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Aizawa T, Maebayashi T, Ishibashi N, Sakaguchi M, Sato A, Yamaguchi K. Study of prostate-specific antigen levels during salvage radiotherapy after prostate cancer surgery. BMC Urol 2023; 23:157. [PMID: 37794380 PMCID: PMC10552428 DOI: 10.1186/s12894-023-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Administration of adjuvant or salvage radiotherapy (RT) after prostate cancer (PCa) surgery is supported by clinical evidence and is a widely adopted strategy. On occasion, we detect changes in prostate-specific antigen (PSA) levels, such as a transient elevation or decline, during RT. Thus, we retrospectively investigated the frequency of changes in PSA levels, their associations with histopathological parameters, PSA doubling time (PSADT), and biochemical recurrence (BR) of PCa. METHODS This study included 23 consecutive patients who underwent surgery for PCa between 2012 and 2019, received salvage RT without hormone therapy, and exhibited changes in PSA levels during RT. The prostatic bed was irradiated with a total dose of 64 to 66 Gy. BR was defined as consecutive PSA levels exceeding 0.2 ng/mL or having to start hormone therapy because of PSA elevation after salvage RT. RESULTS During salvage RT after PCa surgery, PSA levels transiently increased in 11 patients (47.8%) and decreased in 12 (52.2%). When factors associated with BR were examined in patients with transient PSA elevation, seminal vesicle invasion and preoperative PSA values were identified as being statistically significant. When factors for BR were examined in patients with a decline in PSA levels, the Gleason score and PSADT were identified as being significant. Among the cases of a decline in PSA levels during salvage RT, those who received a radiation dose of less than 36 Gy did not experience BR. Similarly, patients who exhibited changes in PSA levels during salvage RT and did not have perineural invasion did not experience BR. CONCLUSION This is the first study to examine the histopathological factors possibly affecting BR in patients undergoing salvage RT after PCa surgery. The results indicate that in patients with transient PSA elevation, seminal vesicle invasion is a significant risk factor. On the other hand, in patients with a decline in PSA levels during irradiation, the Gleason score and perineural invasion were found to be potential risk factors for BR. These findings suggest that a thorough examination of postoperative histopathological results may be necessary for the optimal management of patients with PCa.
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Affiliation(s)
- Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Naoya Ishibashi
- Department of Radiology, Nihon University Hospital, Chiyoda-ku, Tokyo, 101- 8309, Japan
| | - Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akahiko Sato
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenya Yamaguchi
- Department of Urology, Nihon University Hospital, Chiyoda-ku, Tokyo, 101-8309, Japan
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Storey CM, Altai M, Bicak M, Veach DR, Lückerath K, Adrian G, McDevitt MR, Kalidindi T, Park JE, Herrmann K, Abou D, Zedan W, Peekhaus N, Klein RJ, Damoiseaux R, Larson SM, Lilja H, Thorek D, Ulmert D. Quantitative In Vivo Imaging of the Androgen Receptor Axis Reveals Degree of Prostate Cancer Radiotherapy Response. Mol Cancer Res 2023; 21:307-315. [PMID: 36608299 PMCID: PMC10355285 DOI: 10.1158/1541-7786.mcr-22-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Noninvasive biomarkers for androgen receptor (AR) pathway activation are urgently needed to better monitor patient response to prostate cancer therapies. AR is a critical driver and mediator of resistance of prostate cancer but currently available noninvasive prostate cancer biomarkers to monitor AR activity are discordant with downstream AR pathway activity. External beam radiotherapy (EBRT) remains a common treatment for all stages of prostate cancer, and DNA damage induced by EBRT upregulates AR pathway activity to promote therapeutic resistance. [89Zr]11B6-PET is a novel modality targeting prostate-specific protein human kallikrein 2 (hK2), which is a surrogate biomarker for AR activity. Here, we studied whether [89Zr]11B6-PET can accurately assess EBRT-induced AR activity.Genetic and human prostate cancer mouse models received EBRT (2-50 Gy) and treatment response was monitored by [89Zr]11B6-PET/CT. Radiotracer uptake and expression of AR and AR target genes was quantified in resected tissue.EBRT increased AR pathway activity and [89Zr]11B6 uptake in LNCaP-AR and 22RV1 tumors. EBRT increased prostate-specific [89Zr]11B6 uptake in prostate cancer-bearing mice (Hi-Myc x Pb_KLK2) with no significant changes in uptake in healthy (Pb_KLK2) mice, and this correlated with hK2 protein levels. IMPLICATIONS hK2 expression in prostate cancer tissue is a proxy of EBRT-induced AR activity that can noninvasively be detected using [89Zr]11B6-PET; further clinical evaluation of hK2-PET for monitoring response and development of resistance to EBRT in real time is warranted.
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Affiliation(s)
- Claire M Storey
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Mohamed Altai
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mesude Bicak
- Hasso Plattner Institute for Digital Health, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Darren R Veach
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Katharina Lückerath
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, DKTK, Essen, Germany
| | - Gabriel Adrian
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Michael R McDevitt
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Teja Kalidindi
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
| | - Julie E Park
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, DKTK, Essen, Germany
| | - Diane Abou
- Department of Radiology, Washington University School of Medicine, St. Louis, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - Wahed Zedan
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Norbert Peekhaus
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Robert J Klein
- Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Damoiseaux
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
- California NanoSystems Institute, UCLA, Los Angeles, USA
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA
- Department of Radiology, Weill Cornell Medical College, New York, USA
| | - Hans Lilja
- Genitourinary Oncology Service, Department of Medicine, MSKCC, New York, USA
- Urology Service, Department of Surgery, MSKCC, New York, USA
- Department of Laboratory Medicine, MSKCC, New York, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Daniel Thorek
- Department of Radiology, Washington University School of Medicine, St. Louis, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, USA
| | - David Ulmert
- Department of Molecular & Medical Pharmacology, University of California Los Angeles (UCLA), Los Angeles, USA
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- California NanoSystems Institute, UCLA, Los Angeles, USA
- Department of Urology, Institute of Urologic Oncology, UCLA, Los Angeles, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, USA
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Gunnlaugsson A, Johannesson V, Wieslander E, Brun E, Bitzen U, Ståhl O, Bratt O, Ahlgren G, Ohlsson T, Kjellén E, Nilsson P. A prospective phase II study of prostate-specific antigen-guided salvage radiotherapy and 68Ga-PSMA-PET for biochemical relapse after radical prostatectomy - The PROPER 1 trial. Clin Transl Radiat Oncol 2022; 36:77-82. [PMID: 35873652 PMCID: PMC9305618 DOI: 10.1016/j.ctro.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022] Open
Abstract
PSA response during the first weeks of salvage radiotherapy (SRT) of prostate cancer is highly predictive for tumour control. PSA responders received conventional local SRT towards the prostate bed while the treatment plan of PSA non-responders was changed after 5 weeks of SRT to also include pelvic lymph nodes/metastases. High tumour control rate with moderate side effects were observed in both PSA responders and non-responders with this new personalised treatment concept. It is now further investigated in a prospective phase III trial (NCT04858880).
Background and purpose The treatment of biochemical recurrence (BCR) after prostatectomy is challenging as the site of the recurrence is often undetectable. Our aim was to test a personalised treatment concept for BCR based on PSA kinetics during salvage radiotherapy (SRT) combined with prostate-specific membrane antigen positron emission tomography (PSMA-PET). Materials and methods This phase II trial included 100 patients with BCR. PSMA-PET was performed at baseline. PSA was measured weekly during SRT. Initially, 70 Gy in 35 fractions was prescribed to the prostate bed. Radiotherapy was adapted after 50 Gy. Non-responders (PSA still ≥ 0.15 ng/mL) received sequential lymph node irradiation with a boost to PSMA-PET positive lesions, while responders (PSA < 0.15 ng/mL) continued SRT as planned. PET-findings were only taken into consideration for treatment planning in case of PSA non-response after 50 Gy. Results Data from 97 patients were eligible for analysis. Thirty-four patients were classified as responders and 63 as non-responders. PSMA-PET was positive in 3 patients (9%) in the responder group and in 22 (35%) in the non-responder group (p = 0.007). The three-year failure-free survival was 94% for responders and 68% for non-responders (median follow-up 38 months). There were no significant differences in physician-reported urinary and bowel toxicity. Patient-reported diarrhoea at end of SRT was more common among non-responders. Conclusion This new personalised treatment concept with intensified SRT based on PSA response demonstrated a high tumour control rate in both responders and non-responders. These results suggest a clinically significant effect with moderate side effects in a patient group with otherwise poor prognosis. PSMA-PET added limited value. The treatment approach is now being evaluated in a phase III trial. Clinical trial registration numbers: NCT02699424&ISRCTN45905321.
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Affiliation(s)
- Adalsteinn Gunnlaugsson
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
- Corresponding author at: Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Klinikgatan 5, 22185 Lund, Sweden.
| | - Vilberg Johannesson
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Elinore Wieslander
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Eva Brun
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Ulrika Bitzen
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Olof Ståhl
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Ola Bratt
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Science Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tomas Ohlsson
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Elisabeth Kjellén
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Per Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
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Adaptive sequential plan-on-plan optimization during prostate-specific antigen response guided radiotherapy of recurrent prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:5-10. [PMID: 34258401 PMCID: PMC8254191 DOI: 10.1016/j.phro.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
Background Treatment adaptation based on tumour biomarker response during radiotherapy of prostate cancer, could be used for both escalation and de-escalation of radiation doses and volumes. To execute an adaptation involving extension of treatment volumes during radiation can however be restricted by the doses already delivered. The aim of this work was to develop a treatment planning method that addresses this challenge. Material and methods A volumetric-modulated-arc-therapy (VMAT) planning method with sequential plan-on-plan optimization was developed for a prospective phase II trial including 100 patients on salvage radiotherapy (SRT) for prostate cancer recurrence. A treatment adaptation was performed after five weeks of SRT based on prostate-specific antigen response during this phase of the treatment. This involved extension of treatment volumes for non-responders (n = 64) to include pelvic lymph nodes and boost to 68Gallium-Prostate-Specific-Membrane-Antigen-Positron-Emission-Tomography positive lesions. This method was evolved by introducing an EQD2 (equivalent dose in 2.0 Gy fractions) correction of the base plan for improved dose coverage. Results All dose-volume criteria for target coverage were met for the non-responders when based on physical dose. An EQD2 correction of the base plan for non-responders, implemented for the final 29 patients, led to a statistically significant improvement in dose coverage as compared to the 35 patients treated without EQD2 correction. Conclusions This is to our knowledge the only study presented on biomarker-guided sequential VMAT radiotherapy using a plan-on-plan technique in the pelvis. By using a biologically adapted technique an improved target coverage was achieved without compromising doses to organs at risk.
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