PATTERNS OF CARE OF PATIENTS WITH AN OCCULT LOCOREGIONAL RELAPSE ON CHOLINE PET/CT AFTER A PRIOR CURATIVE TREATMENT FOR LOCALIZED PROSTATE CANCER Choline PET: Modification of strategy in  50% (Soyka D et al., EJNMMI 2012) Local, nodal and bone met staging compared to abdomino-pelvic staging alone w/ MR Lymphangiography (Ferumoxtran) or SN SPECT Sensitivity/Specificity:  90% for local failure 85-88% for nodal failure (Meta-analysis from Umbehr et al. Eur Urol 2013)

13 GETUG centers (Radiation Oncology Group) >400 patients with Choline PET for rising PSA 173 patients with LRF only  Patterns of LRF  Patterns of care Statistics: Descriptive only analyzes METHODS 50%≤T2a 81% ≤ GS7 78.4% N0 Median PSA 8.8 ng/mL [ ] 49% RP 34% PLND 61% EBRT 33% ADT 14% Prostate brachy

RESULTS Salvage therapy Distribution of failures Prostate 41% Prostate bed 11% SV 7.5% Nodes 60% ON 16.1% II 25.0% EI 42.0% CI 33.0% LA 25.9% IN 4.5% RP4.4% PLND10.5% Postop EBRT13.3% Nodal EBRT32.9% ADT alone5.2% Watchful waiting24.9%

PET-guided salvage therapy in a curative intent is rapidly growing (25% Watchful waiting and 5% ADT alone) Limits: retrospective, lack of follow-up, lack of pathology, Number of positive nodes may be underestimated Impact of PET-guided salvage therapy on BRFS, Regional- FS, Met-FS, CSS? Longer follow-up needed DISCUSSION