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Objective <p>Next-generation imaging with prostate-specific membrane-antigen Positron Emission Tomography/Computed Tomography (PSMA PET/CT) has emerged as an imaging modality offering high diagnostic accuracy and prognostic biomarkers in the primary staging of prostate cancer (PCa). Among these, PSMA-positive tumor volume (PSMA-TV) may carry prognostic significance but has been poorly investigated in patients receiving radical-intent radiotherapy (RT).</p> Methods <p>Patients with biopsy-proven unfavorable intermediate-to-high-risk PCa staged as non-metastatic (T1-4 N0-1 M0) at [<sup>68</sup>&#xa0;Ga]PSMA-11 or [<sup>18</sup>F]PSMA-1007 PET/CT before definitive RT plus androgen deprivation therapy (ADT) at our Institution (2019–2024) were retrospectively recruited. Following RECIP criteria, semi-quantitative PET parameters extracted were: maximum and mean standardized uptake value (SUVmax and SUVmean), PSMA-TV, and total lesion PSMA uptake (PSMA-TL) [PSMA-TV*SUVmean]). We assessed the association between PET-derived semi-quantitative parameters and clinical outcomes, including time to treatment failure (TTF) and PSA response. Inverse probability of treatment weighting (IPTW) was adopted to address confounders, namely, initial PSA, ISUP score, T stage, and N stage.</p> Results <p>Among 145 patients recruited, median age was 76&#xa0;years and median initial PSA 8.9&#xa0;ng/mL. Most patients had ISUP grade ≥ 3 (39.3%), and 28.3% presented with nodal involvement at staging. Concurrent androgen deprivation therapy was administered in all patients, and the most common duration was 12–24&#xa0;months (60.7%). The median follow-up was 20.5&#xa0;months. While unadjusted analyses showed no significant association between PET parameters and treatment outcomes, IPTW-adjusted survival analysis revealed that high PSMA-TV was significantly associated with shorter TTF (<i>p</i> &lt; 0.05). Other PET-derived metrics were not predictive of outcomes.</p> Conclusion <p>Our findings highlight PSMA-TV as an independent predictor of treatment failure following definitive RT in PCa, supporting its potential role as a risk-stratifying biomarker, paving the way for individualized therapeutic strategies. Prospective validation is warranted to confirm its clinical utility and guide future radiotherapy personalization.</p>

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Baseline PSMA tumor volume as a prognostic marker in radical radiotherapy for prostate cancer: a propensity score-weighted retrospective analysis

  • 期刊论文

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  • 发表日期：

    2025年10月10日

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  • Francesco Lanfranchi,
  • Liliana Belgioia,
  • Daniele Vita,
  • Jacopo Passoni,
  • Sara Mastrogiovanni,
  • Alessandra Catanoso,
  • Luca Sofia,
  • Valentina Pau,
  • Stefano Raffa,
  • Silvia Chiola,
  • Maria Isabella Donegani,
  • Roberta Piva,
  • Mattia Riondato,
  • Michela Marcenaro,
  • Giorgia Timon,
  • Cecilia Marini,
  • Salvina Barra,
  • Gianmario Sambuceti,
  • Matteo Bauckneht

摘要

Objective

Next-generation imaging with prostate-specific membrane-antigen Positron Emission Tomography/Computed Tomography (PSMA PET/CT) has emerged as an imaging modality offering high diagnostic accuracy and prognostic biomarkers in the primary staging of prostate cancer (PCa). Among these, PSMA-positive tumor volume (PSMA-TV) may carry prognostic significance but has been poorly investigated in patients receiving radical-intent radiotherapy (RT).

Methods

Patients with biopsy-proven unfavorable intermediate-to-high-risk PCa staged as non-metastatic (T1-4 N0-1 M0) at [68 Ga]PSMA-11 or [18F]PSMA-1007 PET/CT before definitive RT plus androgen deprivation therapy (ADT) at our Institution (2019–2024) were retrospectively recruited. Following RECIP criteria, semi-quantitative PET parameters extracted were: maximum and mean standardized uptake value (SUVmax and SUVmean), PSMA-TV, and total lesion PSMA uptake (PSMA-TL) [PSMA-TV*SUVmean]). We assessed the association between PET-derived semi-quantitative parameters and clinical outcomes, including time to treatment failure (TTF) and PSA response. Inverse probability of treatment weighting (IPTW) was adopted to address confounders, namely, initial PSA, ISUP score, T stage, and N stage.

Results

Among 145 patients recruited, median age was 76 years and median initial PSA 8.9 ng/mL. Most patients had ISUP grade ≥ 3 (39.3%), and 28.3% presented with nodal involvement at staging. Concurrent androgen deprivation therapy was administered in all patients, and the most common duration was 12–24 months (60.7%). The median follow-up was 20.5 months. While unadjusted analyses showed no significant association between PET parameters and treatment outcomes, IPTW-adjusted survival analysis revealed that high PSMA-TV was significantly associated with shorter TTF (p < 0.05). Other PET-derived metrics were not predictive of outcomes.

Conclusion

Our findings highlight PSMA-TV as an independent predictor of treatment failure following definitive RT in PCa, supporting its potential role as a risk-stratifying biomarker, paving the way for individualized therapeutic strategies. Prospective validation is warranted to confirm its clinical utility and guide future radiotherapy personalization.