Open Access

Fabian Falkenbach, Flemming Lischewski, Sophie Knipper, Daniel Koehler, Pierre I. Karakiewicz, Zhe Tian, Fred Saad, Derya Tilki, Lars Budäus, Thomas Steuber, Philipp Mandel, Mike Wenzel, Jürgen E. Gschwend, Markus Graefen, Matthias M. Heck, Tobias Maurer

• We analyzed data for a cohort of 111 patients with EMBARK-like biochemical recurrence (BCR) of prostate cancer (prostate-specific antigen [PSA] doubling time ≤9 mo, PSA ≥1 ng/ml) after radical prostatectomy and localized oligorecurrence on prostate-specific membrane antigen (PSMA)-based imaging. All patients underwent PSMA-radioguided surgery (RGS). At PSMA-RGS, the median PSA was 1.95 ng/ml (interquartile range [IQR] 1.36–3.20) ng/ml and the median PSA doubling time was 4.0 mo (IQR 2.5–5.5). Clavien-Dindo grade >IIIa complications occurred in nine of 111 patients (8.1%). A complete biochemical response (cBR; PSA decline ≤0.2 ng/ml after PSMA-RGS) was observed in 53 patients (47.7%). In the cBR group (equivalent to the treatment suspension criterion in EMBARK), estimated survival rates at 2 yr were 49.9% (95% confidence interval [CI] 37.2–67.1%) for BCR-free survival and 65.2% (95% CI 52.2–81.4%) for treatment-free survival. A relevant proportion of our PSMA-RGS cohort with localizedWe analyzed data for a cohort of 111 patients with EMBARK-like biochemical recurrence (BCR) of prostate cancer (prostate-specific antigen [PSA] doubling time ≤9 mo, PSA ≥1 ng/ml) after radical prostatectomy and localized oligorecurrence on prostate-specific membrane antigen (PSMA)-based imaging. All patients underwent PSMA-radioguided surgery (RGS). At PSMA-RGS, the median PSA was 1.95 ng/ml (interquartile range [IQR] 1.36–3.20) ng/ml and the median PSA doubling time was 4.0 mo (IQR 2.5–5.5). Clavien-Dindo grade >IIIa complications occurred in nine of 111 patients (8.1%). A complete biochemical response (cBR; PSA decline ≤0.2 ng/ml after PSMA-RGS) was observed in 53 patients (47.7%). In the cBR group (equivalent to the treatment suspension criterion in EMBARK), estimated survival rates at 2 yr were 49.9% (95% confidence interval [CI] 37.2–67.1%) for BCR-free survival and 65.2% (95% CI 52.2–81.4%) for treatment-free survival. A relevant proportion of our PSMA-RGS cohort with localized oligorecurrence on PSMA-based imaging fulfilled the EMBARK criteria. PSMA-RGS yielded meaningful biochemical responses that translated to long-lasting treatment-free periods.…