Kudura Ken, Schaulin Yves, Templeton Arnoud J, Zellweger Tobias, Harms Wolfgang, Georis Raphael, Kreissl Michael C, Foerster Robert
Department of Nuclear Medicine, University Hospital CHU UCL Godinne, 5530 Yvoir, Belgium.
Faculté de Médecine, Université Catholique de Louvain UCLouvain, 1348 Louvain, Belgium.
Cancers (Basel). 2025 Jul 4;17(13):2249. doi: 10.3390/cancers17132249.
PSMA PET/CT imaging has become a cornerstone in the management of prostate cancer, particularly in the setting of biochemical recurrence (BCR). While semi-quantitative parameters such as SUVmean have been evaluated as prognostic biomarkers in metastatic castration-resistant prostate cancer (mCRPC), particularly after the VISION trial, the prognostic role of volumetric measures such as Total Molecular Volume (TMV) remain largely unexplored, especially in earlier stages of the disease such as in biochemical recurrence following primary treatment. This retrospective monocentric study included 84 patients with BCR who underwent PSMA PET/CT imaging between 2020 and 2021 using either [Ga]Ga-PSMA-11(Ga-PSMA) or [F]-PSMA-1007 (F-PSMA) as tracers. Total tumor burden was assessed through manual 3D segmentation to derive whole-body Total Molecular Volume (wb TMV) and Total Lesion PSMA (wb TL-PSMA). Clinical and imaging variables were correlated with overall survival (OS) and progression-free survival (PFS) using Cox regression models. Kaplan-Meier analyses were performed based on wb TMV and thresholds determined by the Youden index. A PSMA PET/CT correlation for BCR was identified in 69% of patients, with comparable detection rates between tracers (Ga-PSMA 67% vs. F-PSMA 63%, = 0.7). A higher wb TMV was significantly associated with worse OS (HR 2.20, < 0.001) and PFS (HR 2.01, < 0.001) in univariable analyses. In multivariable models, log(wb TMV) remained an independent prognostic factor for PFS (HR 1.78, = 0.005). Patients with log(wb TMV) > 2.87 exhibited significantly poorer survival outcomes. A PSA at diagnosis > 17 ng/mL also predicted shorter PFS. Tumor segmentation from PSMA PET/CT imaging provides powerful prognostic information in patients with biochemical recurrence of prostate cancer, independently of the tracer used. The wb TMV represents a promising volumetric biomarker for future risk stratification and therapeutic decision-making, particularly in earlier stages of prostate cancer progression, where predictive imaging biomarkers remain largely undefined.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）成像已成为前列腺癌管理的基石，尤其是在生化复发（BCR）的情况下。虽然诸如平均标准摄取值（SUVmean）等半定量参数已被评估为转移性去势抵抗性前列腺癌（mCRPC）的预后生物标志物，特别是在VISION试验之后，但诸如总分子体积（TMV）等体积测量指标的预后作用在很大程度上仍未得到探索，尤其是在疾病的早期阶段，如初次治疗后的生化复发阶段。这项回顾性单中心研究纳入了84例BCR患者，这些患者在2020年至2021年间接受了PSMA PET/CT成像，使用[镓]镓-PSMA-11（Ga-PSMA）或[氟]氟-PSMA-1007（F-PSMA）作为示踪剂。通过手动三维分割评估总肿瘤负荷，以得出全身总分子体积（wb TMV）和总病变PSMA（wb TL-PSMA）。使用Cox回归模型将临床和影像变量与总生存期（OS）和无进展生存期（PFS）进行关联。基于wb TMV和由约登指数确定的阈值进行Kaplan-Meier分析。在69%的患者中发现了BCR与PSMA PET/CT的相关性，两种示踪剂的检测率相当（Ga-PSMA为67%，F-PSMA为
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