PATTERNS OF CARE OF PATIENTS WITH AN OCCULT LOCOREGIONAL RELAPSE ON CHOLINE PET/CT AFTER A PRIOR CURATIVE TREATMENT FOR LOCALIZED PROSTATE CANCER

• Choline PET: Modification of strategy in 50% (Soyka D et al., EJNMMI 2012)

• Local, nodal and bone met staging compared to abdomino-pelvic staging alone w/ MR Lymphangiography (Ferumoxtran) or SN SPECT

• Sensitivity/Specificity: • 90% for local failure • 85-88% for nodal failure (Meta-analysis from Umbehr et al. Eur Urol

2013)

• 13 GETUG centers (Radiation Oncology Group)

• >400 patients with Choline PET for rising PSA

• 173 patients with LRF onlyPatterns of LRFPatterns of care

• Statistics: Descriptive only analyzes

METHODS

• 50%≤T2a• 81% ≤ GS7• 78.4% N0• Median PSA 8.8 ng/mL [2.4-300]

• 49% RP• 34% PLND• 61% EBRT• 33% ADT• 14% Prostate brachy

RESULTSSalvage therapyDistribution of failures

• Prostate 41%• Prostate bed 11%• SV 7.5%• Nodes 60%

ON 16.1%II 25.0%EI 42.0%

CI 33.0%

LA 25.9%

IN 4.5%

RP 4.4%PLND 10.5%Postop EBRT 13.3%Nodal EBRT 32.9%ADT alone 5.2%Watchful waiting 24.9%

• PET-guided salvage therapy in a curative intent is rapidly growing (25% Watchful waiting and 5% ADT alone)

• Limits: retrospective, lack of follow-up, lack of pathology, Number of positive nodes may be underestimated

• Impact of PET-guided salvage therapy on BRFS, Regional-FS, Met-FS, CSS? Longer follow-up needed

DISCUSSION