68Ga-PSMA PET/CT-avid Tumour Volume: A Potential Prognostic Biomarker in Metastatic Hormone Sensitive Prostate Cancer

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Background Prostate-specific membrane antigen (PSMA) PET/CT provides sensitive whole-body assessment in prostate cancer, yet the prognostic role of total tumour volume (TTV) is not fully defined in metastatic hormone-sensitive disease and needs further exploration. Methods We retrospectively reviewed patients with de novo metastatic prostate cancer undergoing baseline PSMA PET/CT at Royal North Shore Hospital between 2014-2019. TTV was quantified using a standardized Standard Uptake Value (SUV) threshold, and patients were stratified by median TTV. Associations between TTV, progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan–Meier and Cox regression analyses. Results Fifty-nine patients were included in the study. Patients in the high-TTV group demonstrated reduced OS but no significant difference in PFS. Higher PSMA-derived TTV correlated with increased prostate-specific antigen (PSA) at diagnosis and higher rates of skeletal related events. Higher SUVmax was not associated with longer PFS or OS, nor was it associated with increased skeletal related events. Conclusion Baseline PSMA PET/CT-derived tumour volume is an independent prognostic biomarker in metastatic hormone-sensitive prostate cancer, associated with inferior overall survival. Incorporating TTV into existing risk models may refine patient selection for treatment intensification.

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