PSMA-PET for metastatic hormone-sensitive prostate cancer: A multicenter trial

Ziel/Aim Conventional imaging low-(LVD) and high-volume disease (HVD) were associated with survival in metastatic hormone-sensitive prostate cancer (mHSPC) patients in the CHAARTED trial. However, more accurate PSMA-PET becomes the new standard imaging potentially leading to upstaging. We therefore evaluated adapted, PSMA-PET criteria for disease volume classification.

Methodik/Methods Three high-volume PET centers retrospectively screened their PSMA-PET database for mHSPC patients. CT versus PSMA-PET stage, lesion number, and classification of LVD vs. HVD were determined by consensus of one local (unblinded) and one central (blinded) reader; PSMA-positive tumor volume (PSMA-TV) was measured centrally.

Ergebnisse/Results 85 LDV and 20 HDV patients were included. PSMA-PET led to disease volume upstaging in 16/85 (18.8 %) LVD patients. After excluding patients with M1c- or unifocal disease, a tumor volume of 38.75ml was determined as the optimal cutoff value between LVD and HVD (AUC = 0.86). Subsequently, we defined PET-HVD as the presence of (a) >1 lesion and (b) >40 ml PSMA-TV. This led to upstaging of 13 % LVD patients and downstaging of 2 % HVD patients.

Schlussfolgerungen/Conclusions Based on CHAARTED criteria, PSMA-PET leads to disease volume upstaging in about one fifth of patients. Adapted PSMA-PET criteria deliver near equivalent HVD with superior LVD sub-classification, critical for guidance of targeted or multimodal therapy.

Publication History

Article published online:
08 April 2021