PSMA-PET Tumor Volume Stratifies Nonmetastatic Castration-resistant Prostate Cancer
In brief
PSMA-PET tumor volume over 7.8 ml doubles death risk in nonmetastatic castration-resistant prostate cancer
In a registry of 514 men with nmCRPC, PSMA-PET identified metastases in two-thirds and defined a tumor-volume cutoff of 7.8 ml that split patients into low- and high-volume groups; the high-volume group faced about 2.5-fold higher mortality. These results suggest PSMA-PET volume should be added to risk models, but prospective validation is needed.
- Journal
- European urology focus (Q1)
- Published
- 9 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Caner Civan, Madeleine J Karpinski, Christopher Darr, Thanusiah Selvamoorthy, Lisa Marie Rennau, Sebastian Hoberück, et al.
- PMID
- 42716860
- DOI
- 10.1016/j.euf.2026.06.006
Why clinicians should know about it
- Picked for Urology (paper of the day, 11 September 2026): PSMA‑PET tumor volume stratifies nonmetastatic castration‑resistant prostate cancer
Abstract
BACKGROUND AND OBJECTIVE: Prostate-specific membrane-antigen positron emission tomography (PSMA-PET) detects distant metastases in more than half of patients with increasing prostate-specific antigen despite castrate levels of testosterone and high-risk nonmetastatic disease on conventional imaging. Here, we aim to evaluate prognostic implications of PSMA-PET staging in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). METHODS: Overall, 514 patients who underwent PSMA-PET for nmCRPC at investigator sites across the world between 2013 and 2022, were retrospectively evaluated in a large, international multi-center PROMISE-PET Registry study. PROMISE metrics and PSMA-PET reports were retrospectively analyzed in accordance with PROMISE V2 criteria. Total tumor volume, PSMA expression score, and molecular imaging metastatic disease (miM1) were analyzed to prognosticate overall survival (OS). RESULTS: Median follow-up was 4.4 yr (interquartile range 2.9-6.7). Overall, 294 patients (57%) were deceased at last follow-up. PSMA-PET detected metastatic disease in 340 patients (66%), and visceral metastases in 28 patients (5.4%). The optimal cutoff point for tumor volume was identified as 7.8 ml, which significantly stratified the cohort into low- versus high-volume groups. Patients with high-volume disease had worse OS than those with low-volume disease (hazard ratio [HR], 2.47; 95% confidence interval [CI], 2.22-2.71; p < 0.001). Patients with any distant metastases (miM1) on PSMA-PET had significantly shorter OS compared to those without detectable metastatic disease (HR, 1.74; 95% CI, 1.49-2.00; p < 0.001). CONCLUSION: Higher tumor volume on PSMA-PET and presence of distant metastases were strongly associated with OS in patients with nmCRPC. PSMA-PET stage and tumor volume should be included in future nmCRPC risk stratification.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.