Distinct prognostic value of [¹⁸F]FDG PET and [⁶⁸Ga]Ga-PSMA-11 PET in advanced hormone-sensitive prostate cancer

This study aimed to evaluate the distinct prognostic value of [¹⁸F]FDG and [⁶⁸Ga]Ga-PSMA-11 PET imaging in advanced hormone-sensitive prostate cancer, highlighting their complementary roles at both patient and lesion levels.

This study retrospectively included 298 patients with newly diagnosed prostate cancer who underwent baseline dual-tracer PET imaging. Quantitative PET parameters for both [¹⁸F]FDG and [⁶⁸Ga]Ga-PSMA-11 were extracted. Clinical outcomes, including progression-free survival, biochemical response, and radiographic response, were collected during follow-up. Lesion-based analysis was performed in 267 measurable lesions to evaluate the association between tracer uptake and local radiographic response, as determined by changes in lesion diameter following systemic therapy.

Here we show that higher whole-body [¹⁸F]FDG uptake, including total lesion glycolysis (HR = 3.525, p < 0.001) and metabolic tumor volume (HR = 2.757, p < 0.001), is significantly associated with shorter progression-free survival. In contrast, only PSMA-derived tumor volume (HR = 2.019, p = 0.018), but not total lesion PSMA uptake (HR = 1.438, p = 0.221), demonstrates prognostic value. Moreover, patients with higher whole-body [¹⁸F]FDG burden receive greater benefit from chemotherapy (HR = 2.936, p = 0.004). At the lesion level, higher [⁶⁸Ga]Ga-PSMA-11 uptake is significantly correlated with more favorable radiographic response (p < 0.001), while lesion-level [¹⁸F]FDG uptake does not demonstrate predictive value.

[¹⁸F]FDG PET and [⁶⁸Ga]Ga-PSMA-11 PET provide distinct but complementary prognostic value in advanced hormone-sensitive prostate cancer. Dual-tracer PET imaging enhances prognostic accuracy and provides comprehensive guidance for individualized treatment strategies.