S1158
Clinical - Urology
ESTRO 2026
Conclusion: SABR including elective pelvic nodal irradiation, with or without SIB, is feasible and well tolerated in both definitive and post-prostatectomy settings, achieving acceptable local and nodal control without grade ≥ 3 toxicity. Longer follow-up is warranted to confirm durability of disease control. Keywords: SABR, nodal irradiation, ultra- hypofractionation Digital Poster Highlight 928 Diagnostic Capability and Improved Clinical Management of 18F-DCFPyL-PSMA PET/CT in Occult Biochemical Recurrence of Prostate Cancer Francesco Amorelli 1,2 , Pedro Jose Plaza 3 , Augusto Natali 4 , Palmira Foro 5 1 Radiation Oncology, Catalan Institute of Oncology (ICO), Barcelona, Spain. 2 PhD Program, Pompeu Fabra University (UPF), Barcelona, Spain. 3 Nuclear Medicine, Hospital Del Mar, Barcelona, Spain. 4 Laboratory Medicine, Hospital Josep Trueta, Girona, Spain. 5 Radiation Oncology, Hospital Del Mar, Barcelona, Spain Purpose/Objective: This study evaluates the diagnostic capability of 18F- DCFPyL-PET/CT in early biochemical-recurrence (BCR) of prostate cancer (PC) following radical prostatectomy (RP) and its impact on therapeutic decision-making and clinical-management. Material/Methods: We conducted a prospective, single-center study including 85 patients with PC who developed BCR after RP with PSA-levels between 0.2-2.0ng/mL. Eligible patients were those being considered for salvage- radiotherapy or persistent PSA-elevation after adjuvant/salvage treatment, all with negative findings on conventional-imaging (CT, MRI, and bone-scan). Each patient underwent ¹⁸ F-DCFPyL-PET/CT to assess the detection-rate (DR) according to clinical/biochemical parameters, including Gleason- score, ISUP-group, PSA-level (<0.5, 0.5–1, >1ng/mL), and PSA doubling-time (DT-PSA < 6, 6–12, >12months). Lesions were categorized as local-recurrence, pelvic/extra-pelvic lymph-nodes (LN), bone, or visceral disease. Optimal PSA and DT-PSA cut-offs were derived using ROC-analysis. Imaging was performed following EANM-guidelines. Two experienced nuclear medicine-physicians interpreted the scans according to PROMISE-V2-criteria. The impact of PSMA-based findings on therapeutic decision-making and clinical- management was evaluated by radiation oncology experts. Results: 85 patients were eligible. The patient characteristics
Results: After a median follow-up of 30.5 months (range: 1.4 – 63.4), acute grade 1–2 genitourinary (GU) toxicity occurred in 62.3% and gastrointestinal (GI) toxicity in 27.2% of patients. Late grade 1–2 GU and GI toxicities were 41.3% and 11.4%, respectively. No grade ≥ 3 events were recorded. Biochemical failure occurred in 14 patients (12%). Actuarial rates at 24 and 48 months were: overall survival 99.1% and 96.2%; disease-free survival 99.1% and 88.7%; local relapse-free survival 100% and 98.9%; nodal relapse-free survival 100% and 96.2%; and distant metastasis-free survival 98.2% and 94.5%. Two deaths occurred, both related to second pancreatic cancer. (Fig. 1)
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