PSMA PET for the Assessment of Metastatic Hormone-Sensitive Prostate Cancer Volume of Disease

Francesco Barbato, Wolfgang P. Fendler, Isabel Rauscher, Ken Herrmann, Axel Wetter, Justin Ferdinandus, Robert Seifert, Michael Nader, Kambiz Rahbar, Boris Hadaschik, Matthias Eiber, Andrei Gafita, Manuel Weber

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Conventional imaging of low-volume disease (LVD) versus high-volume disease (HVD) is associated with survival in metastatic hormone-sensitive prostate cancer (mHSPC) according to the CHAARTED trial (Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer) and the STAMPEDE trial (Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy). We propose a compatible quantitative PSMA PET framework for disease volume assessment in mHSPC. Methods: Three PET centers screened their PSMA PET database for mHSPC patients. CT versus PSMA PET stage, lesion number, and classification of LVD versus HVD were determined by 1 masked reader; PSMA-positive tumor volume was quantified semiautomatically. Results: In total, 85 CT-based CHAARTED LVD and 20 CT-based CHAARTED HVD patients were included. A PSMA tumor volume of about 40 cm3 was the optimal cutoff between CT-based CHAARTED LVD (nonunifocal) and HVD (non-M1c) (area under the curve, 0.86). Stratification into PET LVD (unifocal or oligometastatic/disseminated, ~40 cm3) and PET HVD (oligometastatic/disseminated $ ~40 cm3 or M1c) had 13% misalignment with the CHAARTED criteria. Conclusion: PSMA PET criteria with volume quantification deliver comparable LVD/HVD discrimination with additional subgroups for unifocal, oligometastatic, and disseminated disease, critical for guidance of targeted or multimodal therapy.

Original languageEnglish
Pages (from-to)1747-1750
Number of pages4
JournalJournal of Nuclear Medicine
Issue number12
StatePublished - 1 Dec 2021
Externally publishedYes


  • PSMA
  • mHSPC
  • metastasis-directed treatment
  • prostate cancer


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