Abstract
INTRODUCTION: This retrospective study aimed to evaluate the prognostic value of [(18)F]FDG parameters in patients with visceral and bone metastatic hormone-sensitive prostate cancer (mHSPC). PATIENTS AND METHODS: This analysis included the mHSPC patients who underwent [(18)F]FDG PET/CT at the initial diagnosis. Baseline characteristics were analyzed, and the uptake of [(18)F]FDG was quantified using SUV(max). Kaplan-Meier and Cox proportional hazard regression analysis were employed to evaluate the correlation between SUV(max) and patient survival. RESULTS: Among the 267 patients enrolled, 90 (33.7%) presented with visceral metastases and 177 (66.3%) had bone metastases. The median follow-up for the visceral metastasis group was 35.5 months (IQR 26-53.8 months). The median overall survival for patients with lung, liver, or both metastases were 30, 21 and 17 months, respectively. Patients exhibiting higher [(18)F]FDG uptake in metastatic lesions experienced shorter overall survival (OS) in comparison to those with lower [(18)F]FDG uptake, both in the visceral metastases group (17 vs. 31 months, p = 0.002) and the bone metastases group (27.5 vs. 34.5 months, p < 0.001). Cox regression analysis further revealed that increased [(18)F]FDG uptake in metastatic lesions emerged as a significant risk factor in both OS and progression-free survival (PFS). In contrast, the variability in [(18)F]FDG uptake in primary lesions did not provide a reliable indicator for predicting prognosis. CONCLUSIONS: In mHSPC patients, higher [(18)F]FDG uptake in metastatic lesions indicates shorter survival and increased risk of disease progression. The [(18)F]FDG SUV(max) in primary tumors did not show significant prognostic value. Our study underscores the unique prognostic potential of [(18)F]FDG PET/CT in mHSPC patients, highlighting its importance in the management of both bone and visceral metastases.