgery to either standard-of-care salvage radiotherapy (RT) vs prostate-specific membrane antigen positron emission tomography (PSMA-PET)–guided salvage RT. Patients with positive PET findings received PSMA-PET–guided intensification of salvage RT (PSMAiSRT) in terms of either target volume and/or radiation dose. Most patients received androgen deprivation therapy (ADT) on each arm. Overall, 130 patients were randomized (128 eligible for analysis, 64 assigned to the experimental arm), and the primary end point was failure-free survival (FFS). If patients in the experimental arm had a negative PSMA-PET, they received standard-of-care salvage RT ± ADT (31 of 64 patients [48.4%]). Of all 128 patients, 33 (25.8%) received PSMAiSRT. The authors found that PSMAiSRT improved FFS (hazard ratio, 0.50; 95% CI, 0.27-0.94; P = .04).
JAMA Oncology , éditorial, 2025