S1205
Clinical - Urology
ESTRO 2026
Digital Poster 1944
Imaging before early salvage radiotherapy after radical prostatectomy: PET-CT, MRI or both? Maria Piedra 1 , Gemma Sancho 1 , Arantxa Mera 1 , Ana Soto 1 , Scarlet Crespo 1 , Gemma Calvet 1 , Andrea Ejimeno 1 , Belén Sopena 1 , Jady Rojas 1 , Katarina Mjercakova 1 , Joan Julia 1 , Nuria Farrè 1 , Josep Isern 1 , Antonio Vila 1 , Josep Balart 1 , Pedro Gallego 2 , Laura Montezuma 1 1 Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 2 Department of Medical Physics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Purpose/Objective: Positron emission tomography (PET-CT)
and multiparametric magnetic resonance imaging (MRI) offer complementary information to investigate where the recurrence before early salvage radiotherapy (SRT) for prostate cancer. We aimed to correlate the incidence and location of visible recurrences identified through MRI and/or PET with clinical and pathological variables in patients with
biochemical recurrence (BCR) after radical prostatectomy (RP) before Planning the SRT. Material/Methods:
We retrospectively analyzed 260 patients with BCR after RP from January 2017 to January 2025. All patients underwent MRI and/or PET to investigate where the recurrence is-local vs regional vs distant- to guide the target volume and need for systemic therapy. We defined positive visible recurrence by MRI (MRI+) or PET (PET+) when detected: local recurrence (LR) and/or lymph node recurrence (LNR), which influenced a change in treatment SRT and defined negative imaging (MRI-) or (PET-) when no findings visible recurrence and treatment didn’t change. We performed univariate analyses to identify any associations between clinical and pathological variables related to imaging results. Results: Of the 260 patients analyzed, 245p (94.2%) underwent MRI, 69p(26.5%) underwent PET (36p PSMA-PET and 33p choline-PET), and 63p (24.2%) both. From the 245p who underwent MRI, visible recurrences (MRI+) were found in 97p (37.3%) with a median PSA at recurrence (BCR_PSA): 0.3ng/ml (IQR: 0.22-0.66), the recurrence patterns were: LR in 68p (70.2%), LNR in 21p (21.6%) and both in 8p (8.2%). The variables: BCR_PSA, pathologic T stage (pT), pathologic Gleason, persistently positive PSA after RP, risk BCR according to either Spain and European Urological Association(EAU) criteria, and PSA doubling time (PSADT) showed a significant association with the presence visible recurrence by MRI (Table 1)
Of the 69p who underwent PET, visible disease (PET+) was detected in 40p (57.9%), with a median BCR_PSA:1.6 ng/ml (IQR: 1.1-2.6), the recurrence patterns on PET were: LR in 9p (22.5%) and LNR in 24p (60%) and both in 7p (17.5%).The variable BCR_PSA demonstrated a trend toward statistical significance in relation to imaging finding by PET (Table 2)
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