Salvage radiotherapy with prostate-specific membrane antigen-directed focal boost - A precision approach for recurrent prostate cancer

Q: What is the purpose of PSMA PET-guided salvage radiotherapy in this study?

It aims to improve disease control in biochemically recurrent prostate cancer by escalating dose to PSMA-avid lesions rather than relying on conventional targeting alone.

Q: What were the main effectiveness and safety findings?

Salvage radiotherapy produced significantly longer failure-free survival than ADT alone, with manageable toxicity. Acute grades 1–2 GI/GU toxicities occurred in 46.9%, late grades 1–2 in 32.7%, and grade 3 hematuria requiring intervention in 8.2%.

Sep 29, 2026

Uploaded by Emma Wilson

Prostate cancer patients are living longer due to new therapies and imaging, yet biochemical recurrence remains common. PSMA PET imaging detects recurrence with high sensitivity at low PSA levels and enables focal dose escalation to PSMA-avid lesions. This study assessed whether PSMA PET-guided salvage radiotherapy improves disease control versus androgen deprivation therapy (ADT) alone, while preserving an acceptable toxicity profile.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Background and rationale

Methods

Results

Conclusion

J Chin MedAssoc Original article Salvage radiotherapy with prostate-specific membrane antigen-directed focal boost: A precision approach for recurrent prostate cancer Tien-Li Lana,b, Ko-Han Linc,d, Tzu-Chun Weie, Yu-Wen Huf, Tzu-Yu Laif, Yu-Mei Kangf, Hsiao-Jen Chunge, Shu-Huei Sheng, Yu-Ming Liuf,* aDepartment of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDepartment of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dDepartment of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, ROC; eDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDepartment of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gDivision of Interventional Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: With the advent of novel therapies and advanced imaging modalities, prostate cancer patients are living longer, but biochemical recurrence has become increasingly common. Prostate-specific membrane antigen (PSMA) PET imaging demonstrates high sensitivity in detecting recurrence at low prostate-specific antigen (PSA) levels, surpassing conventional imaging. While salvage radiotherapy traditionally targets the prostate fossa, PSMA PET enables focal dose escalation to PSMA-avid lesions. This study evaluated whether PSMA PET-guided salvage radiotherapy improves disease control compared with androgen deprivation therapy (ADT) alone, while maintaining an acceptable toxicity profile. Methods: Patients with suspected recurrent prostate cancer underwent PSMA PET, with eligibility defined as a PSMA score >3 . Salvage treatment consisted of high-dose radiotherapy to the prostate fossa with focal boost to PSMA-avid lesions (with or without ADT) or ADT alone. The primary endpoint was failure-free survival (FFS) . Secondary endpoints included treatment-related toxicities. Results: Fifty-six patients were included (mean age, 70.3 years) . The mean initial PSA was 25.2 ng/mL, and the mean PSA before PSMA PET was 2.47 ng/mL. Patients who had previously undergone radical prostatectomy demonstrated significantly longer FFS compared with those initially treated with radiotherapy (41 .2 vs 31.5 months, p = 0.045), although baseline PSA was higher in the radiotherapy group. Salvage radiotherapy yielded significantly longer FFS than ADT alone (42 .1 vs 23.4 months, p < 0 .001) . Acute grades 1 and 2 gastrointestinal or genitourinary toxicities occurred in 23 patients (46 .9%), late grades 1 and 2 events in 16 patients (32 .7%), and grade 3 hematuria requiring intervention in 4 patients (8 .2%) . Conclusion: PSMA PET-guided salvage radiotherapy is an effective and personalized strategy for patients with biochemicallyrecurrent prostate cancer. Compared with ADT alone, it provides superior failure-free survival with manageable toxicity, supporting its role as a standard component of salvage management. Keywords: Prostate cancer; PSMA PET; Salvage radiotherapy 844 [www.ejcma.org](www.ejcma.org) Original Article. (2025) 88:11 J Chin MedAssoc Lay summary Prostate cancer can recur after initial treatment, even when blood test results (PSA levels) are still low. In this study, we used a new type of imaging called PSMA PET to more accurately detect where the cancer had come back. We then treated 56 patients using high-dose radiation therapy focused on the areas shown on the scan. We compared the results with patients who received hormone therapy alone. Patients who received targeted radiation had much better cancer control and were less likely to experience a return of the disease. This focused approach also caused relatively few side effects. Our findings suggest that using PSMA PET scans to guide personalized radiation treatment is an effective

FAQs

What is the purpose of PSMA PET-guided salvage radiotherapy in this study?

It aims to improve disease control in biochemically recurrent prostate cancer by escalating dose to PSMA-avid lesions rather than relying on conventional targeting alone.

How were eligible patients defined for PSMA PET and salvage treatment?

Patients with suspected recurrent prostate cancer underwent PSMA PET, with eligibility defined by a PSMA score greater than 3. Salvage treatment included high-dose radiotherapy to the prostate fossa with a focal boost to PSMA-avid lesions (with or without ADT) or ADT alone.

What were the main effectiveness and safety findings?

Salvage radiotherapy produced significantly longer failure-free survival than ADT alone, with manageable toxicity. Acute grades 1–2 GI/GU toxicities occurred in 46.9%, late grades 1–2 in 32.7%, and grade 3 hematuria requiring intervention in 8.2%.

Sep 29, 2026

Uploaded by Emma Wilson