Predictive and Prognostic ¹⁸F-Fluorocholine PET/CT Radiomics Nomogram in Patients with Castration-Resistant Prostate...

Area of Science:

• Oncology
• Radiopharmaceuticals
• Medical Imaging

Background:

• Castration-resistant prostate cancer with bone metastases (CRPC-BM) has limited treatment options.
• Radium-223 dichloride (²²³Ra) is a therapeutic option for CRPC-BM.
• Predictive tools are needed to optimize ²²³Ra treatment strategies.

Purpose of the Study:

• To develop a nomogram for predicting treatment failure in CRPC-BM patients treated with ²²³Ra.
• To develop a nomogram for predicting skeletal events in CRPC-BM patients treated with ²²³Ra.
• To develop a nomogram for predicting overall survival (OS) in CRPC-BM patients treated with ²²³Ra.

Main Methods:

• Prospective multicenter study (ChoPET-Rad) of 100 CRPC-BM patients treated with ²²³Ra.
• Utilized baseline, interim, and end-of-treatment bone scintigraphy and ¹⁸F-Fluorocholine PET/CT (FCH PET/CT).
• Incorporated imaging radiomics, clinical, and biochemical variables; survival analysis via Kaplan-Meier and Cox regression; nomogram development.

Main Results:

• Median progression-free survival (PFS) was 4 months; median OS was 14 months.
• Predictors of treatment failure included baseline alkaline phosphatase and CT-based bone metastasis characteristics.
• Predictors of OS included therapeutic failure, prior treatment lines, SUVmax, bone marrow infiltration on FCH PET/CT, and interim treatment response.

Conclusions:

• FCH PET/CT is valuable for evaluating and monitoring patients undergoing ²²³Ra therapy.
• Morphological features of bone metastases, bone marrow infiltration, and interim treatment response on FCH PET/CT are robust predictors.
• Developed nomograms demonstrated good discrimination for predicting treatment failure and OS in CRPC-BM patients.