PSMA PET Validates Higher Rates of Metastatic Disease for European Association of Urology Biochemical Recurrence Risk Groups: An International Multicenter Study

Justin Ferdinandus; Wolfgang P. Fendler; Andrea Farolfi; Samuel Washington; Osama Mohamad; Miguel H. Pampaloni; Peter J.H. Scott; Melissa Rodnick; Benjamin L. Viglianti; Matthias Eiber; Ken Herrmann; Johannes Czernin; Wesley R. Armstrong; Jeremie Calais; Thomas A. Hope; Morand Piert

doi:10.2967/jnumed.121.262821

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FIGURE 1.
Study flowchart. IBF = interval from primary therapy to biochemical failure; PSADT = PSA doubling time; RT = radiotherapy.
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FIGURE 2.
PET disease extent in EAU BCR low-risk patients, EAU BCR high-risk patients, and BCP patients (A) and predictors of PET M1 disease (B). OR = odds ratio.

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TABLE 1

Patient Characteristics and PSMA PET Stages

	RP			Radiotherapy
Characteristic	EAU BCR low risk (n = 176)	EAU BCR high risk (n = 931)	BCP (n = 386)	EAU BCR low risk (n = 309)	EAU BCR high risk (n = 158)
Age (y)	71 [9.3]	69 [9.1]	70 [12]	73 [9.6]	72 [9.1]
PSA ( ng/mL)
<0.5	60 (34.1%)	302 (32.4%)	69 (17.9%)	3 (1.0%)	2 (1.3%)
≥0.5 to <1.0	38 (21.6%)	178 (19.1%)	175 (45.3%)	4 (1.3%)	4 (2.5%)
≥1.0 to <2.0	20 (11.4%)	174 (18.7%)	43 (11.1%)	7 (2.3%)	5 (3.2%)
≥2.0 to <5.0	34 (19.3%)	159 (17.1%)	41 (10.6%)	134 (43.4%)	62 (39.2%)
≥5.0	24 (13.6%)	118 (12.7%)	58 (15.0%)	161 (52.1%)	85 (53.8%)
PSA doubling time (mo)	20 [18]	4.2 [5.2]	4.5 [5.8]	8.5 [11]	4.1 [5.7]
Gleason score
6	30 (17.0%)	42 (4.5%)	17 (4.4%)	97 (31.4%)	2 (1.3%)
7	146 (83.0%)	507 (54.5%)	168 (43.5%)	212 (68.6%)	27 (17.1%)
8	—	168 (18.0%)	79 (20.5%)	—	55 (34.8%)
9–10	—	214 (23.0%)	122 (31.6%)	—	74 (46.8%)
IBF (mo)	83 [78]	44 [51]	34 [55]	88 [84]	41 [65]
Adjuvant RT after RP
Adjuvant RT	50 (28.4%)	368 (39.5%)	78 (20.2%)	—	—
No adjuvant RT	126 (71.6%)	563 (60.5%)	308 (79.8%)	309 (100%)	158 (100%)
PSMA PET stage
T0N0M0 (no disease)	58 (33.0%)	275 (29.5%)	85 (22.0%)	20 (6.5%)	7 (4.4%)
Tr/N1M0 (locoregional)	75 (42.6%)	314 (33.7%)	147 (38.1%)	176 (57.0%)	41 (25.9%)
Any M1 (metastatic)	43 (24.4%)	342 (36.7%)	154 (39.9%)	113 (36.6%)	110 (69.6%)
M1 group
M1a only	13 (7.4%)	102 (11.0%)	53 (13.7%)	49 (15.9%)	30 (19.0%)
Any M1b*	19 (10.8%)	201 (21.6%)	88 (22.8%)	48 (15.5%)	65 (41.1%)
Any M1c	11 (6.2%)	39 (4.2%)	13 (3.4%)	16 (5.2%)	15 (9.5%)
No. of M1 regions
0	133 (75.6%)	589 (63.3%)	232 (60.1%)	196 (63.4%)	48 (30.4%)
1–2	5 (2.8%)	55 (5.9%)	44 (11.4%)	11 (3.6%)	18 (11.4%)
≥3	38 (21.6%)	287 (30.8%)	110 (28.5%)	102 (33.0%)	92 (58.2%)

*Not including M1c.
IBF = interval from primary therapy to biochemical failure; RT = radiotherapy.
Qualitative data are number followed by percentage in parentheses; continuous data are median followed by IQR in brackets. PSMA stages are according to PROMISE criteria (13).