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Researchers found correlations between PSMA PET total tumor burden and survival in patients with high-volume metastatic hormone-sensitive prostate cancer.
A recent study presented at the 2024 ASCO Genitourinary Cancers Symposium sheds light on the potential of prostate-specific membrane antigen (PSMA) PET imaging and AI algorithms in guiding clinical decisions for patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC).
Prostate cancer remains a significant healthcare challenge, both in terms of clinical management and economic burden. The high-volume disease poses unique challenges in treatment decision-making due to the variety of patients’ tumor burdens, researchers said. With advancements in medical technology, particularly AI and molecular imaging, there is newfound hope for more accurate risk stratification and tailored therapeutic approaches.
“The identification of subgroups of patients that require closer follow-up or more intense therapeutic regimens has a direct impact on the prognosis and expenses for the patient,” said lead author Francisco Osvaldo García-Perez, MD, and colleagues. “With the development of AI algorithms, it is possible to estimate the PSMA total tumor burden and identify patients who are candidates for specific therapies without exposing them to comorbidities associated with aggressive regimens.”
PSMA Total Tumor Burden Linked to Survival
Researchers retrospectively analyzed the PSMA PET scans of 53 patients with histopathologically confirmed high-volume mHSPC. Patients had an average age of 71 (±5.1) years, and the median follow-up was 44 (±9.7) months. The mean prostate-specific antigen (PSA) level at diagnosis was 62.1 ng/dL, and the cohort exhibited a diverse spectrum of disease severity, with varying Gleason scores and International Society of Urological Pathology (ISUP) grades.
The researchers used AI to estimate PSMA total tumor burden (TTB). The average PSMA TTB was 100.1 cm3 (range 21 cm3 to 518.8 cm3). PSMA TTB was significantly associated with PSA levels (Pearson r= 0.526, P<0.0001), underscoring its potential as a prognostic marker. In addition, patients with PSMA TTB below 45 cm3 (n=21) had longer progression-free survival compared with those with higher PSMA TTB values (n=32; 31.1 months vs 47.8 months, P<0.003).
There was no significant association between PSMA TTB and traditional prognostic factors such as Gleason score or ISUP grade, which supports the complementary role of molecular imaging in risk assessment.
PSMA PET imaging also provided insights into the systemic spread of prostate cancer. Researchers observed one or more detectable lesions in various anatomical sites including the lungs (n=11), pleura (n=9), liver (n=9), adrenal glands (n=5), and brain (n=2), as well as bones such as the ribs (n=24), femur (n=16), skull (n=8), scapula (n=7), and humerus (n=7).
An “Invaluable Tool” for Prostate Cancer Management
By leveraging AI-driven PSMA PET imaging, clinicians can make more informed decisions regarding treatment intensity and follow-up strategies for patients with high-volume mHSPC. Early identification of individuals at higher risk of disease progression allows for timely intervention, potentially improving clinical outcomes and reducing healthcare costs.
“PSMA TTB has great value in predicting progression-free survival of patients with newly diagnosed high-volume metastatic hormone-sensitive prostate cancer and has a strong correlation with PSA,” Dr. García-Perez and colleagues concluded. They added that PSMA PET is “an invaluable tool in initial diagnosis and potentially in follow-up for providing information on the biological behavior of the disease in a systemic way.”
