The Clinical Significance of Gallium‐68 PSMA‐11 PET‐Derived SUVmax in the Management of Metastatic Hormone‐Sensitive Prostate Cancer

PURPOSE: Previous studies have demonstrated an association between PSMA-PET SUVmax and poorer survival outcomes in patients with mCRPC. However, limited data are available in mHSPC. We aim to investigate the relationship between baseline PSMA-PET SUVmax and rPFS in patients with mHSPC. METHODS: The optimal SUVmax cut-off for rPFS was determined using Harrell's C-index. Baseline characteristics were compared using the χ² test between the groups and survival analyses for rPFS were performed. RESULTS: Data from 165 patients were retrospectively analyzed, with a median follow-up of 44 months (mo) (range: 9-103 mo). A total of 17.16 was identified as the optimal SUVmax cutoff. Baseline characteristics were compared whit this threshold. SUVmax higher patients showed poor ECOG PS, high denovo metastases, high volume, higher ALP, and high median PSA level. The median rPFS for the entire cohort was 34.3 mo (95% CI: 22.0-46.5 mo). In univariate analysis, patients with higher SUVmax had a median rPFS of 23 mo versus 60.4 mo in those with low SUVmax (p < 0.001). ALP normal versus higher (41.5 vs. 20.7 mo, p = 0.011), hemoglobin < 12 g/dL versus ≥ 12 g/dL (21.2 vs. 48.4 mo, p = 0.004), low versus high tumor volume (60.4 vs. 23 mo, p = 0.004) and PSA ≥ 35 ng/mL versus PSA < 35 ng/mL (23.9 mo vs NR, p = 0.030). Furthermore, patients not receiving ARPIs therapy exhibited inferior rPFS (ADT-alone:20.7 mo vs. ADT + docetaxel:19.2 mo vs. ADT plus ARPIs: 48.4 mo, p = 0.002). CONCLUSION: We demonstrated that high SUVmax has a negative prognostic impact on rPFS in mHSPC.