Prognostic Value of [¹⁸F]Flotufolastat PET Using Visual RECIP in Docetaxel-Treated Metastatic Prostate Cancer

Area of Science:

• Nuclear Medicine
• Oncology
• Radiopharmaceuticals

Background:

• Metastatic prostate cancer (mPCa) treatment often involves taxane-based chemotherapy (CTx).
• Accurate prognostic tools are crucial for guiding treatment decisions in mPCa.
• Evaluating treatment response with imaging can offer valuable prognostic information.

Purpose of the Study:

• To determine the prognostic value of [18F]flotufolastat PET imaging in patients with metastatic prostate cancer receiving taxane-based chemotherapy.
• To compare the prognostic utility of imaging response (RECIP) with biochemical response in this patient cohort.

Main Methods:

• A cohort of 69 patients with metastatic prostate cancer undergoing CTx were included.
• Baseline and follow-up [18F]flotufolastat PET/CT scans were performed.
• Imaging response was assessed using visual RECIP (dichotomized into progressive disease [PD] and non-PD). Biochemical response was defined by prostate-specific antigen (PSA) levels.
• Overall survival was analyzed using Kaplan-Meier methods and Harrell concordance index.

Main Results:

• Patients with imaging-defined PD had significantly shorter median overall survival (12 months) compared to non-PD (45 months).
• The Harrell concordance index for RECIP (0.84) was substantially higher than for biochemical response (0.66), indicating superior prognostic performance.
• RECIP assessment showed a statistically significant association with overall survival (P < 0.001).

Conclusions:

• [18F]flotufolastat PET imaging, evaluated by visual RECIP, possesses high prognostic utility in metastatic prostate cancer patients undergoing chemotherapy.
• Visual RECIP assessment of [18F]flotufolastat PET scans is a more powerful predictor of overall survival than standard biochemical markers.
• This imaging modality can aid in risk stratification and treatment management for patients with advanced prostate cancer.