Evaluation of the impact on overall survival curves of patients with metastatic castration-sensitive prostate cancer staged with PSMA-pet and classified according to current prognostic criteria by volume and risk

Keywords

Castration-sensitive prostate cancer - PSMA PET/CT - risk - volume - overall survival

Introduction: The treatment of metastatic castration-sensitive prostate cancer (mCSPC) has evolved over the years. These therapies are guided by current volume (CHAARTED) and risk (LATITUDE) criteria, instituted based on conventional exams. The emergence of new imaging exams like PSMA-PET, with its greater accuracy and early detection of metastatic disease raises questions about the applicability of these criteria in this context for earlier initiation of systemic therapy and its benefit in overall survival (OS).

Methods: We conducted a retrospective, single-center study comparing patients staged with PSMA PET between August 2017 and February 2022 and classified as metastatic after curative therapy or de novo metastatic. Patients with stage IVA, i.e., N1, were also included. Patients were stratified into high and low volume and risk, with the aim of comparing these patients with each other, with the primary outcome of OS.

Results: A total of 48 patients were selected for analysis, with a median age of 66 years at diagnosis. Of these, 81.3% had a Gleason score between 8 and 10, 57% had a T classification of T3 or higher, and 32% were N1 based on conventional imaging. According to PSMA PET, 40% were de novo metastatic, with disease sites identified as follows: bones (M1b - 52%), non-pelvic lymph nodes (M1a – 21%), pelvic lymph nodes (N1 – 17%), and viscera (M1c – 10%). Applying CHAARTED criteria, 71% of patients were classified as low volume, and applying LATITUDE criteria, 75% were classified as low risk. With a median follow-up time of 37.5 months and a total of 7 deaths, the median OS was not reached. At 36 months, 64.6% of the high-volume group were alive compared to 96.6% of the low volume group (p = 0.054), and 77.8% of the high risk patients were alive compared to 89.9% of the low risk patients (p = 0.739). There was a 67% increase in the detection of distant metastases. When correlated with bone scintigraphy (BS) (n = 19), there was a 78.9% discordance in the number and/or location of bone lesions, and in 53.3% of cases, PSMA PET was positive for bone disease while BS was negative at the same time.

Conclusion: PSMA PET appears to be prognostic when applied to volume-based curves, despite a p-value of 0.054, which does not hold for risk. It also increases the detection of metastatic disease compared to conventional imaging and is more precise in detecting bone disease compared to BS.

Corresponding author: Isadora Martins de Sousa (e-mail: [e-mail]).

 

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Artikel online veröffentlicht:
06. Mai 2025