Prostate-specific Membrane Antigen Positron Emission Tomography-detected Disease Extent and Overall Survival of Patients with High-risk Nonmetastatic Castration-resistant Prostate Cancer: An International Multicenter Retrospective Study
- Author(s)
- Weber, M; Fendler, WP; Ravi Kumar, AS; Calais, J; Czernin, J; Ilhan, H; Saad, F; Kretschmer, A; Hekimsoy, T; Brookman-May, SD; Mundle, SD; Small, EJ; Smith, MR; Perez, PM; Hope, TA; Herrmann, K; Hofman, MS; Eiber, M; Hadaschik, BA;
- Details
- Publication Year 2024-06,Volume 85,Issue #6,Page 511-516
- Journal Title
- European Urology
- Publication Type
- Research article
- Abstract
- Previously, we demonstrated that prostate-specific membrane antigen positron emission tomography (PSMA-PET) revealed distant metastases in 109/200 patients (39% distant nodes, 24% bone, and 6% visceral organ) with nonmetastatic castration-resistant prostate cancer (nmCRPC) and high-risk features (International Society of Urological Pathology score ≥4 and/or prostate-specific antigen doubling time ≤10 mo) without metastases by conventional imaging. However, the impact of disease extent determined by PSMA-PET on patient outcomes is unknown. We followed these 200 patients for a median of 43 mo after PSMA-PET and retrospectively assessed the association between patient characteristics, PSMA-PET findings, treatment management, and outcomes using a Kaplan-Meier model and Cox multivariable regressions. Among assessed disease characteristics, polymetastatic disease (five or more distant lesions on PET) was independently associated with shorter overall survival (OS; median 61 mo vs not reached; hazard ratio [95% confidence interval], 1.81 [1.00-3.27]; p = 0.050) and time to new metastases (median 38 vs 60 mo; 1.80 [1.10-2.96]; p = 0.019), and initial pN1 status with shorter OS (55 mo vs not reached; 1.94 [1.12-3.37]; p = 0.019). Following PSMA-PET, locoregional salvage therapies were used most commonly in no/local disease (58%), and androgen receptor signaling inhibitors were used in distant metastatic disease (51%). PSMA-PET provides additional risk stratification for patients with nmCRPC. Polymetastatic disease (five or more distant lesions) is associated with worse outcomes. PATIENT SUMMARY: A novel sensitive imaging technology, called prostate-specific membrane antigen positron emission tomography (PSMA-PET), allows doctors to detect the spread of prostate cancer, known as distant metastases, earlier and more accurately than in the past. In our study, PSMA-PET detected none to many metastases in patients who were considered free of distant metastasis by conventional imaging. These findings predicted outcomes and were used to select appropriate treatment.
- Publisher
- Elsevier
- Keywords
- Humans; Male; *Prostatic Neoplasms, Castration-Resistant/pathology/diagnostic imaging/mortality; Retrospective Studies; Aged; *Positron-Emission Tomography; Middle Aged; Glutamate Carboxypeptidase II; Antigens, Surface; Prostate-Specific Antigen/blood; Aged, 80 and over; Nonmetastatic castration-resistant prostate cancer; Prostate cancer; Prostate-specific membrane antigen positron emission tomography; Spartan
- Department(s)
- Cancer Imaging
- Publisher's Version
- https://doi.org/10.1016/j.eururo.2024.01.019
- Open Access at Publisher's Site
https://doi.org/10.1016/j.eururo.2024.01.019- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-07-25 05:51:35
Last Modified: 2024-07-25 05:51:55