Article Figures & Data
Figures
- FIGURE 1.
BCR (PSA, 14.1 ng/mL) in patient with CRPC who was previously treated with radical prostatectomy, salvage radiation therapy to prostate bed, and ADT. 18F-fluciclovine (Axumin) PET/CT (first panel) showed single oligometastasis in proximal right femur (arrow), which was treated with SABR, with initial transient decline in PSA level but rapid subsequent rise within 3 mo to 15.5 ng/mL. 68Ga-PSMA PET/CT (second panel) showed heterogeneous activity in proximal right femur and additional metastatic lesions in right ribs (arrows). Serum PSA level rose rapidly again within 2 mo to 84.4 ng/mL, at which time repeat 68Ga-PSMA-11 PET/CT (third panel) showed numerous metastases. Companion 18F-FDG PET/CT showed that some metastases also exhibited high glycolytic phenotype (fourth panel). Patient was enrolled in clinical trial. All images are maximum-intensity projections. RP = radical prostatectomy; SBRT = stereotactic body radiation therapy. (Courtesy of Jeremie Calais, UCLA.)
- FIGURE 2.
Metachronous oligometastasis in 48-y-old man with BCR (PSA, 0.45 ng/mL) of prostate cancer (Gleason score, 8; International Society of Urologic Pathologists grade, 4) after prostatectomy. (A) Baseline 68Ga-PSMA PET/CT shows subcentimeter 68Ga-PSMA–avid metastasis in right internal iliac lymph node (arrows). (B) Follow-up 68Ga-PSMA PET/CT obtained 20 mo after metastasis-directed SABR shows complete local response, with PSA decline to 0.031 ng/mL. Shown are maximum-intensity projection images (rightmost and leftmost panels), axial CT images (upper middle panels), and axial PET/CT images (lower middle panels). RT = radiation therapy. (Reprinted with permission of (35)).
- FIGURE 3.
BCR (PSA, 0.63 ng/mL) in patient with prostate cancer (pT3bN0M0; Gleason score, 4 + 3) treated with radical prostatectomy. 68Ga-PSMA-11 PET/CT showed single rib lesion (green crossbar), which was subsequently treated with SABR (45 Gy × 5). Follow-up serum PSA levels at 3 and 26 mo were 0.03 and 0.01 ng/mL, respectively. Shown are CT images (left panel), PET/CT images (middle panel), and PET images (right panel); all panels depict axial (top), sagittal (middle), coronal (bottom) views. (Courtesy of Jeremie Calais, UCLA.)
- FIGURE 4.
Metachronous oligometastasis in 73-y-old man with BCR (PSA, 4.0 ng/mL) after prostatectomy and adjuvant radiation therapy for prostate cancer (Gleason score, 9; International Society of Urologic Pathologists grade, 5). (A) Baseline 68Ga-PSMA PET/CT shows single osseous lesion at T8 vertebral body (arrow in A, dotted circles in A and B). (B) Follow-up 68Ga-PSMA PET/CT obtained 8 mo after metastasis-directed SABR of T8 lesion shows partial radiographic local response of lesion but development of new lesions elsewhere in spine despite biochemical response, with overall PSA decline to 2.28 ng/mL. Arrows in B show new metastatic lesions in spine. Shown are maximum-intensity projections (first and fourth panels) and sagittal PET/CT images (second and third panels). SBRT = stereotactic body radiation therapy. (Reprinted with permission of (35)).
Tables
Trial Imaging modality Oligometastatic definition Oligometastatic therapy Outcome measure Reference ORIOLE CT, BS ≤3 bone or LN SABR vs. observation Progression at 6 m 54 POPSTAR 18F-NaF PET/CT ≤3 bone SABR Radiographic PFS 55 RAVENS CT, BS ≤3 bone or ST (at least 1 bone) SABR + 223RaCl2 PFS 56 STOMP Choline PET/CT ≤3 bone or LN Surveillance vs. SABR ADT-free survival 61 LOCATE 18F-fluciclovine PET/CT ≤5 extraprostatic (≤3 in any single organ) NA Change in management 64 TROD 09-004 PSMA PET/CT ≤5 bone SABR 2-y PFS 73 OLI-P PSMA PET/CT ≤5 bone or LN SABR Time to ADT initiation; time to PSA progression 75 BULLSEYE PSMA PET/CT ≤5 bone or LN 177Lu-PSMA-617 vs. SOC (deferred ADT) Progression at 24 wk 78 BS = bone scan; LN = lymph node; NA = not applicable; SOC = standard of care; ST = soft tissue.
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