Baseline PSMA PET/CT Parameters Predict Overall Survival and Treatment Response in Metastatic Castration-resistant Prostate Cancer Patients

Overview

Journal Eur Radiol

Date 2025 Jan 22

PMID 39843627

Authors

Fleur Kleiburg

Lioe-Fee de Geus-Oei

Romy Spijkerman

Wyanne A Noortman

Floris H P van Velden

Srirang Manohar

Frits Smit

Frank A J Toonen

Saskia A C Luelmo

Tom van der Hulle

Linda Heijmen

Affiliations

Soon will be listed here.

Abstract

Objective: Metastatic castration-resistant prostate cancer (mCRPC) is a heterogeneous disease with varying survival outcomes. This study investigated whether baseline PSMA PET/CT parameters are associated with survival and treatment response.

Methods: Sixty mCRPC patients underwent [F]PSMA-1007 PET/CT before treatment with androgen receptor-targeted agents (ARTAs) or chemotherapy. Intensity-based parameters, volumetric parameters, metastatic sites and DmaxVox (distance between the two outermost voxels) from baseline PSMA PET/CT were collected, as well as age, Gleason score and laboratory parameters. Cox regression analysis evaluated their prognostic value for overall survival (OS). Additionally, a preliminary lesion-level analysis was done (n = 241 lesions) with lesion location and twelve radiomic features selected from previous literature. Logistic regression evaluated their association with PSMA PET/CT-based lesion progression after 3-4 months of treatment.

Results: Total tumour volume (PSMA-TV) (HR = 1.41 per doubling [1.17-1.70]), total lesion uptake (TL-PSMA) (HR = 1.40 per doubling [1.16-1.69]) and DmaxVox (HR = 1.31 per 10 cm increase [1.07-1.62]) were prognostic for OS, each independent of baseline PSA level (HR = 0.82 per doubling [0.68-0.98]), haemoglobin level (HR = 0.68 per mmol/L increase [0.49-0.95]) and line of treatment. On lesion-level, location (prostate vs bone OR = 0.23 [0.06-0.83]) and SUV (OR = 1.72 per doubling [1.08-2.75]) were independent prognostic markers for lesion progression, morphological and texture-based radiomic features were not.

Conclusion: Baseline PSMA PET/CT scans have prognostic value in mCRPC patients and can potentially aid in treatment decision-making. DmaxVox can serve as a simpler alternative to PSMA-TV when automated segmentation software is not available. When combined with PSMA-TV, lower PSA levels indicated worse OS, which may be a marker of tumour dedifferentiation. Further research is needed to validate these models in larger patient cohorts.

Key Points: Question mCRPC is a highly heterogeneous disease, requiring good prognostic markers. Findings PSMA-TV was the best independent prognostic marker for OS; maximum distance between lesions (DmaxVox) can be used as a simpler alternative. Clinical relevance Baseline PSMA PET/CT parameters representing tumour burden were independently associated with OS in mCRPC patients, providing prognostic insights for clinical decision-making. Although PSMA-TV was the best prognostic marker, DmaxVox can serve as an easier to obtain alternative.

Citing Articles

Large Italian Multicenter Study on Prognostic Value of Baselines Variables in mCRPC Patients Treated with RaCl: Ten Years of Clinical Experience.

De Feo M, Filippi L, Bauckneht M, Lodi Rizzini E, Ferrari C, Lavelli V Diagnostics (Basel). 2025; 15(3).

PMID: 39941269 PMC: 11817225. DOI: 10.3390/diagnostics15030339.

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