Dual-tracer PET/CT with [68Ga]Ga-PSMA-617 and [68Ga]Ga-RM26 improves early prediction of biochemical failure in prostate cancer: a prospective phase II trial.
IF 7.6 1区 医学Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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引用次数: 0
Abstract
PURPOSE
Prostate-specific membrane antigen (PSMA) and Gastrin-releasing peptide receptor (GRPR) PET demonstrate hopeful results in initial staging of prostate cancer (PCa), offering potential to support precision treatment decisions. We investigated whether the dual-tracer PET/CT with [68Ga]Ga-PSMA-617 and [68Ga]Ga-RM26 could enhance prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) in PCa.
METHODS
102 patients from prospective cohort NCT05073653 underwent preoperative [68Ga]Ga-PSMA-617 and [68Ga]Ga-RM26 PET/CT. Tumor uptake was quantified by maximum standardized uptake value (SUVmax), with optimal cutoffs determined using maximally selected rank statistics. Biochemical recurrence-free survival (BRFS) was estimated by Kaplan-Meier analysis, and the correlations between BRFS and predictors were examined using Cox regression. Predictive values were assessed using time-dependent receiver-operating characteristic (ROC) curves. We additionally used transcriptomic data (GSE70770, n = 198) for external validation.
RESULTS
52 patients (51.0%) experienced BCR within the follow-up (median, 22.3 months). High PSMA-SUVmax (> 6.6) was associated with shorter BRFS (hazard ratio [HR] 3.17, p = 0.004), as was low GRPR-SUVmax (≤ 13.0) (HR 0.51, p = 0.026). Both were identified as independent predictors for BRFS. PSMA-SUVmax correlated with most of conventional clinicopathological factors (p < 0.005), whereas GRPR-SUVmax did not (p > 0.200). The combined PSMA + GRPR-SUVmax model achieved a superior time-dependent AUC of 0.73, compared with PSMA (AUC 0.63) or GRPR alone (AUC 0.62). External transcriptomic analysis corroborated that PSMAhigh/GRPRlow phenotype was associated with poorer BRFS (p = 0.029).
CONCLUSION
This study provides first clinical evidence that [68Ga]Ga-RM26 PET/CT adds independent prognostic value to PSMA PET/CT for early prediction of BCR after RP. Dual-tracer PET/CT may enable more accurate risk stratification and guide personalized management in PCa patients.
期刊介绍:
The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.