Kleiburg F, de Geus-Oei L F, Luelmo S A C, Spijkerman R, Goeman J J, Toonen F A J, Smit F, van der Hulle T, Heijmen L
Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Centre, Leiden, the Netherlands.
Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Centre, Leiden, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, Delft, the Netherlands.
Eur J Radiol. 2024 Dec;181:111774. doi: 10.1016/j.ejrad.2024.111774. Epub 2024 Oct 2.
In metastatic castration-resistant prostate cancer (mCRPC), using serum prostate-specific antigen (PSA) levels to evaluate treatment response is not always accurate. This study aimed to assess the efficacy of PSMA PET/CT at specific time points for evaluating treatment response and predicting survival in mCRPC patients, compared to PSA.
Sixty mCRPC patients underwent [F]PSMA-1007 PET/CT at baseline and for treatment response evaluation of either androgen receptor-targeted agents (after 3 months) or chemotherapy (after completion), and were retrospectively analysed. Visual assessment categorised overall response and response of the worst responding lesion as partial response, stable disease, or progressive disease, using the EAU/EANM criteria. Additionally, percentage changes in SUV, total tumour volume and total lesion uptake (tumour volume * SUV) were calculated. PSA response was defined according to the PCWG3 criteria. Cox regression analysis identified predictors of overall survival.
PSMA PET/CT and PSA response were discordant in 47 % of patients, and PSMA PET/CT response was worse in 89 % of these cases. Overall response on PSMA PET/CT independently predicted overall survival (progression versus non-progression: HR = 4.05, p < 0.001), outperforming PSA response (progression versus non-progression: HR = 2.53, p = 0.010) and other PSMA PET/CT parameters. Among patients with a PSA decline of > 50 %, 31 % showed progressive disease on PSMA PET/CT, correlating with higher mortality risk (progression versus non-progression: HR = 4.38, p = 0.008). No flare in PSMA uptake was observed in this cohort.
PSMA PET/CT for assessing treatment response at predefined time points was superior to PSA-based response for predicting overall survival in mCRPC patients treated with androgen receptor-targeted agents and chemotherapy. PSMA PET/CT showed the ability to detect disease progression earlier than PSA levels, which can affect treatment decisions and has the potential to improve patient outcomes. We recommend further research to validate these findings in larger patient cohorts, to extend the number of treatments, and to evaluate cost-effectiveness and impact on patient outcomes.
在转移性去势抵抗性前列腺癌（mCRPC）中，使用血清前列腺特异性抗原（PSA）水平评估治疗反应并不总是准确的。本研究旨在评估PSMA PET/CT在特定时间点评估mCRPC患者治疗反应和预测生存的疗效，并与PSA进行比较。
60例mCRPC患者在基线时接受[F]PSMA-1007 PET/CT检查，并在接受雄激素受体靶向药物治疗（3个月后）或化疗（完成后）时进行治疗反应评估，并进行回顾性分析。采用EAU/EANM标准，通过视觉评估将总体反应和反应最差的病灶反应分类为部分反应、疾病稳定或疾病进展。此外，计算SUV、总肿瘤体积和总病灶摄取（肿瘤体积*SUV）的百分比变化。PSA反应根据PCWG3标准定义。Cox回归分析确定总生存的预测因素。
47%的患者PSMA PET/CT和PSA反应不一致，其中89%的病例PSMA PET/CT反应更差。PSMA PET/CT的总体反应独立预测总生存（进展与未进展：HR = 4.05，p < 0.001），优于PSA反应（进展与未进展：HR = 2.53，p = 0.010）和其他PSMA PET/CT参数。在PSA下降>50%的患者中，31%在PSMA PET/CT上显示疾病进展，这与更高的死亡风险相关（进展与未进展：HR = 4.38，p = 0.008）。该队列中未观察到PSMA摄取的flare现象。
在接受雄激素受体靶向药物和化疗的mCRPC患者中，在预定义时间点使用PSMA PET/CT评估治疗反应在预测总生存方面优于基于PSA的反应。PSMA PET/CT显示出比PSA水平更早检测疾病进展的能力，这可以影响治疗决策并有可能改善患者预后。我们建议进一步开展研究，在更大的患者队列中验证这些发现，扩大治疗数量，并评估成本效益以及对患者预后的影响。
