Vienna, Austria

ESTRO 2023

Session Item

Poster (Digital)
Profiling PCa patients with BCR in the era of early imaging detection: an AIRO-URO group study


Profiling PCa patients with BCR in the era of early imaging detection: an AIRO-URO group study

Giulia Marvaso1,2, Fabio Matrone3, Alessandro Magli4, Giulio Francolini5, Riccardo Villa6,2, Federico Mastroleo6, Ciro Franzese7, Luca Nicosia8, Francesco Pasqualetti9, Luca Eolo Trodella10, Annamaria Vinciguerra11, Salvina Barra12, Giorgia Timon13, Matteo Augugliaro14, Mattia Zaffaroni15, Giulia Corrao15, Maria Giulia Vincini6, Marta Scorsetti15, Barbara Alicja Jereczek-Fossa6,16, Stefano Arcangeli17, Luca Triggiani18

1IEO, European Institute of Oncology, IRCCS, Division of Radiation oncology, Milan, Italy; 2University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy; 3Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Department of Radiation Oncology, Aviano, Italy; 4Udine General Hospital, Department of Radiation Oncology, Udine, Italy; 5A.O.U. Careggi, University of Florence, Radiation Oncology, Firenze, Italy; 6IEO, European Institute of Oncology, IRCCS, Division of Radiation Oncology, Milan, Italy; 7Humanitas Clinical and Research Center - IRCCS, Department of Radiotherapy and Radiosurgery, Milan, Italy; 8IEO, European Institute of Oncology, IRCCS, Breast Imaging Division, Radiology Department, Milan, Italy; 9Azienda Ospedaliera Universitaria Pisana, University of Pisa, Department of Radiation Oncology, Pisa, Italy; 10Campus Bio-Medico University, Radiation Oncology, Rome, Italy; 11"SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, Department of Radiation Oncology, Chieti, Italy; 12Ospedale Policlinico San Martino, Pediatric Radiotherapy and Special Techniques Unit, Genova, Italy; 13Azienda USL-IRCCS di Reggio Emilia, Radiation Oncology Unit, Reggio Emilia, Italy; 14Azienda USL-IRCCS di Reggio Emilia, Radiation Therapy Unit, Reggio Emilia, Italy; 15 IEO, European Institute of Oncology, IRCCS, Division of Radiation Oncology, Milan, Italy; 16University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy; 17School of Medicine and Surgery, University of Milan Bicocca, Department of Radiation Oncology, Milan, Italy; 18ASST Spedali Civili di Brescia, University of Brescia, Radiation Oncology Department, Brescia, Italy

Show Affiliations
Purpose or Objective

Although radical prostatectomy represents a curative treatment, 44% of patients experience BCR at least 6 months after surgery. While in low-risk patients, the interval between surgery and BCR does not influence mortality, in patients with unfavorable disease characteristics, early disease recurrence increases mortality risk. Aim of the present study is to create a predictive model capable of identifying the category of patients most at risk of local or distant metastasis to undergo early imaging investigations.

Material and Methods

Data have been acquired from Italian centers joining the AIRO-URO initiative. Patients who underwent RP and salvage RT after experiencing BCR have been considered for study inclusion.
Descriptive and frequency analysis has been performed and mean time to event has been calculated for variables involving timespans. Disease progression after salvage radiotherapy has been considered as event of interest in time-to-event analysis. Multivariate Cox Regression model with multi-block enter approach has been adopted, chi-square test for log-likelihoods significant difference was used in the rounds to assess increase in model performance. Covariates were defined significative when p < 0.05 and HR not encompassing 1.


A total of 580 patients (median age 64.7 y) with a median follow-up of 4.5 y (range 0.2-15.9) were included in the analysis. IMRT/VMAT accounted for 90.7% of all the treatment modalities.  Biochemical progression-free survival rate < 12 months was 92%, at 1-year 83%, and at 2-years 75%. In the Multivariate Cox Regression model, 232 of 580 (39.9%) biochemical disease progression events have been considered eligible for the analysis. Median biochemical progression-free survival time resulted 2.1 y. Site of progression was available for 171 patients out of the reported 232 events. Of them, pelvic and distant progression occurred in 55% and 45% of the patients. Survival Cox Regression plot can be seen in Fig1.
The covariates found significantly associated with a higher risk of biochemical disease progression were: PSA higher or equal to 0.5 ng/ml at the biochemical relapse (HR 1.422, CI 95% 1.036-1.952, p < 0.029) and less than 12 months from surgery to biochemical relapse (HR 1.718, CI 95% 1.299-2.271, p < .001). Pelvic irradiation during salvage radiotherapy (HR 0.670, CI 95% 0.469-0.958, p < .028) was significantly associated with a lower risk of recurrence.

Figure 1


Given the results of the present preliminary analysis which reports a high recurrence rate, it remains of relevant importance to continue to offer potentially curative salvage treatment. In the PSMA-PET and WB-MRI era, and the ability to detect potentially distant metastatic disease so early, it becomes crucial to select patients for such examination based on criteria and clinical stratification. The present and future analyses on an enlarged dataset, based on a retrospective experience will lay the foundation for better understanding how to target care in this patient setting.