Related Experiment Video
Updated: Jan 8, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Higher Preoperative Maximum Standardised Uptake Values Are Associated with a Higher Risk of Metastases After
K C C de Bie1, M F Creanza2, Y J L Bodar1
1Amsterdam University Medical Center, VU University, Department of Urology, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Background And Objective:
Prostate-specific membrane antigen (PSMA) expression on positron emission tomography/computed tomography (PET/CT), semiquantitatively expressed as the standardised uptake value (SUVmax), is increasingly recognised as a prognostic factor and may predict metastatic progression after treatment. This study aims to evaluate the predictive value of SUVmax on preoperative PSMA PET/CT for metastatic development after robot-assisted radical prostatectomy (RARP).
Methods:
This retrospective two-centre study included patients with nonmetastatic primary prostate cancer who underwent [68Ga]Ga-PSMA-11 or [18F]DCFPyL PSMA PET/CT prior to RARP. The minimum follow-up period was 1 yr. Metastases were assessed by restaging PSMA PET/CT at biochemical recurrence. SUVmax was calculated for the dominant intraprostatic lesion on preoperative PSMA PET/CT. Multivariable Cox regression included SUVmax, clinical tumour stage (cT), initial prostate-specific antigen density, percentage positive biopsy cores, and biopsy International Society of Urological Pathology grade group. SUVmax thresholds and model performance were investigated.
Key Findings And Limitations:
A total of 293 patients underwent preoperative PSMA PET/CT, of whom 53 developed metastases after a median follow-up of 39 mo (interquartile range [IQR] 29-54). SUVmax was higher in participants who developed metastases at 2-yr follow-up than in those without metastases (median 8.8; IQR 7.1-16 vs 7.8; IQR 5.7-13; p = 0.015). An SUVmax of >10 was associated with an increased metastatic risk (hazard ratio [HR] 1.81; 95% confidence interval [CI] 1.04-3.13; p = 0.035) and log-SUVmax independently predicted metastases (HR 2.80; 95% CI 1.02-7.70; p = 0.046). The limitations include potential selection and detection biases due to selective follow-up imaging and nonstandardised treatment decisions.
Conclusions And Clinical Implications:
In patients with primary prostate cancer, preoperative SUVmax is associated with metastatic progression after RARP. An SUVmax of >10 may aid in risk stratification for adverse outcomes.
