Metastasis-directed therapy (MDT) may benefit men with prostate cancer who have metastases detected on PSMA PET scans following radical prostatectomy (RP), investigators reported at the 38th Annual Congress of the European Association of Urology (EAU23) in Milan, Italy.

A team led by Antony Pellegrino, MD, of IRCCS Ospedale San Raffaele Vita-Salute, San Raffaele University in Milan, noted that little evidence exists regarding the role of MDT in this patient population and the effect of MDT on patterns of subsequent clinical recurrence (CR). To address this gap, he and his colleagues retrospectively studied 226 patients with positive 68Ga-PSMA PET findings after post-RP biochemical recurrence. MDT consisted of stereotactic ablative radiation therapy focused on nodal, bony, or visceral metastatic sites. The investigators defined CR as development of any new metastases detected on follow up PSMA PET scans. Of the 226 patients, 109 received MDT and 117 did not.

At a median follow-up of 24 months after initial PSMA PET scans, 73 patients had CR. The 3-year CR-free rates were 51% in the MDT group and 28% in the no MDT group, said Dr Pellegrino, who reported study findings on behalf of his team. At CR, the men who did not receive MDT had a significantly higher rate of distant metastases compared those who did (86% vs 77%). The MDT group had a significantly lower proportion of distant metastases (67% vs 76%).

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“Interestingly, the pattern of recurrence was influenced by the use of MDT with a lower rate of clinical recurrence to non-pelvic distant sites,” Dr Pellegrino told attendees. “Therefore, salvage therapies may alter patterns of prostate cancer dissemination.”

The investigators observed no statistically significant differences between the groups in the distribution of metastatic sites found on the initial or post-CR PSMA PET scans.


Pellegrino A, Gandaglia G, Stabile A, et al. Exploring the effect of metastasis-directed therapy on progression patterns of patients with positive 68Ga-PSMA PET/CT and biochemical recurrence from prostate cancer. Presented at: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0264.