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Introduction <p>Biochemical recurrence (BCR) in prostate cancer (PCa) after definitive radiotherapy (RT) is defined by a PSA rise ≥ 2.0&#xa0;ng/mL (Phoenix criteria, Pc). In clinical settings, PSMA PET/CT has demonstrated the ability to identify recurrent disease in case of PSA values remain below this threshold. This retrospective, multicentre study evaluated PSMA PET/CT in patients with rising PSA below the Phoenix-threshold.</p> Materials and methods <p>We retrospectively analysed PCa patients who underwent PSMA PET/CT for rising PSA below Pc in the period 2020–2023. Patients with prior recurrence treatments were excluded. PSMA PET/CT findings were classified by prostate cancer molecular imaging standardized evaluation (PROMISE) score and stratified by D’Amico risk. Treatment decisions were extracted from clinical records. A non‑parametric statistical analysis was employed (MedCalc® software).</p> Results <p>Sixty patients were included (median age 79&#xa0;years, IQR: 75–82). Median PSA value was 1.25&#xa0;ng/ml (range 0.12–5.02), and median PSA doubling time was 11.8&#xa0;months (range 0–87.9). The overall PSMA PET/CT detection rate was 71.7% (<i>n</i> = 43/60). Of those with positive scans, 81% (<i>n</i> = 35/43) were oligo‑metastatic and 19% (<i>n</i> = 8/43) were multi‑metastatic. According to the PROMISE score, 10 (23%) patients had only local recurrence, 10 (23%) only pelvic lymph node disease, 10 (23%) only distant metastases, 13 (31%) had local and distant disease (both lymph nodes and bone metastases). By D’Amico risk classification, 83.9% (30/35) of unfavourable intermediate/high‑risk patients had a positive PET, compared with 52.0% (13/25) of low/favourable intermediate‑risk patients (chi squared, <i>p</i> &lt; 0.05). Follow‑up data were available for 54 patients (90%). In 92.6% (<i>n</i> = 50/54), PET findings guided therapy choice: 97% (<i>n</i> = 38/39) of PET‑positive patients received additional treatment (hormonal therapy, RT, or chemotherapy), whereas 80% (<i>n</i> = 12/15) of PET‑negative patients were managed with watchful waiting (chi-square, <i>p</i> &lt; 0.001).</p> Conclusions <p>PSMA PET/CT detects PCa recurrence in about 72% of patients with PSA rises below Phoenix-threshold. By identifying disease at an earlier stage, many patients may become eligible for salvage or metastasis-directed therapies.</p>

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PSMA PET/CT for the detection of prostate cancer biochemical recurrence after primary radiation therapy: is it time to review the Phoenix criteria?

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Laura Evangelista,
  • Carlo Vallone,
  • Priscilla Guglielmo,
  • Sara Damiani,
  • Jelena Jandric,
  • Andrea Brignoli,
  • Manuela Marenco,
  • Francesco Martino,
  • Luciana Di Cristina,
  • Ciro Franzese,
  • Rosario Mazzola

摘要

Introduction

Biochemical recurrence (BCR) in prostate cancer (PCa) after definitive radiotherapy (RT) is defined by a PSA rise ≥ 2.0 ng/mL (Phoenix criteria, Pc). In clinical settings, PSMA PET/CT has demonstrated the ability to identify recurrent disease in case of PSA values remain below this threshold. This retrospective, multicentre study evaluated PSMA PET/CT in patients with rising PSA below the Phoenix-threshold.

Materials and methods

We retrospectively analysed PCa patients who underwent PSMA PET/CT for rising PSA below Pc in the period 2020–2023. Patients with prior recurrence treatments were excluded. PSMA PET/CT findings were classified by prostate cancer molecular imaging standardized evaluation (PROMISE) score and stratified by D’Amico risk. Treatment decisions were extracted from clinical records. A non‑parametric statistical analysis was employed (MedCalc® software).

Results

Sixty patients were included (median age 79 years, IQR: 75–82). Median PSA value was 1.25 ng/ml (range 0.12–5.02), and median PSA doubling time was 11.8 months (range 0–87.9). The overall PSMA PET/CT detection rate was 71.7% (n = 43/60). Of those with positive scans, 81% (n = 35/43) were oligo‑metastatic and 19% (n = 8/43) were multi‑metastatic. According to the PROMISE score, 10 (23%) patients had only local recurrence, 10 (23%) only pelvic lymph node disease, 10 (23%) only distant metastases, 13 (31%) had local and distant disease (both lymph nodes and bone metastases). By D’Amico risk classification, 83.9% (30/35) of unfavourable intermediate/high‑risk patients had a positive PET, compared with 52.0% (13/25) of low/favourable intermediate‑risk patients (chi squared, p < 0.05). Follow‑up data were available for 54 patients (90%). In 92.6% (n = 50/54), PET findings guided therapy choice: 97% (n = 38/39) of PET‑positive patients received additional treatment (hormonal therapy, RT, or chemotherapy), whereas 80% (n = 12/15) of PET‑negative patients were managed with watchful waiting (chi-square, p < 0.001).

Conclusions

PSMA PET/CT detects PCa recurrence in about 72% of patients with PSA rises below Phoenix-threshold. By identifying disease at an earlier stage, many patients may become eligible for salvage or metastasis-directed therapies.