{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:22:20Z","timestamp":1790886140095,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>Metastatic castration-resistant prostate cancer (mCRPC) is a heterogeneous disease with varying survival outcomes. This study investigated whether baseline PSMA PET\/CT parameters are associated with survival and treatment response.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Sixty mCRPC patients underwent [<jats:sup>18<\/jats:sup>F]PSMA-1007 PET\/CT before treatment with androgen receptor-targeted agents (ARTAs) or chemotherapy. Intensity-based parameters, volumetric parameters, metastatic sites and DmaxVox (distance between the two outermost voxels) from baseline PSMA PET\/CT were collected, as well as age, Gleason score and laboratory parameters. Cox regression analysis evaluated their prognostic value for overall survival (OS). Additionally, a preliminary lesion-level analysis was done (<jats:italic>n<\/jats:italic>\u2009=\u2009241 lesions) with lesion location and twelve radiomic features selected from previous literature. Logistic regression evaluated their association with PSMA PET\/CT-based lesion progression after 3\u20134 months of treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Total tumour volume (PSMA-TV) (HR\u2009=\u20091.41 per doubling [1.17\u20131.70]), total lesion uptake (TL-PSMA) (HR\u2009=\u20091.40 per doubling [1.16\u20131.69]) and DmaxVox (HR\u2009=\u20091.31 per 10\u2009cm increase [1.07\u20131.62]) were prognostic for OS, each independent of baseline PSA level (HR\u2009=\u20090.82 per doubling [0.68\u20130.98]), haemoglobin level (HR\u2009=\u20090.68 per mmol\/L increase [0.49\u20130.95]) and line of treatment. On lesion-level, location (prostate vs bone OR\u2009=\u20090.23 [0.06\u20130.83]) and SUV<jats:sub>mean<\/jats:sub> (OR\u2009=\u20091.72 per doubling [1.08\u20132.75]) were independent prognostic markers for lesion progression, morphological and texture-based radiomic features were not.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Baseline PSMA PET\/CT scans have prognostic value in mCRPC patients and can potentially aid in treatment decision-making. DmaxVox can serve as a simpler alternative to PSMA-TV when automated segmentation software is not available. When combined with PSMA-TV, lower PSA levels indicated worse OS, which may be a marker of tumour dedifferentiation. Further research is needed to validate these models in larger patient cohorts.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Question<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>mCRPC is a highly heterogeneous disease, requiring good prognostic markers<\/jats:italic>.<\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>PSMA-TV was the best independent prognostic marker for OS; maximum distance between lesions (DmaxVox) can be used as a simpler alternative<\/jats:italic>.<\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>Baseline PSMA PET\/CT parameters representing tumour burden were independently associated with OS in mCRPC patients, providing prognostic\u00a0insights for clinical decision-making. Although PSMA-TV was the best prognostic marker, DmaxVox can serve as an easier to obtain alternative<\/jats:italic>.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00330-025-11360-3","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T18:01:20Z","timestamp":1737568880000},"page":"4223-4232","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Baseline PSMA PET\/CT parameters predict overall survival and treatment response in metastatic castration-resistant prostate cancer patients"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4757-8777","authenticated-orcid":false,"given":"Fleur","family":"Kleiburg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lioe-Fee","family":"de Geus-Oei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romy","family":"Spijkerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wyanne A.","family":"Noortman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris H. P.","family":"van Velden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srirang","family":"Manohar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits","family":"Smit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank A. J.","family":"Toonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia A. C.","family":"Luelmo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"van der Hulle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Heijmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"11360_CR1","unstructured":"EAU (2022) EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. European Association of Urology, Arnhem"},{"key":"11360_CR2","doi-asserted-by":"publisher","unstructured":"Freedland SJ, Davis M, Epstein AJ, Arondekar B, Ivanova JI (2023) Real-world treatment patterns and overall survival among men with metastatic castration-resistant prostate cancer (mCRPC) in the US Medicare population. Prostate Cancer Prostatic Dis. https:\/\/doi.org\/10.1038\/s41391-023-00725-8","DOI":"10.1038\/s41391-023-00725-8"},{"key":"11360_CR3","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.eururo.2013.08.007","volume":"66","author":"RJ van Soest","year":"2014","unstructured":"van Soest RJ, de Morree ES, Shen L, Tannock IF, Eisenberger MA, de Wit R (2014) Initial biopsy Gleason score as a predictive marker for survival benefit in patients with castration-resistant prostate cancer treated with docetaxel: data from the TAX327 study. Eur Urol 66:330\u2013336","journal-title":"Eur Urol"},{"key":"11360_CR4","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1200\/JCO.2013.52.3696","volume":"32","author":"S Halabi","year":"2014","unstructured":"Halabi S, Lin CY, Kelly WK et al (2014) Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer. J Clin Oncol 32:671\u2013677","journal-title":"J Clin Oncol"},{"key":"11360_CR5","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-22594-1","volume":"8","author":"S Bravaccini","year":"2018","unstructured":"Bravaccini S, Puccetti M, Bocchini M et al (2018) PSMA expression: a potential ally for the pathologist in prostate cancer diagnosis. Sci Rep 8:4254","journal-title":"Sci Rep"},{"key":"11360_CR6","doi-asserted-by":"publisher","first-page":"3289","DOI":"10.1007\/s00259-022-05756-2","volume":"49","author":"MJ Roberts","year":"2022","unstructured":"Roberts MJ, Morton A, Papa N et al (2022) Primary tumour PSMA intensity is an independent prognostic biomarker for biochemical recurrence-free survival following radical prostatectomy. Eur J Nucl Med Mol Imaging 49:3289\u20133294","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"11360_CR7","doi-asserted-by":"publisher","first-page":"62","DOI":"10.2967\/jnmt.113.130393","volume":"42","author":"R Sanchez-Jurado","year":"2014","unstructured":"Sanchez-Jurado R, Devis M, Sanz R, Aguilar JE, del Puig Cozar M, Ferrer-Rebolleda J (2014) Whole-body PET\/CT studies with lowered (1)(8)F-FDG doses: the influence of body mass index in dose reduction. J Nucl Med Technol 42:62\u201367","journal-title":"J Nucl Med Technol"},{"key":"11360_CR8","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1200\/JCO.2015.64.2702","volume":"34","author":"HI Scher","year":"2016","unstructured":"Scher HI, Morris MJ, Stadler WM et al (2016) Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the Prostate Cancer Clinical Trials Working Group 3. J Clin Oncol 34:1402\u20131418","journal-title":"J Clin Oncol"},{"key":"11360_CR9","doi-asserted-by":"publisher","first-page":"4786","DOI":"10.1158\/0008-5472.CAN-18-0125","volume":"78","author":"C Nioche","year":"2018","unstructured":"Nioche C, Orlhac F, Boughdad S et al (2018) LIFEx: a freeware for radiomic feature calculation in multimodality imaging to accelerate advances in the characterization of tumor heterogeneity. Cancer Res 78:4786\u20134789","journal-title":"Cancer Res"},{"key":"11360_CR10","doi-asserted-by":"publisher","first-page":"663631","DOI":"10.3389\/fonc.2021.663631","volume":"11","author":"LM Mittlmeier","year":"2021","unstructured":"Mittlmeier LM, Brendel M, Beyer L et al (2021) Feasibility of different tumor delineation approaches for (18)F-PSMA-1007 PET\/CT imaging in prostate cancer patients. Front Oncol 11:663631","journal-title":"Front Oncol"},{"key":"11360_CR11","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1148\/radiol.2016142043","volume":"280","author":"JH O","year":"2016","unstructured":"O JH, Lodge MA, Wahl RL (2016) Practical PERCIST: a simplified guide to PET response criteria in solid tumors 1.0. Radiology 280:576\u2013584","journal-title":"Radiology"},{"key":"11360_CR12","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/MNM.0000000000001539","volume":"43","author":"A Aksu","year":"2022","unstructured":"Aksu A, Vural Topuz O, Yilmaz B, Karahan Sen NP, Acar E, Capa Kaya G (2022) Prediction of early biochemical response after 177Lu-PSMA radioligand therapy with 68Ga-PSMA PET, a different perspective with quantitative parameters. Nucl Med Commun 43:468\u2013474","journal-title":"Nucl Med Commun"},{"key":"11360_CR13","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.eururo.2014.07.020","volume":"68","author":"G Gandaglia","year":"2015","unstructured":"Gandaglia G, Karakiewicz PI, Briganti A et al (2015) Impact of the site of metastases on survival in patients with metastatic prostate cancer. Eur Urol 68:325\u2013334","journal-title":"Eur Urol"},{"key":"11360_CR14","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1200\/JCO.2015.65.7270","volume":"34","author":"S Halabi","year":"2016","unstructured":"Halabi S, Kelly WK, Ma H et al (2016) Meta-analysis evaluating the impact of site of metastasis on overall survival in men with castration-resistant prostate cancer. J Clin Oncol 34:1652\u20131659","journal-title":"J Clin Oncol"},{"key":"11360_CR15","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.cpet.2021.06.007","volume":"16","author":"F Orlhac","year":"2021","unstructured":"Orlhac F, Nioche C, Klyuzhin I, Rahmim A, Buvat I (2021) Radiomics in PET imaging:: a practical guide for newcomers. PET Clin 16:597\u2013612","journal-title":"PET Clin"},{"key":"11360_CR16","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1109\/TSMC.1973.4309314","volume":"3","author":"RM Haralick","year":"1973","unstructured":"Haralick RM, Shanmugam K, Dinstein I (1973) Textural features for image classification. IEEE Trans Syst Man Cybern SMC 3:610\u2013621","journal-title":"IEEE Trans Syst Man Cybern SMC"},{"key":"11360_CR17","doi-asserted-by":"crossref","unstructured":"Roll W, Schindler P, Masthoff M et al (2021) Evaluation of (68)Ga-PSMA-11 PET-MRI in patients with advanced prostate cancer receiving (177)Lu-PSMA-617 therapy: a radiomics analysis. Cancers (Basel) 13:3489","DOI":"10.3390\/cancers13153849"},{"key":"11360_CR18","doi-asserted-by":"crossref","unstructured":"Moazemi S, Erle A, Lutje S, Gaertner FC, Essler M, Bundschuh RA (2021) Estimating the potential of radiomics features and radiomics signature from pretherapeutic PSMA-PET-CT scans and clinical data for prediction of overall survival when treated with (177)Lu-PSMA. Diagnostics (Basel) 11:186","DOI":"10.3390\/diagnostics11020186"},{"key":"11360_CR19","doi-asserted-by":"crossref","unstructured":"Mattoni S, Farolfi A, Formaggio F et al (2022) PSMA PET for the evaluation of liver metastases in castration-resistant prostate cancer patients: a multicenter retrospective study. Cancers (Basel) 14:5680","DOI":"10.3390\/cancers14225680"},{"key":"11360_CR20","doi-asserted-by":"publisher","first-page":"33312","DOI":"10.18632\/oncotarget.26051","volume":"9","author":"Z Khurshid","year":"2018","unstructured":"Khurshid Z, Ahmadzadehfar H, Gaertner FC et al (2018) Role of textural heterogeneity parameters in patient selection for 177Lu-PSMA therapy via response prediction. Oncotarget 9:33312\u201333321","journal-title":"Oncotarget"},{"key":"11360_CR21","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1148\/radiol.2020191145","volume":"295","author":"A Zwanenburg","year":"2020","unstructured":"Zwanenburg A, Vallieres M, Abdalah MA et al (2020) The image biomarker standardization initiative: standardized quantitative radiomics for high-throughput image-based phenotyping. Radiology 295:328\u2013338","journal-title":"Radiology"},{"key":"11360_CR22","doi-asserted-by":"publisher","first-page":"e0124165","DOI":"10.1371\/journal.pone.0124165","volume":"10","author":"A Chalkidou","year":"2015","unstructured":"Chalkidou A, O\u2019Doherty MJ, Marsden PK (2015) False discovery rates in PET and CT studies with texture features: a systematic review. PLoS One 10:e0124165","journal-title":"PLoS One"},{"key":"11360_CR23","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/s41391-017-0024-7","volume":"21","author":"T Nordstrom","year":"2018","unstructured":"Nordstrom T, Akre O, Aly M, Gronberg H, Eklund M (2018) Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis 21:57\u201363","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"11360_CR24","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s00259-020-04934-4","volume":"48","author":"S Fanti","year":"2021","unstructured":"Fanti S, Goffin K, Hadaschik BA et al (2021) Consensus statements on PSMA PET\/CT response assessment criteria in prostate cancer. Eur J Nucl Med Mol Imaging 48:469\u2013476","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"11360_CR25","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1177\/00045632211050531","volume":"59","author":"RM West","year":"2022","unstructured":"West RM (2022) Best practice in statistics: the use of log transformation. Ann Clin Biochem 59:162\u2013165","journal-title":"Ann Clin Biochem"},{"key":"11360_CR26","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1038\/s41391-020-0228-0","volume":"24","author":"R Aggarwal","year":"2021","unstructured":"Aggarwal R, Romero GR, Friedl V et al (2021) Clinical and genomic characterization of low PSA secretors: a unique subset of metastatic castration resistant prostate cancer. Prostate Cancer Prostatic Dis 24:81\u201387","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"11360_CR27","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1007\/s12149-022-01785-x","volume":"36","author":"TA Telli","year":"2022","unstructured":"Telli TA, Ozguven S, Alan O et al (2022) Role of baseline (68)Ga-PSMA PET\/CT-derived whole-body volumetric parameters in predicting survival outcomes of metastatic castration-resistant prostate cancer patients receiving first-line treatment. Ann Nucl Med 36:964\u2013975","journal-title":"Ann Nucl Med"},{"key":"11360_CR28","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1097\/RLU.0000000000004763","volume":"48","author":"QA Shagera","year":"2023","unstructured":"Shagera QA, Karfis I, Sideris S et al (2023) Tumor volume on PSMA PET as a prognostic biomarker in prostate cancer patients treated with cabazitaxel. Clin Nucl Med 48:775\u2013780","journal-title":"Clin Nucl Med"},{"key":"11360_CR29","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1007\/s12149-021-01610-x","volume":"35","author":"D Has Simsek","year":"2021","unstructured":"Has Simsek D, Kuyumcu S, Karadogan S et al (2021) Can PSMA-based tumor burden predict response to docetaxel treatment in metastatic castration-resistant prostate cancer? Ann Nucl Med 35:680\u2013690","journal-title":"Ann Nucl Med"},{"key":"11360_CR30","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.1002\/cncr.34704","volume":"129","author":"G Ghiaur","year":"2023","unstructured":"Ghiaur G, Valkenburg KC, Esteb C et al (2023) Bone marrow niche chemoprotection of metastatic solid tumors mediated by CYP3A4. Cancer 129:1744\u20131751","journal-title":"Cancer"},{"key":"11360_CR31","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00259-017-3740-2","volume":"44","author":"N Aide","year":"2017","unstructured":"Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R (2017) EANM\/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 44:17\u201331","journal-title":"Eur J Nucl Med Mol Imaging"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11360-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-11360-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11360-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T15:42:09Z","timestamp":1749829329000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-11360-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["11360"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-11360-3","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]},"assertion":[{"value":"12 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Prof. Dr. L.F. de Geus-Oei.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Prof. J.J. Goeman (professor of biostatistics at the Department of Biomedical Data Sciences at Leiden University Medical Center) kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent for the use of their data for scientific medical research was obtained from all subjects in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The Medical Research Ethics Committee Leiden Den Haag Delft has confirmed that the Medical Research Involving Human Subjects Act does not apply in this study (reference number nWMODIV2_2022002). Therefore, it was approved for exemption from review.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The study subjects have been previously reported in\u00a0the paper\u00a0\u201cPSMA PET\/CT for treatment response evaluation at predefined time points is superior to PSA response for predicting survival in metastatic castration-resistant prostate cancer patients\u201d,\u00a0.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}