Prostate-specific membrane antigen positron emission tomography/computed tomography imaging as a precision diagnostic at prostate cancer recurrence after radical prostatectomy: Modeling long-term survival

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-10-18 DOI:10.1002/cncr.70131

Kemal Caglar Gogebakan PhD, Zizi Elsisi MS, Felipe Montano-Campos MS, Lukas Owens BA, Yibai Zhao PhD, Roman Gulati MS, Justin Ferdinandus MD, Wolfgang P. Fendler MD, Jeremie Calais MD, PhD, Thomas A. Hope MD, Sigrid Carlsson MD, PhD, MPH, Jonathan Fainberg MD, MPH, Vincent Laudone MD, Natalia Kunst PhD, Alejandro Berlin MD, Matthew Schipper PhD, Andrew Barbour MD, PhD, Amir Iravani MD, Ruth Etzioni PhD

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Abstract

Background

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) is affecting the management of patients with prostate cancer with biochemical recurrence after radical prostatectomy. The long-term outcomes of tailoring salvage treatment on the basis of PSMA-PET/CT status remain to be determined.

Methods

A decision-analytic model was developed to project incremental life-years of strategies that allocate treatments at biochemical recurrence after radical prostatectomy on the basis of PSMA-PET/CT status (PSMA-metastatic vs. PSMA-nonmetastatic). Modeled treatments are local/regional (radiation) or systemic (hormone therapy and doublet therapy), administered immediately or delayed. PSMA-metastatic status was assumed to lead to treatment intensification, whereas PSMA-nonmetastatic status would lead to deintensification. To project survival, data on progression to metastasis from a clinical cohort were combined with registry data on postmetastasis survival. Because of the lack of data on long-term treatment benefits by PSMA status, survival was projected by varying the hazard ratio (HR) for disease-specific death among PSMA-metastatic versus PSMA-nonmetastatic patients under delayed or local/regional regimens (HR1) and under immediate systemic regimens (HR2).

Results

Mean life-years are projected to be 15.5 under the non–PSMA-tailored strategy, and mean incremental life-years range from 0.38 to 0.81 depending on HR1 and HR2. A greater benefit is projected when PSMA-metastatic status is more adverse under salvage regimens that do not include systemic agents.

Conclusions

This decision-analytic modeling study projects that PSMA-PET/CT–guided management at biochemical recurrence after radical prostatectomy yields a modest survival benefit under the specified model inputs and assumptions regarding treatment distributions. These findings may complement emerging data on the corresponding economic costs and health-related quality of life.

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前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描成像作为根治性前列腺切除术后前列腺癌复发的精确诊断：模拟长期生存

前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA-PET/CT）影响前列腺癌根治性前列腺切除术后生化复发患者的处理。基于PSMA-PET/CT状态定制救助治疗的长期结果仍有待确定。方法建立决策分析模型，根据PSMA-PET/CT状态（psma转移与psma非转移）预测根治性前列腺切除术后生化复发分配治疗策略的增量寿命年。模拟治疗是局部/区域（放射）或全身（激素治疗和双重治疗），立即或延迟给予。假定psma转移状态导致治疗强化，而psma非转移状态将导致去强化。为了预测生存期，将临床队列的转移进展数据与转移后生存登记数据相结合。由于缺乏PSMA状态的长期治疗益处的数据，因此通过改变延迟或局部/区域方案（HR1）和立即全身方案（HR2）下PSMA转移性与PSMA非转移性患者疾病特异性死亡的风险比（HR）来预测生存率。结果：在非psma定制策略下，平均寿命年预计为15.5年，根据HR1和HR2，平均增量寿命年范围为0.38至0.81年。在不包括全身性药物的挽救方案下，当psma转移状态更不利时，预计会有更大的益处。本决策分析模型研究表明，在特定的模型输入和治疗分布假设下，PSMA-PET/ ct引导下根治性前列腺切除术后生化复发的治疗可获得适度的生存益处。这些发现可以补充有关相应经济成本和与健康有关的生活质量的新数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research