Real-World Treatment Outcomes in Patients With Ga68-PSMA-PET Positive Metastatic Hormone-Sensitive Prostate Cancer...

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• Prostate-specific membrane antigen (PSMA) PET imaging detects metastatic prostate cancer invisible to conventional methods.
• This identifies a new group: PSMA-avid/CT-negative metastatic prostate cancer, with undefined optimal management.
• Investigating treatment intensification with androgen receptor signaling inhibitors (ARSI) in this population.

Purpose of the Study:

• To evaluate if ARSI intensification improves outcomes for metastatic hormone-sensitive prostate cancer (mHSPC) patients with PSMA-avid/CT-negative disease.
• To compare treatment outcomes between PSMA-avid/CT-negative and PSMA-avid/CT-positive mHSPC cohorts.

Main Methods:

• Retrospective analysis of 159 mHSPC patients diagnosed with PSMA PET/CT.
• Stratification into PSMA-avid/CT-negative and PSMA-avid/CT-positive groups based on imaging findings.
• Comparison of prostate-specific antigen progression-free survival (PSA PFS) and castration resistance-free survival (CRFS).

Main Results:

• 51% of patients had PSMA-avid/CT-negative disease, 49% had PSMA-avid/CT-positive disease.
• PSMA-avid/CT-negative patients demonstrated significantly longer PSA PFS and CRFS.
• Within the PSMA-avid/CT-negative group, ARSI intensification did not improve CRFS compared to standard androgen deprivation therapy (ADT) monotherapy.

Conclusions:

• PSMA-avid/CT-negative mHSPC indicates a more favorable prognosis with lower risk of progression.
• Current data suggest ADT monotherapy may suffice for this group, but ARSI benefit needs prospective validation.
• PSMA PET/CT imaging redefines metastatic prostate cancer staging and informs prognostic assessment.