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Main Authors:	Nicole Handa, Richard Bennett, Eric V. Li, Austin Ho, Mitchell M. Huang, Sai Kumar, Clayton Neill, Ridwan Alam, Hiten D. Patel, Edward M. Schaeffer, Ashley E. Ross
Format:	Artículo Open Access
Published:	Wiley 2025
Subjects:	BJUI Compass
Online Access:	https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.70028
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PSMA PET/CT findings in high‐risk biochemical recurrence after local treatment of prostate cancer Nicole Handa Richard Bennett Eric V. Li Austin Ho Mitchell M. Huang Sai Kumar Clayton Neill Ridwan Alam Hiten D. Patel Edward M. Schaeffer Ashley E. Ross BJUI Compass AbstractObjectivesTo describe PSMA PET/CT characteristics of patients with high‐risk BCR.Subjects/patients and methodsThis was a retrospective analysis of patients with high‐risk BCR prostate cancer (PSA ≥ 2 ng/ml above nadir after radiation therapy [RT] or ≥1 ng/ml after radical prostatectomy [RP] +/− RT) who underwent PET/CT from July 2021–March 2023. Patients with prior cytotoxic chemotherapy, androgen deprivation therapy (ADT) initiated >3 months prior to PET/CT or positive conventional imaging within 3 months of PET/CT were excluded. Neoadjuvant/adjuvant ADT completed ≥9 months prior was allowed. Logistic regression, Pearson's Chi‐squared, Wilcoxon rank sum and Fisher's exact tests were used for analysis.ResultsA total of 113 of 145 (77%) included patients in the analysis had ≥1 lesion on PSMA PET/CT. There was no difference in PSMA PET/CT positivity based on age, race, Gleason Grade at initial biopsy or PSA. Overall, 29 (20%) patients had lesions in the prostate/prostate bed only, 31 (21%) had lesions consistent with N1M0 disease and 53 (37%) had lesions consistent with M1 disease. For M1 patients, 21/53 (40%) had oligometastatic disease (1–3 lesions), and 32/53 (60%) had a higher burden (>3 lesions). Local recurrence was more common with RT and nodal recurrence with RP, with no difference in distant metastasis by initial treatment.ConclusionNearly 80% of patients with high‐risk BCR after local treatment for prostate cancer with RP and/or RT will have positive findings on PSMA PET/CT. In addition to intensified systemic therapy, up to 55% of the patients may have benefitted from salvage local therapy, nodal pelvic radiation or metastasis‐directed therapies for oligometastatic disease. 10.1002/bco2.70028 http://creativecommons.org/licenses/by/4.0/

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