Prognostic value of PSMA PET in predicting long‐term biochemical control following curative intent treatment for prostate cancer

Abstract Introduction The aim of this study is to investigate the prognostic value of 68 Ga‐labelled prostate‐specific membrane antigen (PSMA) positron emission tomography (PET) metrics in predicting long‐term biochemical failure‐free survival (BFFS) following curative intent treatment for prostate cancer. Methods We completed a prospective study that followed men who had PSMA PET for staging of newly diagnosed prostate cancer between 2015 and 2017 who went on to have curative intent treatment with radiotherapy (RT) or radical prostatectomy (RP). PSMA PET CT imaging was reported and the intraprostatic maximum standardised uptake value (SUV max ) was recorded. The primary outcome was BFFS. Statistical analysis included descriptive statistics, Cox proportional hazards (PH) models, Kaplan–Meier survival analysis and a regression tree structured method. Results A total of 183 men were included in the analysis with a median age of 66 years and the majority of patients (55.2%) had ISUP grade 1–3 disease. All patients had PSMA PET staging prior to curative intent treatment with RP (66.1%) or external beam radiotherapy (33.9%). PSMA‐avid pelvic nodes were present in 26 patients but were not associated with worse biochemical control. A PSMA SUV max of the prostate primary greater than the median (>5.6) was associated with a lower BFFS (HR: 4.4, 95% CI 1.42–3.72, P = 0.01). A multivariate Cox model incorporating initial biopsy grade, age and PSMA SUV max showed that PSMA SUV max was an independent predictor of BFFS. The RT‐structured method identified an optimal threshold of 6.8 for PSMA SUV max , above which patients with ISUP 1–3 disease had a significantly worse BFFS. Conclusion PSMA SUV max is a strong predictor of BFFS in patients with non‐metastatic prostate cancer who underwent curative intent treatment. Patients with low‐risk disease on biopsy (ISUP 1–3) but high PSMA SUV max may have biochemical failure risk analogous to higher‐risk disease (ISUP 4–5). These findings allow for further risk stratification and prognosis of patients with newly diagnosed prostate cancer planned for definitive treatment.