Prognostic value of baseline Ga-68 PSMA PET/CT–derived volumetric parameters in patients undergoing radical prostatectomy for prostate cancer

In this study, we aimed to evaluate the prognostic role of preoperative Ga-68 PSMA PET/CT-derived volumetric parameters in patients diagnosed with prostate cancer via biopsy and subsequently treated with radical prostatectomy (RP). For each of the 256 patients included, the SUVmax, SUVmean, PSMA-TV, and TL-PSMA values of lesions with increased Ga-68 PSMA uptake were calculated, and from these, wbPSMA-TV and wbTL-PSMA values were derived. The predictive value of these parameters for bPFS and OS was assessed using statistical methods. All volumetric parameters were found to be significantly higher in patients who experienced biochemical progression compared to those who did not. However, these parameters did not show a statistically significant impact on OS. Additionally, the PROMISE V2 criteria—including miTNM stage, PRIMARY score, and PSMA expression score—did not demonstrate significant influence on either bPFS or OS. Among patients who developed biochemical progression within the first year after RP, prostate SUVmax and SUVmean values were significantly higher compared to those without early biochemical recurrence. We conclude that baseline Ga-68 PSMA PET/CT-derived volumetric parameters play an important predictive role in estimating biochemical progression in patients undergoing RP for prostate cancer. Moreover, prostate SUVmax and SUVmean values were found to be predictive of early biochemical recurrence within the first year following surgery. These findings suggest that preoperative PSMA PET/CT imaging may assist in therapeutic decision-making, including the potential need for neoadjuvant or systemic treatment in patients at high risk of early biochemical failure following RP.