Presented by: Michael Frumer MD
Rabin Medical Center

Introduction

Neoadjuvant lutetium-177-prostate-specific membrane antigen (LuPSMA) therapy before definitive local therapy may improve oncological outcomes by targeting the primary tumor and micro-metastatic disease. The safety of LuPSMA has already been reported.  This study aims to describe early oncological outcomes of LuPSMA in patients with High-risk prostate cancer (HRPCa).

Materials

Patients with HRPCa and increased uptake on PSMA-PET/CT were enrolled in an open-label, single-arm clinical trial. Two or three LuPSMA doses (7.4 GBq) were given at two-week intervals. Robotic-assisted laparoscopic radical prostatectomy (RALP) with lymph node dissection was done 4 weeks after the last LuPSMA dose. The oncological outcomes including histological findings, biochemical response, biochemical recurrence free survival and overall survival, were descriptively analyzed. 

Results

,

Thirteen patients were treated with LuPSMA followed by RALP (median age, 67). Final whole-mount pathology showed significant (≥3 mm) positive margins in 4 patients (30%) and downgrading to ISUP 3 in 3 patients (23%). At 5 weeks after surgery, 12 patients (92%) had undetectable PSA (<0.1 ng/ml).

During median follow-up of 26.3 months (IQR 21-33), 6 patients (46%) experienced biochemical recurrence and were referred to early salvage radiation and androgen deprivation Therapy. Median time from surgery to biochemical recurrence was 14 months (IQR 11-17). On follow-up PSMA-PET/CT, among those 6 patients, 2 had positive lymph nodes and 1 had positive lymph nodes and abnormal uptake in femur bone. Regarding functional outcomes, 12 patients (92%) required one or less pad/day.

Conclusion

In this first report of early oncological after neoadjuvant LuPSMA in HRPCa patients, about half experienced biochemical recurrence and required salvage therapy.  Additional follow up is required to assess long term outcomes.  

Funding

Dr. Adolph and Klara Brettler Endowment Fund in Urology, Sackler Faculty of Medicine, and Tel Aviv University.

Co-Authors

Daniel Kedar, MD
Rabin Medical Center

Jack Baniel, MD
Rabin Medical Center

David Groshar, MD
Rabin Medical Center

Hanna Bernstine, MD
Rabin Medical Center

Maxim Yakimov, MD
Rabin Medical Center

Eli Rosenbaum, MD
Rabin Medical Center

Shay Golan, MD
Rabin Medical Center