The prognostic power of 18F-FDG PET/CT extends to estimating systemic treatment response duration in metastatic castration-resistant prostate cancer (mCRPC) patients

Abstract

Background We aimed to test whether the prognostic value of 18 F‐Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in metastatic castration-resistant prostate cancer (mCRPC) extends to the estimation of systemic treatment response duration. Methods mCRPC patients submitted to FDG-PET/CT in four Italian centers from 2005 to 2020 were retrospectively enrolled. Clinical and biochemical data at the time of imaging were collected, and SUV max of the hottest lesion, total metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. The correlation between PET- and biochemical-derived parameters with Overall Survival (OS) was analysed. The prediction of treatment response duration was assessed in the subgroup submitted to FDG-PET/CT in the six months preceding Chemotherapy (namely Docetaxel or Cabazitaxel, 24 patients) or Androgen-Receptor Targeted Agents (ARTA, namely Abiraterone or Enzalutamide, 20 patients) administration. Results We enrolled 114 mCRPC patients followed-up for a median interval lasting 15 months. While at univariate analysis, prostate-specific antigen (PSA), Alkaline Phosphatase (ALP), MTV, and TLG were associated with OS, at the multivariate Cox regression analysis, the sole MTV could independently predict OS (p < 0.0001). In the subgroup submitted to FDG-PET/CT before the systemic treatment initiation, PSA and TLG could also predict treatment response duration independently (p < 0.05). Of note, while PSA could not indicate the best treatment choice, lower TLG was associated with higher success rates for ARTA but had no impact on chemotherapy efficacy. Conclusions FDG-PET/CT’s prognostic value extends to predicting treatment response duration in mCRPC, thus potentially guiding the systemic treatment selection.

The prognostic power of inflammatory indices and clinical factors in metastatic castration-resistant prostate cancer patients treated with radium-223 (BIO-Ra study)

“…On the other hand, many studies already showed the prognostic value of circulating PSA and ALP at baseline, as biochemical indicators of the tumor extent [28,[31][32][33][34][35][36][37][38]. This is coherent with the unfavorable prognosis observed in patients with massive bone metastases (> 20) at the bone scan or high tumor burden assessed with more sophisticated quantification approaches [32,[39][40][41][42][43].…”

Radiomics for Identification and Prediction in Metastatic Prostate Cancer: A Review of Studies

“…Standardised uptake value (SUV) max of identified tumours is a prognostic imaging biomarker ( 108 ), and when measured from [ 18 F]-fluorodeoxyglucose (FDG) PET-avid lesions has been shown to correlate with patient survival ( 109 ). Total lesion glycolysis (TLG) or total SUV (SUV total ), measured as the sum of individual SUVs in each voxel for each individual lesion, is another prognostic imaging biomarker that has been shown to correlate with overall survival in metastatic castration-resistant prostate cancer (mCRPC) patients ( 110 ). Radiomics possesses great potential because rather than attempting to replace these biomarkers, clinicopathologic risk factors and patient characteristics can be incorporated into the modelling process and leveraged to make better model predictions.…”

Concomitant Prostate Cancer and Hodgkin Lymphoma: A Differential Diagnosis Guided by a Combined 68Ga-PSMA-11 and 18F-FDG PET/CT Approach

“…However, in addition to the specificity of these tracers for the prostatic tissues, PSMA molecules can be concentrated even by a wide range of solid and haematologic malignancies due to its expression by the cancer neovascularization, in the absence of a specific receptor-mediated mechanism [7][8][9]. Conversely, in contrast with the advanced metastatic hormone-refractory stage [10][11][12], the low 18F-FDG-avidity of well-differentiated, low-grade, naïve prostate cancer makes this tool not routinely recommended in this clinical setting [13]. The divergent uptake pattern of the two radiotracers thus raised the suspicion of the coexistence of two different tumour entities, which were subsequently pathologically confirmed.…”