Background and objective: In metastatic hormone-sensitive prostate cancer (mHSPC), to evaluate therapy response is currently used conventional imaging and PSA levels. Positron emission tomography with68 Gallium Prostate-specific membrane antigen (68 Ga-PSMA-PET/CT) could be useful, although it is not recommended by international guidelines. Its prognostic utility has been already investigated in several works in the castration-resistant setting, but no sufficient efforts have been made to better define it in mHSPC. Methods: Retrospective monocentric study to preliminary explore the value of68 Ga-PSMA-PET/CT in this setting. We enrolled metastatic patients at the baseline68 Ga-PSMA-PET/CT, treated with androgen deprivation therapy plus docetaxel or androgen receptor signaling inhibitors (ARSI) or both as first-line. Key findings and limitations: The survival analysis indicated that a Major SUVmax exceeding the cut-off ( P = .037) and a SUVmean above the cut-off ( P = .025) were linked to improved progression-free survival (PFS) as compared to values ≤cut-off. While several parameters were associated with undetectable PSA levels at any point after the initiation of first-line therapy, only low-volume disease (HR 7.64, P .002), MTV ≤cut-off 3-months PSA (HR 5.36, P = .012) and SUVmean ≤cut-off 3-months PSA (HR 38.6, P < .001) were associated with a higher probability of reaching an undetectable value of PSA in the multivariate analysis. Limitations: retrospective nature, short follow-up time and lack of comparison with conventional imaging. Conclusion and clinical implications: Lower values of68 Ga- PSMA-PET/CT derived-parameters at baseline are negative prognostic factor, in view of the correlation with lower PFS. This study could help oncologists in the management of mHSPC patients, although further investigations are needed to better understand the prognostic and predictive68 Ga-PSMA-PET/CT role in this setting.
Marchetti, A., Mollica, V., Farolfi, A., Bianciardi, G., Rosellini, M., Tassinari, E., et al. (2025). The Prognostic Role of 68GA-PSMA-PET/CT in Metastatic Hormone-Sensitive Prostate Cancer: A Preliminary Analysis. CLINICAL GENITOURINARY CANCER, Online ahead of print, 1-12 [10.1016/j.clgc.2025.102406].
The Prognostic Role of 68GA-PSMA-PET/CT in Metastatic Hormone-Sensitive Prostate Cancer: A Preliminary Analysis
Marchetti, AndreaPrimo
;Mollica, Veronica;Farolfi, Andrea;Bianciardi, Gianfilippo;Rosellini, Matteo;Tassinari, Elisa;Danielli, Linda;Bianchi, Lorenzo;Schiavina, Riccardo;Fanti, StefanoCo-ultimo
;Massari, Francesco
Co-ultimo
2025
Abstract
Background and objective: In metastatic hormone-sensitive prostate cancer (mHSPC), to evaluate therapy response is currently used conventional imaging and PSA levels. Positron emission tomography with68 Gallium Prostate-specific membrane antigen (68 Ga-PSMA-PET/CT) could be useful, although it is not recommended by international guidelines. Its prognostic utility has been already investigated in several works in the castration-resistant setting, but no sufficient efforts have been made to better define it in mHSPC. Methods: Retrospective monocentric study to preliminary explore the value of68 Ga-PSMA-PET/CT in this setting. We enrolled metastatic patients at the baseline68 Ga-PSMA-PET/CT, treated with androgen deprivation therapy plus docetaxel or androgen receptor signaling inhibitors (ARSI) or both as first-line. Key findings and limitations: The survival analysis indicated that a Major SUVmax exceeding the cut-off ( P = .037) and a SUVmean above the cut-off ( P = .025) were linked to improved progression-free survival (PFS) as compared to values ≤cut-off. While several parameters were associated with undetectable PSA levels at any point after the initiation of first-line therapy, only low-volume disease (HR 7.64, P .002), MTV ≤cut-off 3-months PSA (HR 5.36, P = .012) and SUVmean ≤cut-off 3-months PSA (HR 38.6, P < .001) were associated with a higher probability of reaching an undetectable value of PSA in the multivariate analysis. Limitations: retrospective nature, short follow-up time and lack of comparison with conventional imaging. Conclusion and clinical implications: Lower values of68 Ga- PSMA-PET/CT derived-parameters at baseline are negative prognostic factor, in view of the correlation with lower PFS. This study could help oncologists in the management of mHSPC patients, although further investigations are needed to better understand the prognostic and predictive68 Ga-PSMA-PET/CT role in this setting.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
