Baseline Ga-68 PSMA PET-Derived Primary Tumor Parameters in Patients with Prostate Cancer and Their Association with Clinical Risk Stratification and Clinicopathologic Features

Abstract

Aim This article evaluates whether parameters derived from the gallium-68-labeled prostate-specific membrane antigen ( ⁶⁸ Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging studies of primary prostate cancer (PCa) lesions were associated with Gleason score (GS), D'Amico risk class, Candiolo nomograms, and the metastatic status of the disease. Methods We retrospectively evaluated newly diagnosed PCa patients who underwent ⁶⁸ Ga-PSMA PET/CT before therapy. Age, baseline serum prostate-specific antigen (PSA), and metastatic status were recorded. Maximal standardized uptake value (SUVmax), mean SUV (SUVmean), total lesion PSMA (TL-PSMA), and PSMA-derived tumor volume (PSMA-TV) were analyzed. The patients were grouped according to GS (GS ≤ 7 and GS ≥ 8), D'Amico risk classes (low intermediate and high-risk), and also based on their results with the Candiolo nomogram which normally creates five risk classes. For Candiolo classes, very-low risk and low-risk patients were pooled into the low-risk Candiolo (LRC) group, high and very high-risk patients were pooled into the high-risk Candiolo (HRC) group. The intermediate-risk Candiolo group was utilized as-is (IRC). Results Mean age was 67 ± 8 years, median PSA value was 14.3 (3-211). There were 82 patients with GS ≤ 7 and 38 patients with GS ≥ 8; intermediate D'Amico class comprised 32 patients, while the high D'Amico class comprised 88 patients. For Candiolo, there were 23 LRC, 40 IRC, and 57 HRC patients. PSMA-positive metastases were detected in 44 (36.7%) patients. The SUVmean, SUVmax, PSMA-TV, and TL-PSMA values of the primary tumor demonstrated significant differences when compared according to classifications for GS, D'Amico, LRC versus HRC, and metastatic versus nonmetastatic patients. Of note, TL-PSMA was the only parameter that varied significantly among all risk groups. Conclusion Primary tumor parameters obtained from baseline ⁶⁸ Ga-PSMA PET/CT are useful to distinguish PCa patients in terms of GS, D'Amico, Candiolo nomogram, and metastatic states. TL-PSMA appears to be the best parameter as it is the only parameter that can distinguish all risk groups from each other.

Keywords: 68 Ga-PSMA PET/CT; Candiolo nomogram; D'Amico risk class; Gleason score; prostate cancer.

Fig. 1

Pretreatment gallium-68-labeled prostate-specific membrane antigen (Ga-68-PSMA) positron emission tomography/computed tomography (PET/CT) images of a 68-year-old prostate cancer (PCa) patient categorized as Gleason score (GS): 4 + 3, D'Amico intermediate risk, low-risk Candiolo (LRC), nonmetastatic tumor. Summary of maximal standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) values derived from the primary prostate tumor (arrow) on axial fused pretreatment 68Ga-PSMA PET/CT images of a patient with low risk ( A – C ).

Fig. 2

Pretreatment gallium-68-labeled prostate-specific membrane antigen (Ga-68-PSMA) positron emission tomography/computed tomography (PET/CT) images of a 59-year-old prostate cancer (PCa) patient categorized as Gleason score (GS): 4 + 5, D'Amico high risk, high-risk Candiolo (HRC), metastatic tumor. Summary of maximal standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) values derived from primary prostate tumor (arrow) on axial fused pretreatment 68Ga-PSMA PET/CT images of a patient with low risk ( A – C ).