Standardised Uptake Values as Determined on PSMA PET/CT is associated with Oncological Outcomes in Prostate Cancer Patients.

To investigate the association between intraprostatic, intratumoural maximum standardized uptake values (SUVmax ) on prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer (PCa) prior to robot-assisted radical prostatectomy (RARP) and pathology outcomes, including pathological ISUP score (pISUP) and lymph node status (pN0/pN1).

A bi-centric, secondary analysis of two previous, prospective cohort studies was performed in 318 patients with biopsy-proven PCa and who were scheduled for RARP. Prior to surgery, patients received a PSMA PET/CT with either 68 Ga-PSMA-11 (59% patients) or 18 F-PSMA (DCFPyL) (41% patients) as radiotracer. PET/CT images were analysed both visually and semi-quantitatively by measuring the SUVmax of the most intense suspect lesion in the prostate. The association between the SUVmax of the primary tumor and preoperative and postoperative variables was analyzed.

SUVmax was associated with clinical and biopsy pre-operative variables, as well as with pISUP score and pathological tumour stage. Patients with pISUP≤2 showed significantly lower SUVmax compared to patients with pISUP>2 for both tracers (SUVmax 18 F-PSMA: median 5.1 versus 9.6; p = 0.002, SUVmax 68 Ga-PSMA-11: 6.6 versus 8.6; p = 0.003, respectively). Moreover, patients with pN1 had significantly higher median SUVmax than those with pN0/pNx for both tracers (SUVmax 18 F-PSMA: 7.9 versus 12.3; p = 0.04, SUVmax 68 Ga-PSMA-11: 7.6 versus 12.0; p < 0.001). On multivariable logistic regression analysis, the intraprostatic SUVmax was an independent predictor of pN1 for both 68 Ga-PSMA-11 (per doubling: odds ratio (OR) 1.96 (95% Confidence Interval (CI) 1.27-3.01)) and 18 F-PSMA (per doubling: OR 1.79 (95%CI 1.06-3.03).

Intraprostatic, intratumoural PSMA intensity on PET/CT, as semi-quantitatively expressed by SUVmax , may be a valuable innovative biomarker in patients with localised PCa, as it is highly associated with known conventional prognostic factors, such as pISUP and lymph node status.

BJU international. 2022 Feb 15 [Epub ahead of print]

Yves J L Bodar, Hans Veerman, Dennie Meijer, Katelijne de Bie, Pim J van Leeuwen, Maarten L Donswijk, R Jeroen van Moorselaar, N Harry Hendrikse, Ronald Boellaard, Daniela E Oprea-Lager, André N Vis

Amsterdam University Medical Center, VU University, Department of Urology, Amsterdam, The Netherlands., Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands., The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands., Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Amsterdam, The Netherlands.

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