Communications medicine · 2026
Distinct prognostic value of [18F]FDG PET and [68Ga]Ga-PSMA-11 PET in advanced hormone-sensitive prostate cancer.
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Li Ang, Wu Haotian, Zhou Xiang, Zhu Yinjie, Zhang Weiwei, Shen Kai, Tang Linglin, Yi Jiayan, Liu Bo, Su Ruopeng, Liu Xinyu, Chai Xinyu, Wang Qi, Pan Jiahua, Xue Wei
Аннотация
BACKGROUND: This study aimed to evaluate the distinct prognostic value of [18F]FDG and [68Ga]Ga-PSMA-11 PET imaging in advanced hormone-sensitive prostate cancer, highlighting their complementary roles at both patient and lesion levels.
METHODS: This study retrospectively included 298 patients with newly diagnosed prostate cancer who underwent baseline dual-tracer PET imaging. Quantitative PET parameters for both [18F]FDG and [68Ga]Ga-PSMA-11 were extracted. Clinical outcomes, including progression-free survival, biochemical response, and radiographic response, were collected during follow-up. Lesion-based analysis was performed in 267 measurable lesions to evaluate the association between tracer uptake and local radiographic response, as determined by changes in lesion diameter following systemic therapy.
RESULTS: Here we show that higher whole-body [18F]FDG uptake, including total lesion glycolysis (HR = 3.525, p < 0.001) and metabolic tumor volume (HR = 2.757, p < 0.001), is significantly associated with shorter progression-free survival. In contrast, only PSMA-derived tumor volume (HR = 2.019, p = 0.018), but not total lesion PSMA uptake (HR = 1.438, p = 0.221), demonstrates prognostic value. Moreover, patients with higher whole-body [18F]FDG burden receive greater benefit from chemotherapy (HR = 2.936, p = 0.004). At the lesion level, higher [68Ga]Ga-PSMA-11 uptake is significantly correlated with more favorable radiographic response (p < 0.001), while lesion-level [18F]FDG uptake does not demonstrate predictive value.
CONCLUSIONS: [18F]FDG PET and [68Ga]Ga-PSMA-11 PET provide distinct but complementary prognostic value in advanced hormone-sensitive prostate cancer. Dual-tracer PET imaging enhances prognostic accuracy and provides comprehensive guidance for individualized treatment strategies.
METHODS: This study retrospectively included 298 patients with newly diagnosed prostate cancer who underwent baseline dual-tracer PET imaging. Quantitative PET parameters for both [18F]FDG and [68Ga]Ga-PSMA-11 were extracted. Clinical outcomes, including progression-free survival, biochemical response, and radiographic response, were collected during follow-up. Lesion-based analysis was performed in 267 measurable lesions to evaluate the association between tracer uptake and local radiographic response, as determined by changes in lesion diameter following systemic therapy.
RESULTS: Here we show that higher whole-body [18F]FDG uptake, including total lesion glycolysis (HR = 3.525, p < 0.001) and metabolic tumor volume (HR = 2.757, p < 0.001), is significantly associated with shorter progression-free survival. In contrast, only PSMA-derived tumor volume (HR = 2.019, p = 0.018), but not total lesion PSMA uptake (HR = 1.438, p = 0.221), demonstrates prognostic value. Moreover, patients with higher whole-body [18F]FDG burden receive greater benefit from chemotherapy (HR = 2.936, p = 0.004). At the lesion level, higher [68Ga]Ga-PSMA-11 uptake is significantly correlated with more favorable radiographic response (p < 0.001), while lesion-level [18F]FDG uptake does not demonstrate predictive value.
CONCLUSIONS: [18F]FDG PET and [68Ga]Ga-PSMA-11 PET provide distinct but complementary prognostic value in advanced hormone-sensitive prostate cancer. Dual-tracer PET imaging enhances prognostic accuracy and provides comprehensive guidance for individualized treatment strategies.