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Purpose <p>Prostate-specific membrane antigen (PSMA) and Gastrin-releasing peptide receptor (GRPR) PET demonstrate hopeful results in initial staging of prostate cancer (PCa), offering potential to support precision treatment decisions. We investigated whether the dual-tracer PET/CT with [<sup>68</sup>Ga]Ga-PSMA−617 and [<sup>68</sup>Ga]Ga-RM26 could enhance prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) in PCa.</p> Methods <p>102 patients from prospective cohort NCT05073653 underwent preoperative [<sup>68</sup>Ga]Ga-PSMA-617 and [<sup>68</sup>Ga]Ga-RM26 PET/CT. Tumor uptake was quantified by maximum standardized uptake value (SUVmax), with optimal cutoffs determined using maximally selected rank statistics. Biochemical recurrence-free survival (BRFS) was estimated by Kaplan–Meier analysis, and the correlations between BRFS and predictors were examined using Cox regression. Predictive values were assessed using time-dependent receiver-operating characteristic (ROC) curves. We additionally used transcriptomic data (GSE70770, <i>n</i> = 198) for external validation.</p> Results <p>52 patients (51.0%) experienced BCR within the follow-up (median, 22.3 months). High PSMA-SUVmax (&gt; 6.6) was associated with shorter BRFS (hazard ratio [HR] 3.17, <i>p</i> = 0.004), as was low GRPR-SUVmax (≤ 13.0) (HR 0.51, <i>p</i> = 0.026). Both were identified as independent predictors for BRFS. PSMA-SUVmax correlated with most of conventional clinicopathological factors (<i>p</i> &lt; 0.005), whereas GRPR-SUVmax did not (<i>p</i> &gt; 0.200). The combined PSMA + GRPR-SUVmax model achieved a superior time-dependent AUC of 0.73, compared with PSMA (AUC 0.63) or GRPR alone (AUC 0.62). External transcriptomic analysis corroborated that PSMA<sub>high</sub>/GRPR<sub>low</sub> phenotype was associated with poorer BRFS (<i>p</i> = 0.029).</p> Conclusion <p>This study provides first clinical evidence that [<sup>68</sup>Ga]Ga-RM26 PET/CT adds independent prognostic value to PSMA PET/CT for early prediction of BCR after RP. Dual-tracer PET/CT may enable more accurate risk stratification and guide personalized management in PCa patients.</p>

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Dual-tracer PET/CT with [68Ga]Ga-PSMA−617 and [68Ga]Ga-RM26 improves early prediction of biochemical failure in prostate cancer: a prospective phase II trial

  • 期刊论文

  • 发表日期：

    2025年10月3日

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  • Jinhui Yang,
  • Yujia Li,
  • Yongxiang Tang,
  • Bei Chen,
  • Ling Xiao,
  • Axel Rominger,
  • Kuangyu Shi,
  • Ming Zhou,
  • Jian Li,
  • Yi Cai,
  • Tao Jiang,
  • Shuo Hu

摘要

Purpose

Prostate-specific membrane antigen (PSMA) and Gastrin-releasing peptide receptor (GRPR) PET demonstrate hopeful results in initial staging of prostate cancer (PCa), offering potential to support precision treatment decisions. We investigated whether the dual-tracer PET/CT with [68Ga]Ga-PSMA−617 and [68Ga]Ga-RM26 could enhance prediction of biochemical recurrence (BCR) after radical prostatectomy (RP) in PCa.

Methods

102 patients from prospective cohort NCT05073653 underwent preoperative [68Ga]Ga-PSMA-617 and [68Ga]Ga-RM26 PET/CT. Tumor uptake was quantified by maximum standardized uptake value (SUVmax), with optimal cutoffs determined using maximally selected rank statistics. Biochemical recurrence-free survival (BRFS) was estimated by Kaplan–Meier analysis, and the correlations between BRFS and predictors were examined using Cox regression. Predictive values were assessed using time-dependent receiver-operating characteristic (ROC) curves. We additionally used transcriptomic data (GSE70770, n = 198) for external validation.

Results

52 patients (51.0%) experienced BCR within the follow-up (median, 22.3 months). High PSMA-SUVmax (> 6.6) was associated with shorter BRFS (hazard ratio [HR] 3.17, p = 0.004), as was low GRPR-SUVmax (≤ 13.0) (HR 0.51, p = 0.026). Both were identified as independent predictors for BRFS. PSMA-SUVmax correlated with most of conventional clinicopathological factors (p < 0.005), whereas GRPR-SUVmax did not (p > 0.200). The combined PSMA + GRPR-SUVmax model achieved a superior time-dependent AUC of 0.73, compared with PSMA (AUC 0.63) or GRPR alone (AUC 0.62). External transcriptomic analysis corroborated that PSMAhigh/GRPRlow phenotype was associated with poorer BRFS (p = 0.029).

Conclusion

This study provides first clinical evidence that [68Ga]Ga-RM26 PET/CT adds independent prognostic value to PSMA PET/CT for early prediction of BCR after RP. Dual-tracer PET/CT may enable more accurate risk stratification and guide personalized management in PCa patients.