Observational Management for Patients with Biochemical Recurrence Following Radical Prostatectomy, in the Absence of Detectable Disease on Restaging PSMA PET/CT Imaging

Q: What patient group was studied in this work?

Men with biochemical recurrence after radical prostatectomy who had negative prostate-specific membrane antigen (PSMA) PET/CT findings at baseline and were managed with observation.

Q: How did the study define biochemical and radiological progression?

Biochemical progression was defined by a PSA rise above baseline threshold or initiation of additional treatment, while radiological progression was assessed as local or metastatic disease on follow-up PSMA PET/CT.

Q: Which factors independently predicted biochemical progression?

A higher pathological ISUP grade group (≥4) and a shorter PSA doubling time (PSAdt < 20 months) independently predicted biochemical progression.

Sep 30, 2026

Uploaded by Miles

Biochemical recurrence after radical prostatectomy is often managed with salvage radiotherapy when imaging shows no metastases, yet the best strategy for men with negative PSMA PET/CT is uncertain. This retrospective multicentre cohort study assessed 89 patients with BCR and negative PSMA PET/CT managed by observation (2015–2022), applying PSA and imaging progression end points over at least 3 years. EAU BCR risk stratification and multivariable Cox regression identified predictors of biochemical progression and radiological progression, supporting risk-adapted deferral of SRT in selected low-risk patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article Observational Management for Patients with Biochemical Recurrence Following Radical Prostatectomy, in the Absence of Detectable Disease on Restaging PSMA PET/CT Imaging Katelijne C. C. de Bie 1,2,3, *, Jan-Jaap J. Mellema 4, Dennie Meijer 1,2, Frederik R. Teunissen 5, Pim J. van Leeuwen 2,6, Daniela E. Oprea-Lager 7, Maarten L. Donswijk 8, Roderick C. N. van den Bergh 9 and André N. Vis 1,2 Academic Editor: Nicola Longo Received: 16 November 2025 Revised: 13 December 2025 Accepted: 15 December 2025 Published: 22 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Urology, Amsterdam University Medical Center, VU University, 1081 HV Amsterdam, The Netherlands; [a.vis@amsterdamumc.nl](a.vis@amsterdamumc.nl) (A.N.V.) 2 Prostate Cancer Network The Netherlands, The Netherlands 3 Cancer Center Amsterdam, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands 4 Department of Oncology, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; [j.mellema@nki.nl](j.mellema@nki.nl) 5 Department of Radiation Oncology, Radboud University Medial Center, 6525 GA Nijmegen, The Netherlands 6 Department of Urology, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands 7 Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands 8 Department of Nuclear Medicine, Antoni van Leeuwenhoek Hospital—The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands 9 Department of Urology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands * Correspondence: [k.debie@amsterdamumc.nl](k.debie@amsterdamumc.nl) Abstract Background/Objectives: In men with biochemical recurrence (BCR) after a radical prostatectomy (RP), salvage radiotherapy (SRT) is commonly recommended when imaging shows no metastases. The optimal management for patients with negative prostate-specific membrane antigen (PSMA) PET/CT findings at BCR remains uncertain. This study evaluated outcomes of patients with BCR and negative PSMA PET/CT to identify who may be safely observed and who may benefit from early SRT. Methods: This retrospective multicentre cohort study included 89 patients with BCR and negative PSMA PET/CT findings after a RP (2015–2022) who were managed with observation. The exclusion criteria were PSA levels ≥ 0.8 ng/mL at baseline, prior SRT, or prior or ongoing hormonal therapy. Minimum follow-up was 3 years. Biochemical progression (PSA rise > 0.2 ng/mL above baseline or initiation of additional treatment) and radiological progression (local or metastatic disease on follow-up PSMA PET/CT) were assessed. Patients were stratified by EAU BCR-risk classification. Multivariable Cox regression included age, biochemical persistence (BCP) after a RP, pathological tumour stage (pT), pathological ISUP grade group (pISUP), node status (pN), margin status (R), and PSA doubling time (PSAdt) . Results: The median age was 66 years (IQR 60–69) and the median PSA measurement at BCR was 0.2 ng/mL (IQR 0.2–0.3) . A total of 27/89 (30%) patients were EAU BCR low-risk and 62/89 (70%) were high-risk. At three years, biochemical progression occurred in 14/27 (52%) low-risk vs. 51/62 (83%) high-risk patients, with time to progression being 21 vs. 12 months (p = 0.01) . A pISUP grade group ≥ 4 (HR 2.04 [95%-CI 1.11–3.74]; p = 0.022) and a PSAdt < 20 months (HR 5.72 [95%-CI 2.41–13,56]; p < 0.01) independently predicted biochemical progression. Radiological progression occurred in 43/68 (66%) rescanned patients, with 32/43 (74%) showing disease outside the prostatic fossa. Conclusions: Nearly half of patients with BCRand negative PSMA PET/CT findings who were classified as EAU BCR low-risk remained progression-fr

FAQs

What patient group was studied in this work?

Men with biochemical recurrence after radical prostatectomy who had negative prostate-specific membrane antigen (PSMA) PET/CT findings at baseline and were managed with observation.

How did the study define biochemical and radiological progression?

Biochemical progression was defined by a PSA rise above baseline threshold or initiation of additional treatment, while radiological progression was assessed as local or metastatic disease on follow-up PSMA PET/CT.

Which factors independently predicted biochemical progression?

A higher pathological ISUP grade group (≥4) and a shorter PSA doubling time (PSAdt < 20 months) independently predicted biochemical progression.

Sep 30, 2026

Uploaded by Miles