Baseline PSMA PET/CT parameters predict overall survival and treatment response in metastatic castration-resistant prostate cancer patients

• DOI: 10.1007/s00330-025-11360-3
• Publication Date: 2025-01-22T18:01:20Z
• Authors: Fleur Kleiburg; Lioe-Fee de Geus-Oei; Romy Spijkerman; Wyanne A. Noortman; Floris H. P. van ...; Srirang Manohar; Frits Smit; Frank A. J. Toonen; Saskia A. C. Luelmo; Tom van der Hulle; Linda Heijmen
• Keywords: Doubling time; PET-CT

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 and treatment response. Methods Sixty mCRPC patients underwent [ 18 F]PSMA-1007 before androgen receptor-targeted agents (ARTAs) or chemotherapy. Intensity-based parameters, volumetric metastatic sites DmaxVox (distance between the two outermost voxels) from were collected, as well age, Gleason score laboratory parameters. Cox regression analysis evaluated their prognostic value for overall (OS). Additionally, preliminary lesion-level was done ( n = 241 lesions) lesion location twelve radiomic features selected previous literature. Logistic association PET/CT-based progression after 3–4 months of treatment. Results Total tumour volume (PSMA-TV) (HR 1.41 per doubling [1.17–1.70]), total uptake (TL-PSMA) 1.40 [1.16–1.69]) 1.31 10 cm increase [1.07–1.62]) OS, each independent PSA level 0.82 [0.68–0.98]), haemoglobin 0.68 mmol/L [0.49–0.95]) line On lesion-level, (prostate vs bone OR 0.23 [0.06–0.83]) SUV mean (OR 1.72 [1.08–2.75]) markers progression, morphological texture-based not. Conclusion Baseline scans have in can potentially aid decision-making. serve simpler alternative to PSMA-TV when automated segmentation software not available. When combined PSMA-TV, lower levels indicated worse which may be marker dedifferentiation. Further research needed validate these models larger patient cohorts. Key Points Question highly disease, requiring good . Findings best OS; maximum distance lesions (DmaxVox) used Clinical relevance representing burden independently OS patients, providing insights clinical Although marker, an easier obtain