Impact of Metastasis-directed Therapy Guided by Different PET/CT Radiotracers on Distant and Local Disease Control in Oligorecurrent Hormone-sensitive Prostate Cancer: A Secondary Analysis of the PRECISE-MDT Study.

Prospective trials suggest that metastasis-directed therapy (MDT) is an effective treatment for patients with oligometastatic prostate cancer (PCa). Gallium 68 (68Ga) prostate-specific membrane antigen (PSMA)-11 PET/CT-guided MDT seems to improve the oncologic outcome in these patients compared with fluorine 18 (18F)-fluorocholine and 18F-PSMA-1007 PET/CT-guided MDT, but the effects in terms of local or distant disease control remain unclear. Thus, the present subanalysis of the PRECISE-MDT study analyzed patients with hormone-sensitive PCa who underwent MDT guided by PET/CT for nodal or bone oligorecurrent disease and were restaged with the same imaging modality in case of biochemical recurrence after MDT. Among 340 lesions detected in 241 male patients (median age, 74 [IQR, 9] years), 18F-fluorocholine, 68Ga-PSMA-11, and 18F-PSMA-1007 PET/CT-guided MDT was performed in 179, 81, and 80 lesions, respectively. At restaging imaging, the PET/CT imaging modality used to guide MDT was not significantly associated with local recurrence-free survival (LRFS), with median LRFS not reached for 68Ga-PSMA-11 PET/CT, 18F-PSMA-11 PET/CT, and 18F-fluorocholine PET/CT (P = .73). However, the detection rate of a new metastasis was significantly higher if MDT was guided by 18F-fluorocholine PET/CT (119 of 179 lesions, 66.5%) compared with 68Ga-PSMA-11 or 18F-PSMA-1007 PET/CT (23 of 81 lesions, 28%, and 27 of 80, 34%, respectively; P < .001 for both). Moreover, MDT guided by 68Ga-PSMA-11 PET/CT led to an improved median metastasis-free survival (MFS) (not reached) compared with 18F-PSMA-1007 (median MFS, 24.9 months; P < .001) or 18F-fluorocholine PET/CT (median MFS, 18 months; P < .001). These findings suggest that using different PET/CT imaging modalities to guide MDT might impact the distant disease control in this clinical scenario. Keywords: Radiation Therapy, Oncology, Urinary, Prostate, PET/CT Supplemental material is available for this article. Published under a CC BY 4.0 license.