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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

Gogebakan, Kemal Caglar ; Elsisi, Zizi ; Montano-Campos, Felipe ; Owens, Lukas ; Zhao, Yibai ; Gulati, Roman ; Ferdinandus, Justin ; Fendler, Wolfgang P. ; Calais, Jeremie and Hope, Thomas A. , et al. (2025) In Cancer 131(21).
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.... (More)

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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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
biochemical recurrence, decision-analytic model, prostate cancer, prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT)
in
Cancer
volume
131
issue
21
article number
e70131
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:41108673
  • scopus:105019072048
ISSN
0008-543X
DOI
10.1002/cncr.70131
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 American Cancer Society.
id
7594df0d-d4a9-42b9-8796-d598c6b3ce90
date added to LUP
2025-12-16 15:50:48
date last changed
2025-12-17 03:00:09
@article{7594df0d-d4a9-42b9-8796-d598c6b3ce90,
  abstract     = {{<p>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.</p>}},
  author       = {{Gogebakan, Kemal Caglar and Elsisi, Zizi and Montano-Campos, Felipe and Owens, Lukas and Zhao, Yibai and Gulati, Roman and Ferdinandus, Justin and Fendler, Wolfgang P. and Calais, Jeremie and Hope, Thomas A. and Carlsson, Sigrid and Fainberg, Jonathan and Laudone, Vincent and Kunst, Natalia and Berlin, Alejandro and Schipper, Matthew and Barbour, Andrew and Iravani, Amir and Etzioni, Ruth}},
  issn         = {{0008-543X}},
  keywords     = {{biochemical recurrence; decision-analytic model; prostate cancer; prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT)}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{21}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Cancer}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1002/cncr.70131}},
  doi          = {{10.1002/cncr.70131}},
  volume       = {{131}},
  year         = {{2025}},
}