PT  - JOURNAL ARTICLE
AU  - Andreas G. Wibmer
AU  - Michael J. Morris
AU  - Mithat Gonen
AU  - Junting Zheng
AU  - Hedvig Hricak
AU  - Steven Larson
AU  - Howard I. Scher
AU  - Hebert Alberto Vargas
TI  - Quantification of Metastatic Prostate Cancer Whole-Body Tumor Burden with <sup>18</sup>F-FDG PET Parameters and Associations with Overall Survival After First-Line Abiraterone or Enzalutamide: A Single-Center Retrospective Cohort Study
AID  - 10.2967/jnumed.120.256602
DP  - 2021 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 1050--1056
VI  - 62
IP  - 8
4099  - http://jnm.snmjournals.org/content/62/8/1050.short
4100  - http://jnm.snmjournals.org/content/62/8/1050.full
SO  - J Nucl Med2021 Aug 01; 62
AB  - New biomarkers for metastatic prostate cancer are needed. The aim of this study was to evaluate the prognostic value of 18F-FDG PET whole-body tumor burden parameters in patients with metastatic prostate cancer who received first-line abiraterone or enzalutamide therapy. Methods: This was a retrospective study of patients with metastatic castration-sensitive prostate cancer (mCSPC, n = 25) and metastatic castration-resistant prostate cancer (mCRPC, n = 71) who underwent 18F-FDG PET/CT within 90 d before first-line treatment with abiraterone or enzalutamide at a tertiary-care academic cancer center. Whole-body tumor burden on PET/CT was quantified as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and correlated with overall survival (OS) probabilities using Kaplan–Meier curves and Cox models. Results: The median follow-up in survivors was 56.3 mo (interquartile range, 37.7–66.8 mo); the median OSs for patients with mCRPC and mCSPC were 27.8 and 76.1 mo, respectively (P < 0.001). On univariate analysis, the OS probability of mCRPC patients was significantly associated with plasma levels of alkaline phosphatase (hazard ratio [HR], 1.90; P < 0.001), plasma levels of lactate dehydrogenase (HR, 1.01; P < 0.001), hemoglobin levels (HR, 0.80; P = 0.013), whole-body SUVmax (HR, 1.14; P < 0.001), the number of 18F-FDG–avid metastases (HR, 1.08; P < 0.001), whole-body metabolic tumor volume (HR, 1.86; P < 0.001), and TLG (HR, 1.84; P < 0.001). On multivariable analysis with stepwise variable selection, hemoglobin levels (HR, 0.81; P = 0.013) and whole-body TLG (HR, 1.88; P < 0.001) were independently associated with OS. In mCSPC patients, no significant association was observed between these variables and OS. Conclusion: In patients with mCRPC receiving first-line treatment with abiraterone or enzalutamide, 18F-FDG PET WB TLG is independently associated with OS and might be used as a quantitative prognostic imaging biomarker.