TY - JOUR
T1 - Prognostic value of PSMA PET/CT-Based local staging in predicting biochemical recurrence after radical prostatectomy
AU - Sweere, Vera
AU - Slot, Alexandra Bruins
AU - Hermsen, Rick
AU - Heetman, Joris G
AU - Wever, Lieke
AU - Lavalaye, Jules
AU - Vinken, Maarten
AU - Bahler, Clinton D
AU - Tann, Mark
AU - Kesch, Claudia
AU - Telli, Tugce
AU - Fendler, Wolfgang P
AU - Chiu, Peter Ka-Fung
AU - Zattoni, Fabio
AU - Evangelista, Laura
AU - Ceci, Francesco
AU - Miszczyk, Marcin
AU - Rajwa, Pawel
AU - Barletta, Francesco
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Gandaglia, Giorgio
AU - van Basten, Jean-Paul A
AU - van Melick, Harm H E
AU - van den Bergh, Roderick C N
AU - Marra, Giancarlo
AU - Scheltema, Matthijs J V
AU - Soeterik, Timo F W
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2026/1
Y1 - 2026/1
N2 - Purpose: PSMA PET/CT outperforms conventional imaging for detecting pelvic nodal and distant metastasis, but its role regarding local staging and risk stratification remains unclear. This study aims to evaluate the association between PSMA PET/CT characteristics and biochemical recurrence-free survival (BRFS) after robot-assisted radical prostatectomy (RARP) in patients with prostate cancer. Methods: In this international multicentre retrospective study, we analyzed 476 patients with localized or locally advanced miN0 prostate cancer, staged with PSMA PET/CT and MRI before RARP (2016–2023). Predictors of BRFS were identified using univariate and multivariate Cox regression with backward elimination based on Akaike information criterion (AIC). Kaplan-Meier analysis assessed the association of clinical stage by MRI, PSMA PET, and their combination with BRFS. Results: In total 476 patients were included with a median follow-up of 18.0 months (IQR 6.9–29.3). Of the 127 BCRs, 101 (79.5%) occurred within two years post-surgery. The final multivariate model included initial PSA (10–20 vs. <10: HR 1.92 [95% CI 1.21–3.05]; >20 vs. <10: HR 2.26 [95% CI 1.30–3.93]), biopsy ISUP grade group (2–3 vs. 1: HR 2.28 [95% CI 0.70–7.41]; 4–5 vs. 1: HR 3.62 [95% CI 1.12–11.65]), MRI T-stage (T3a vs. ≤T2: HR 1.19 [95% CI 0.75–1.90]; ≥T3b vs. ≤T2: HR 2.09 [95% CI 1.21–3.62]), and PSMA PET T-stage (T3a vs. ≤T2: HR 1.05 [95% CI 0.59–1.85]; ≥T3b vs. ≤T2: HR 2.75 [95% CI 1.63–4.63]). From the full model, clinical T-stage, MRI-derived index diameter, SUVmax, PSMAtotal and PSMAvol were eliminated. The 2-year BRFS was 19% (95% CI 6.7–51%) in patients with T3b disease on both MRI and PSMA PET compared to 58% (95% CI 40–84%) in those with T3b detected only on MRI (p = 0.03). Conclusion: Clinical tumor stage assessed by PSMA PET was independently associated with BRFS in multivariate analysis, adjusting for clinical parameters and MRI-derived staging. This suggests that incorporating PSMA PET-based local staging may improve risk stratification and guide treatment decisions.
AB - Purpose: PSMA PET/CT outperforms conventional imaging for detecting pelvic nodal and distant metastasis, but its role regarding local staging and risk stratification remains unclear. This study aims to evaluate the association between PSMA PET/CT characteristics and biochemical recurrence-free survival (BRFS) after robot-assisted radical prostatectomy (RARP) in patients with prostate cancer. Methods: In this international multicentre retrospective study, we analyzed 476 patients with localized or locally advanced miN0 prostate cancer, staged with PSMA PET/CT and MRI before RARP (2016–2023). Predictors of BRFS were identified using univariate and multivariate Cox regression with backward elimination based on Akaike information criterion (AIC). Kaplan-Meier analysis assessed the association of clinical stage by MRI, PSMA PET, and their combination with BRFS. Results: In total 476 patients were included with a median follow-up of 18.0 months (IQR 6.9–29.3). Of the 127 BCRs, 101 (79.5%) occurred within two years post-surgery. The final multivariate model included initial PSA (10–20 vs. <10: HR 1.92 [95% CI 1.21–3.05]; >20 vs. <10: HR 2.26 [95% CI 1.30–3.93]), biopsy ISUP grade group (2–3 vs. 1: HR 2.28 [95% CI 0.70–7.41]; 4–5 vs. 1: HR 3.62 [95% CI 1.12–11.65]), MRI T-stage (T3a vs. ≤T2: HR 1.19 [95% CI 0.75–1.90]; ≥T3b vs. ≤T2: HR 2.09 [95% CI 1.21–3.62]), and PSMA PET T-stage (T3a vs. ≤T2: HR 1.05 [95% CI 0.59–1.85]; ≥T3b vs. ≤T2: HR 2.75 [95% CI 1.63–4.63]). From the full model, clinical T-stage, MRI-derived index diameter, SUVmax, PSMAtotal and PSMAvol were eliminated. The 2-year BRFS was 19% (95% CI 6.7–51%) in patients with T3b disease on both MRI and PSMA PET compared to 58% (95% CI 40–84%) in those with T3b detected only on MRI (p = 0.03). Conclusion: Clinical tumor stage assessed by PSMA PET was independently associated with BRFS in multivariate analysis, adjusting for clinical parameters and MRI-derived staging. This suggests that incorporating PSMA PET-based local staging may improve risk stratification and guide treatment decisions.
KW - Biochemical recurrence-free survival
KW - MRI
KW - PSMA PET/CT
KW - Prostate cancer
UR - https://www.scopus.com/pages/publications/105016811970
U2 - 10.1007/s00259-025-07455-0
DO - 10.1007/s00259-025-07455-0
M3 - Article
C2 - 40717186
SN - 1619-7070
VL - 53
SP - 921
EP - 930
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
IS - 2
ER -