Baseline PSMA PET/CT tumor volume improves survival prediction in metastatic hormone-sensitive prostate cancer

In 204 patients with synchronous metastatic hormone-sensitive prostate cancer, baseline PSMA PET/CT total tumor volume (PSMA-TV) independently predicted overall survival (HR 1.39 per doubling, p<0.001). A model combining PSMA-TV and performance status had C-index 0.71. An explor…

• Multidisciplinary team consensus classified 37% as low-volume and 63% as high-volume disease, with median PSMA-TV of 60 vs 483 mL and median overall survival of 69 vs 41 months.
• PSMA-TV independently predicted overall survival (HR 1.39 per doubling, p<0.001); a model with PSMA-TV and WHO performance status achieved bootstrapped C-index 0.71 (95% CI 0.66-0.77).
• Exploratory threshold PSMA-TV ≥150 mL or any visceral metastasis yielded HR 3.01, similar to MDT classification (HR 2.68); multicentre validation is required before clinical implementation.

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