TY  - JOUR
AU  - Gogebakan, Kemal Caglar
AU  - Elsisi, Zizi
AU  - Montano-Campos, Felipe
AU  - Owens, Lukas
AU  - Zhao, Yibai
AU  - Gulati, Roman
AU  - Ferdinandus, Justin
AU  - Fendler, Wolfgang P
AU  - Calais, Jeremie
AU  - Hope, Thomas A
AU  - Carlsson, Sigrid
AU  - Fainberg, Jonathan
AU  - Laudone, Vincent
AU  - Kunst, Natalia
AU  - Berlin, Alejandro
AU  - Schipper, Matthew
AU  - Barbour, Andrew
AU  - Iravani, Amir
AU  - Etzioni, Ruth
TI  - 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.
JO  - Cancer
VL  - 131
IS  - 21
SN  - 0008-543X
CY  - New York, NY
PB  - Wiley-Liss
M1  - DKFZ-2025-02170
SP  - e70131
PY  - 2025
N1  - ISSN 1097-0142
AB  - 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.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).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.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.
KW  - Humans
KW  - Male
KW  - Prostatic Neoplasms: diagnostic imaging
KW  - Prostatic Neoplasms: mortality
KW  - Prostatic Neoplasms: surgery
KW  - Prostatic Neoplasms: pathology
KW  - Prostatic Neoplasms: therapy
KW  - Prostatectomy
KW  - Positron Emission Tomography Computed Tomography: methods
KW  - Neoplasm Recurrence, Local: diagnostic imaging
KW  - Neoplasm Recurrence, Local: mortality
KW  - Glutamate Carboxypeptidase II: metabolism
KW  - Antigens, Surface: metabolism
KW  - Salvage Therapy
KW  - Aged
KW  - Middle Aged
KW  - biochemical recurrence (Other)
KW  - decision‐analytic model (Other)
KW  - prostate cancer (Other)
KW  - prostate‐specific membrane antigen positron emission tomography/computed tomography (PSMA‐PET/CT) (Other)
KW  - Glutamate Carboxypeptidase II (NLM Chemicals)
KW  - FOLH1 protein, human (NLM Chemicals)
KW  - Antigens, Surface (NLM Chemicals)
LB  - PUB:(DE-HGF)16
C6  - pmid:41108673
DO  - DOI:10.1002/cncr.70131
UR  - https://inrepo02.dkfz.de/record/305452
ER  -