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. 2024 Dec;56(1):2411017.
doi: 10.1080/07853890.2024.2411017. Epub 2024 Oct 11.

Prognostic value of [18F]FDG PET/CT in metastatic hormone-sensitive prostate cancer at initial diagnosis: a retrospective cohort study

Ang Li  1 , Kai Shen  1 , Yiyi Ji  1 , Weiwei Zhang  1 , Bo Liu  1 , Ruopeng Su  1 , Xiang Zhou  2 , Liang Dong  1 , Yinjie Zhu  1 , Baijun Dong  1 , Jiahua Pan  1 , Qi Wang  1   3 , Wei Xue  1
Affiliations

Prognostic value of [18F]FDG PET/CT in metastatic hormone-sensitive prostate cancer at initial diagnosis: a retrospective cohort study

Ang Li et al. Ann Med. 2024 Dec.

Abstract

Introduction: This retrospective study aimed to evaluate the prognostic value of [18F]FDG parameters in patients with visceral and bone metastatic hormone-sensitive prostate cancer (mHSPC).

Patients and methods: This analysis included the mHSPC patients who underwent [18F]FDG PET/CT at the initial diagnosis. Baseline characteristics were analyzed, and the uptake of [18F]FDG was quantified using SUVmax. Kaplan-Meier and Cox proportional hazard regression analysis were employed to evaluate the correlation between SUVmax and patient survival.

Results: Among the 267 patients enrolled, 90 (33.7%) presented with visceral metastases and 177 (66.3%) had bone metastases. The median follow-up for the visceral metastasis group was 35.5 months (IQR 26-53.8 months). The median overall survival for patients with lung, liver, or both metastases were 30, 21 and 17 months, respectively. Patients exhibiting higher [18F]FDG uptake in metastatic lesions experienced shorter overall survival (OS) in comparison to those with lower [18F]FDG uptake, both in the visceral metastases group (17 vs. 31 months, p = 0.002) and the bone metastases group (27.5 vs. 34.5 months, p < 0.001). Cox regression analysis further revealed that increased [18F]FDG uptake in metastatic lesions emerged as a significant risk factor in both OS and progression-free survival (PFS). In contrast, the variability in [18F]FDG uptake in primary lesions did not provide a reliable indicator for predicting prognosis.

Conclusions: In mHSPC patients, higher [18F]FDG uptake in metastatic lesions indicates shorter survival and increased risk of disease progression. The [18F]FDG SUVmax in primary tumors did not show significant prognostic value. Our study underscores the unique prognostic potential of [18F]FDG PET/CT in mHSPC patients, highlighting its importance in the management of both bone and visceral metastases.

Keywords: 18F-fludeoxyglucose; Metastatic hormone-sensitive prostate cancer; bone metastasis; prognosis; visceral metastasis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flow diagram of included and excluded patients in this study.
Figure 2.
Figure 2.
Constitution of the mHSPC cohort.
Figure 3.
Figure 3.
(A) Kaplan–Meier survival curves for OS among patients with visceral metastasis and bone metastasis; (B) Kaplan–Meier survival curves for PFS between patients with visceral metastasis and bone metastasis; (C) Kaplan–Meier survival curves for OS among mHSPC patients according to the site of visceral metastasis; (D) Kaplan–Meier survival curves for PFS among metastatic mHSPC patients according to the site of visceral metastasis.
Figure 4.
Figure 4.
(A,B) Kaplan–Meier survival curves for OS (A) and PFS (B) among patients with visceral metastases according to [18F]FDG SUVmax of metastatic lesions; (C,D) Kaplan–Meier survival curves for OS (C) and PFS (D) among patients with visceral metastases according to [18F]FDG SUVmax of primary tumors.
Figure 5.
Figure 5.
(A,B) Kaplan–Meier survival curves for OS (A) and PFS (B) among patients with bone metastases according to [18F]FDG SUVmax of metastatic lesions; (C,D) Kaplan–Meier survival curves for OS (C) and PFS (D) among patients with bone metastases according to [18F]FDG SUVmax of primary tumors.
Figure 6.
Figure 6.
Two representative cases of mHSPC patients with similar baseline characteristics but distinct prognoses. (A) An 85-year-old man who was first diagnosed with liver metastatic prostate cancer in 2020, with Gleason score of 4 + 4 = 8 and serum PSA of 96.56 ng/ml. [18F]FDG PET/CT (upper left: axial PET/CT imaging of primary tumor; lower left: axial PET/CT imaging of liver metastatic lesion; Right: maximum intensity projection (MIP)) showed widespread visceral and lymph node metastasis. Although treated with endocrine therapy and chemotherapy immediately after diagnosis, he had a dismal prognosis, with an OS of 12 months from definitive PET/CT diagnosis to death; (B) a 67-year-old man who was first diagnosed with lung metastatic prostate cancer in 2018, with Gleason score of 4 + 4 = 8 and serum PSA of >150ng/ml. [18F]FDG PET/CT (upper left: axial PET/CT imaging of primary tumor; lower left: axial PET/CT imaging of lung metastatic lesion; right: maximum intensity projection (MIP)) showed multiple visceral and bone metastasis. This patient received ADT (including surgical castration) after being diagnosed. No evidence of tumor progression was noted with follow-up as of November 2022.
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