Biochemical relapse after local treatment for prostate cancer: isolated or systemic relapse?

Transkript

1 Biochemical relapse after local treatment for prostate cancer: isolated or systemic relapse? Christian Gratzke LMU Munich

2 Disclosures Grants/research support from AMS, Astellas, Bayer HealthCare, Lilly, Rottapharm Madaus Consultant for Amgen, AMS, Astellas, GSK, Ipsen, Janssen, STEBA, Lilly, Rottapharm Madaus

3 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence

4 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence

5 Definition of BCR Radical Prostatectomy: Two consecutive PSA values of > 0.2 ng/ml and rising Radiation Therapy: Any PSA increase > 2 ng/ml higher than the PSA nadir

6 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence

7 Natural history of PC after treatment Retrospective cohort study of 379 men who had undergone radical prostatectomy and who had a biochemical recurrence Freedland et al, JAMA 2005

8 Natural history of PC after treatment Biochemical recurrence segregated by pathological Gleason score among patients who experienced a biochemical recurrence. Freedland et al, JAMA 2005

9 Natural history of PC after treatment Biochemical recurrence segregated by PSADT among patients who experienced a biochemical recurrence. Freedland et al, JAMA 2005

10 Natural history of PC after treatment Biochemical recurrence stratified by all comers vs early biochemical recurrence (within 3 years following surgery) vs late biochemical recurrence(>3 years following surgery). Freedland et al, JAMA 2005

11 Natural history of PC after treatment GS < 8, PSADT >15 mo, >3 yr from surgery to BCR: 15-yr CSM 6% GS 8, PSADT <3 mo, <3 yr from surgery to BCR: 10-yr CSM 99% Freedland et al, JAMA 2005

12 Natural history of PC after treatment Time from surgery to BCR really? Boorjian et al, Eur Urol 2011

13 Natural history of PC after treatment At 10 years: BCR-free survival CR-free survival Salvage treatment 50 % 87 % 37 % 1100 D Amico high-risk PCa patients who underwent RARP between 2002 and 2013 at three tertiary care centers. Abdollah et al, Eur Urol 2015

14 Natural history of PC after treatment Only a subset of men with BCR after definitive primary treatment will have clinical progression during their lifetime

15 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence Risk assessment Imaging

16 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence Risk assessment Imaging

17 Risk assessment for prostate cancer recurrence Nomograms: 59-93% predictive accuracy Unable to predict with high accuracy who will need salvage therapy and who will not.

18 Definition of biochemical recurrence (BCR) Natural history of prostate cancer after treatment Assessment of prostate cancer recurrence Risk assessment Imaging

19 Imaging modalities for detecting BCR CT-Scan (CT) Low rate of positive findings if PSA 10 ng/ml Bone scan (BS) Low rate of positive findings if PSA 10 ng/ml Multiparametric MRI (Dynamic contrast diffusion weighting, spectroscopy, whole-body MRI) PET-CT (Choline / PSMA) Martino et al, WJU 2011, Okotie et al J Urol 2004 Dotan et al, JCO 2005

20 Imaging modalities for detecting BCR 68 GA-PSMA-PET-CT vs Choline PET-CT 18 F-Choline 68 Ga-PSMA Afshar-Oromieh et al Eur J Nucl Med Mol Imaging 2014

21 F-18 Fluorethyl-Choline Ga-68 PSMA Imaging modalities for detecting BCR 68 GA-PSMA-PET-CT vs Choline PET-CT Fendler W., Gratzke C (unpublished data)

22 F-18 Fluorethyl-Choline Ga-68 PSMA Imaging modalities for detecting BCR 68 GA-PSMA-PET-CT vs Choline PET-CT Fendler W., Gratzke C (unpublished data)

23 Imaging modalities for detecting LN 68 GA-PSMA-PET-CT Maurer et al, J Urol 2016 Herlemann et al, Eur Urol 2016 Budäus et al, BJUI 2015

24 Imaging modalities for detecting BCR 68 GA-PSMA-PET-CT PSA Eiber et al, J Nucl Med 2015

25 Imaging modalities for detecting BCR 68 GA-PSMA-PET-CT Probability of a positive PSMA-scan in function of PSA value 1 Probability 0,75 0,5 0,25 0 0,01 0, PSA ng/ml PSA cut-off value: 0,45 ng/ml In patients PSA 0,45 ng/ml: PSA DT 5 months Cromphout // Joniau, Eur Urol Suppl 2016

26 Conclusions Natural history of PC after treatment is variable Some men will progress (benefit from local treatment?) Novel imaging modalities emerge and improve detection of BCR / CR 68GA-PSMA-PET-CT seems to have the highest accuracy in detecting BCR, even in PSA-values 1 ng/ml