Primary tumour PSMA intensity is an independent prognostic biomarker for biochemical recurrence-free survival following radical prostatectomy

Abstract

Purpose The prognostic value of PSMA intensity on PSMA PET/CT due to underlying biology and subsequent clinical implications is an emerging topic of interest. We sought to investigate whether primary tumour PSMA PET intensity contributes to pre- and post-operative prediction of oncological outcomes following radical prostatectomy. Methods We performed a retrospective cohort study of 848 men who underwent all of multiparametric MRI (mpMRI), transperineal prostate biopsy, and 68 Ga-PSMA PET/CT prior to radical prostatectomy. PSMA intensity, quantified as maximum standard uptake value (SUVmax), and other clinical variables were considered relative to post-operative biochemical recurrence-free survival (BRFS) using Cox regression and Kaplan–Meier analysis. Results After a median follow-up of 41 months, 219 events occurred; the estimated 3-year BRFS was 79% and the 5-year BRFS was 70%. Increasing PSMA intensity was associated with less favourable BRFS overall (Log rank p < 0.001), and within subgroups of Gleason score category (Log rank p < 0.03). PSMA intensity was significantly associated with shorter time to biochemical recurrence, after adjusting for pre-operative (HR per 5-unit SUVmax increase = 1.15) and post-operative (HR per 5-unit SUVmax increase = 1.10) parameters. Conclusion These results in a large series of patients confirm PSMA intensity to be a novel, independent prognostic factor for BRFS.

An Australian experience using Tc‐PSMA SPECT/CT in the primary diagnosis of prostate cancer and for staging at biochemical recurrence after local therapy

“…Like this study, Goffin et al also found a relationship between prostate uptake and biopsy grade 11 . By comparison Roberts et al found a lower detection rate with Ga‐PSMA: 92% of 848 men with biopsy‐proven PC had primary lesions with SUV max ≥ 3 22 . In a meta‐analysis of Ga‐PSMA, Perera et al found that for men with Gleason score of ≤7 had a positivity of 72% compared with 80% in men with a Gleason sum of ≥8 23 .…”

Event‐free survival after radical prostatectomy according to prostate‐specific membrane antigen‐positron emission tomography and European Association of Urology biochemical recurrence risk groups

“…The incorporation of imaging such as PSMA‐PET into clinical practice and the subsequent oncological outcomes can be captured by national registries and provide benchmarking for evidence‐based care [21]. Other considerations include different PSA thresholds to define BCR [22] or other imaging [23,24] or molecular tests [25]. For instance, molecular tests such as the Decipher ® genomic classifier, which is independently prognostic for major oncological outcomes (adverse surgical pathology, progression‐free survival, metastasis‐free survival and overall survival) for patients prior to or after RP may provide further prognostic information [26], and merit inclusion in prospective trials in this setting.…”

Clinical advancement of precision theranostics in prostate cancer

“…Univariate logistic regression models established by SUVmax, intraprostatic PSMA-derived tumor volume (iPSMA-TV), and intraprostatic total lesion PSMA (iTL-PSMA) could be able to efficiently previse high-risk PCa with the sensitivity and specificity of 87.5% and 50%, 62.5% and 100%, and 87.5% and 100%, respectively. A study performed by Roberts that included 848 patients after radical prostatectomy found that the SUVmax value of PSMA imaging lesions was remarkably negatively correlated with biochemical recurrence-free survival (BRFS) ( 22 ). Gleason score (GS) was also negatively correlated with BRF, and SUVmax value was an independent predictor of BRFS in patients.…”