PSMA PET/CT for treatment response evaluation at predefined time points is superior to PSA response for predicting survival in metastatic castration-resistant prostate cancer patients.

Autor: Kleiburg F; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: F.Kleiburg@lumc.nl., de Geus-Oei LF; 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., Luelmo SAC; Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands., Spijkerman R; Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Centre, Leiden, the Netherlands., Goeman JJ; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands., Toonen FAJ; Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands., Smit F; Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, the Netherlands., van der Hulle T; Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands., Heijmen L; Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Centre, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2024 Oct 02; Vol. 181, pp. 111774. Date of Electronic Publication: 2024 Oct 02.
DOI: 10.1016/j.ejrad.2024.111774
Abstrakt: Background: 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.
Methods: Sixty mCRPC patients underwent [ 18 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 max , total tumour volume and total lesion uptake (tumour volume * SUV mean ) were calculated. PSA response was defined according to the PCWG3 criteria. Cox regression analysis identified predictors of overall survival.
Results: 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.
Conclusions: 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.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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