Kleiburg Fleur, de Geus-Oei Lioe-Fee, Spijkerman Romy, Noortman Wyanne A, van Velden Floris H P, Manohar Srirang, Smit Frits, Toonen Frank A J, Luelmo Saskia A C, van der Hulle Tom, Heijmen Linda
Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Eur Radiol. 2025 Jan 22. doi: 10.1007/s00330-025-11360-3.
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.
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.
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.
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.
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.
转移性去势抵抗性前列腺癌（mCRPC）是一种具有不同生存结局的异质性疾病。本研究调查了基线PSMA PET/CT参数是否与生存及治疗反应相关。
60例mCRPC患者在接受雄激素受体靶向药物（ARTAs）或化疗前接受了[F]PSMA-1007 PET/CT检查。收集了基于强度的参数、体积参数、转移部位以及基线PSMA PET/CT的DmaxVox（两个最外层体素之间的距离），以及年龄、Gleason评分和实验室参数。Cox回归分析评估了它们对总生存期（OS）的预后价值。此外，对241个病灶进行了初步的病灶水平分析，选择了病灶位置和先前文献中的12个影像组学特征。Logistic回归评估了它们与治疗3-4个月后基于PSMA PET/CT的病灶进展的相关性。
总肿瘤体积（PSMA-TV）（每增加一倍HR = 1.41 [1.17-1.70]）、总病灶摄取量（TL-PSMA）（每增加一倍HR = 1.40 [1.16-1.69]）和DmaxVox（每增加10 cm HR = 1.31 [1.07-1.62]）对OS具有预后意义，每一项均独立于基线PSA水平（每增加一倍HR = 0.82 [0.68-0.98]）、血红蛋白水平（每增加1 mmol/L HR = 0.68 [0.49-0.95]）和治疗线数。在病灶水平上，位置（前列腺与骨OR = 0.23 [0.06-0.83]）和SUV（每增加一倍OR = 1.72 [1.08-2.75]）是病灶进展的独立预后标志物，基于形态和纹理的影像组学特征则不是。
基线PSMA PET/CT扫描对mCRPC患者具有预后价值，并可能有助于治疗决策。当没有自动分割软件时，DmaxVox可作为PSMA-TV的更简单替代方法。当与PSMA-TV结合时，较低的PSA水平表明OS较差，这可能是肿瘤去分化的一个标志物。需要进一步研究以在更大的患者队列中验证这些模型。
问题mCRPC是一种高度异质性疾病，需要良好的预后标志物。发现PSMA-TV是OS的最佳独立预后标志物；病灶之间的最大距离（DmaxVox）可作为更简单的替代方法。临床意义代表肿瘤负荷的基线PSMA PET/CT参数与mCRPC患者的OS独立相关，为临床决策提供预后见解。虽然PSMA-TV是最佳预后标志物，但DmaxVox可作为更容易获得的替代方法。
