ESTRO 2023

Session Item

Urology

Session Type: Poster (Digital)

Track: Clinical

Journey:

Profiling PCa patients with BCR in the era of early imaging detection: an AIRO-URO group study

, Italy

Presentation Number: PO-1491

Abstract

Abstract Title:

Profiling PCa patients with BCR in the era of early imaging detection: an AIRO-URO group study

Authors:

Giulia Marvaso^1,2, Fabio Matrone³, Alessandro Magli⁴, Giulio Francolini⁵, Riccardo Villa^6,2, Federico Mastroleo⁶, Ciro Franzese⁷, Luca Nicosia⁸, Francesco Pasqualetti⁹, Luca Eolo Trodella¹⁰, Annamaria Vinciguerra¹¹, Salvina Barra¹², Giorgia Timon¹³, Matteo Augugliaro¹⁴, Mattia Zaffaroni¹⁵, Giulia Corrao¹⁵, Maria Giulia Vincini⁶, Marta Scorsetti¹⁵, Barbara Alicja Jereczek-Fossa^6,16, Stefano Arcangeli¹⁷, Luca Triggiani¹⁸

¹IEO, European Institute of Oncology, IRCCS, Division of Radiation oncology, Milan, Italy; ²University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy; ³Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Department of Radiation Oncology, Aviano, Italy; ⁴Udine General Hospital, Department of Radiation Oncology, Udine, Italy; ⁵A.O.U. Careggi, University of Florence, Radiation Oncology, Firenze, Italy; ⁶IEO, European Institute of Oncology, IRCCS, Division of Radiation Oncology, Milan, Italy; ⁷Humanitas Clinical and Research Center - IRCCS, Department of Radiotherapy and Radiosurgery, Milan, Italy; ⁸IEO, European Institute of Oncology, IRCCS, Breast Imaging Division, Radiology Department, Milan, Italy; ⁹Azienda Ospedaliera Universitaria Pisana, University of Pisa, Department of Radiation Oncology, Pisa, Italy; ¹⁰Campus Bio-Medico University, Radiation Oncology, Rome, Italy; ¹¹"SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, Department of Radiation Oncology, Chieti, Italy; ¹²Ospedale Policlinico San Martino, Pediatric Radiotherapy and Special Techniques Unit, Genova, Italy; ¹³Azienda USL-IRCCS di Reggio Emilia, Radiation Oncology Unit, Reggio Emilia, Italy; ¹⁴Azienda USL-IRCCS di Reggio Emilia, Radiation Therapy Unit, Reggio Emilia, Italy; ¹⁵ IEO, European Institute of Oncology, IRCCS, Division of Radiation Oncology, Milan, Italy; ¹⁶University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy; ¹⁷School of Medicine and Surgery, University of Milan Bicocca, Department of Radiation Oncology, Milan, Italy; ¹⁸ASST Spedali Civili di Brescia, University of Brescia, Radiation Oncology Department, Brescia, Italy

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Purpose or Objective

Although radical prostatectomy represents a curative treatment, 44% of patients experience BCR at least 6 months after surgery. While in low-risk patients, the interval between surgery and BCR does not influence mortality, in patients with unfavorable disease characteristics, early disease recurrence increases mortality risk. Aim of the present study is to create a predictive model capable of identifying the category of patients most at risk of local or distant metastasis to undergo early imaging investigations.

Material and Methods

Data have been acquired from Italian centers joining the AIRO-URO initiative. Patients who underwent RP and salvage RT after experiencing BCR have been considered for study inclusion.
Descriptive and frequency analysis has been performed and mean time to event has been calculated for variables involving timespans. Disease progression after salvage radiotherapy has been considered as event of interest in time-to-event analysis. Multivariate Cox Regression model with multi-block enter approach has been adopted, chi-square test for log-likelihoods significant difference was used in the rounds to assess increase in model performance. Covariates were defined significative when p < 0.05 and HR not encompassing 1.

Results

A total of 580 patients (median age 64.7 y) with a median follow-up of 4.5 y (range 0.2-15.9) were included in the analysis. IMRT/VMAT accounted for 90.7% of all the treatment modalities. Biochemical progression-free survival rate < 12 months was 92%, at 1-year 83%, and at 2-years 75%. In the Multivariate Cox Regression model, 232 of 580 (39.9%) biochemical disease progression events have been considered eligible for the analysis. Median biochemical progression-free survival time resulted 2.1 y. Site of progression was available for 171 patients out of the reported 232 events. Of them, pelvic and distant progression occurred in 55% and 45% of the patients. Survival Cox Regression plot can be seen in Fig1.
The covariates found significantly associated with a higher risk of biochemical disease progression were: PSA higher or equal to 0.5 ng/ml at the biochemical relapse (HR 1.422, CI 95% 1.036-1.952, p < 0.029) and less than 12 months from surgery to biochemical relapse (HR 1.718, CI 95% 1.299-2.271, p < .001). Pelvic irradiation during salvage radiotherapy (HR 0.670, CI 95% 0.469-0.958, p < .028) was significantly associated with a lower risk of recurrence.

Figure 1

Conclusion

Given the results of the present preliminary analysis which reports a high recurrence rate, it remains of relevant importance to continue to offer potentially curative salvage treatment. In the PSMA-PET and WB-MRI era, and the ability to detect potentially distant metastatic disease so early, it becomes crucial to select patients for such examination based on criteria and clinical stratification. The present and future analyses on an enlarged dataset, based on a retrospective experience will lay the foundation for better understanding how to target care in this patient setting.