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Nomogram to predict the presence of PSMA-negative but FDG-positive lesion in castration-resistant prostate cancer: a multicenter cohort study.
Pan, Jian; Zhang, Tingwei; Chen, Shouzhen; Bu, Ting; Zhao, Jinou; Ni, Xudong; Shi, Benkang; Gan, Hualei; Wei, Yu; Wang, Qifeng; Wang, Beihe; Wu, Junlong; Song, Shaoli; Wang, Feng; Liu, Chang; Ye, Dingwei; Zhu, Yao.
Affiliation
  • Pan J; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
  • Zhang T; Shanghai Genitourinary Cancer Institute, Shanghai, China.
  • Chen S; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
  • Bu T; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
  • Zhao J; Shanghai Genitourinary Cancer Institute, Shanghai, China.
  • Ni X; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
  • Shi B; Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China.
  • Gan H; Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
  • Wei Y; Department of Nuclear Medicine, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China.
  • Wang Q; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
  • Wang B; Shanghai Genitourinary Cancer Institute, Shanghai, China.
  • Wu J; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
  • Song S; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
  • Wang F; Shanghai Genitourinary Cancer Institute, Shanghai, China.
  • Liu C; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
  • Ye D; Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong Province, China.
  • Zhu Y; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Ther Adv Med Oncol ; 16: 17588359231220506, 2024.
Article in En | MEDLINE | ID: mdl-38188464
ABSTRACT

Background:

PSMA-negative but FDG-positive (PSMA-/FDG+) lesion in dual-tracer (68Ga-PSMA and 18F-FDG) positron emission tomography/computed tomography (PET/CT) is associated with an unfavorable response to Lutetium-177 (177Lu)-PSMA-617. This study sought to develop both radiomics and clinical models for the precise prediction of the presence of PSMA-/FDG+ lesions in patients with castration-resistant prostate cancer (CPRC).

Methods:

A cohort of 298 patients who underwent dual-tracer PET/CT with a less than 5-day interval was included. The evaluation of the prognostic performance of the radiomics model drew upon the survival data derived from 40 patients with CRPC treated with 177Lu-PSMA-617 in an external cohort. Two endpoints were evaluated (a) prostate-specific antigen (PSA) response rate, defined as a reduction exceeding 50% from baseline and (b) overall survival (OS), measured from the initiation of 177Lu-PSMA-617 to death from any cause.

Results:

PSMA-/FDG+ lesions were identified in 56 (18.8%) CRPC patients. Both radiomics (area under the curve [AUC], 0.83) and clinical models (AUC, 0.78) demonstrated robust performance in PSMA-/FDG+ lesion prediction. Decision curve analysis revealed that the radiomics model yielded a net benefit over the 'screen all' strategy at a threshold probability of ⩾4%. At a 5% probability threshold, the radiomics model facilitated a 21% reduction in 18F-FDG PET/CT scans while only missing 2% of PSMA-/FDG+ cases. Patients with a low estimated score exhibited significantly prolonged OS (hazard ratio = 0.49, p = 0.029) and a higher PSA response rate (75% versus 35%, p = 0.011) compared to those with a high estimated score.

Conclusion:

This study successfully developed two models with accurate estimations of the risk associated with PSMA-/FDG+ lesions in CRPC patients. These models held potential utility in aiding the selection of candidates for 177Lu-PSMA-617 treatment and guiding 68Ga-PSMA PET/CT-directed radiotherapy.
Predictive nomogram for PSMA-/FDG+ lesion This study developed two models with accurate estimations of the risk associated with specific lesions in prostate cancer.
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Full text: 1 Collection: 01-internacional Health context: 6_ODS3_enfermedades_notrasmisibles Database: MEDLINE Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Language: En Journal: Ther Adv Med Oncol Year: 2024 Document type: Article
Fulltext
Print
XML
PubMed Links
Search on Google

Full text: 1 Collection: 01-internacional Health context: 6_ODS3_enfermedades_notrasmisibles Database: MEDLINE Type of study: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Language: En Journal: Ther Adv Med Oncol Year: 2024 Document type: Article