{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:07:41Z","timestamp":1789574861470,"version":"build-2803163510"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"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>Background<\/jats:title>\n                    <jats:p>Traditional metastatic burden classifications in metastatic hormone-sensitive prostate cancer (mHSPC) rely on conventional imaging using CHAARTED criteria. As PSMA PET\/CT is increasingly used for staging, revised definitions of low-volume (LVD) and high-volume disease (HVD) are needed to guide treatment decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This study included 204 patients with synchronous mHSPC staged with PSMA PET\/CT between 2017 and 2023. As part of standard clinical practice, patients were prospectively classified as LVD or HVD by a multidisciplinary team (MDT) consensus. Retrospective analysis collected PSMA-total tumour volume (PSMA-TV), total lesion uptake (TL-PSMA), maximum distance between voxels (DmaxVox), SUV\n                      <jats:sub>max<\/jats:sub>\n                      , SUV\n                      <jats:sub>mean<\/jats:sub>\n                      and metastatic status. Additionally, age, WHO performance status (WHO-PS), Gleason score and laboratory values were retrieved. Cox regression identified predictors of overall survival (OS). Model performance was assessed using Harrell\u2019s C-index with internal validation via bootstrapping.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      By MDT consensus, 75 patients (37%) had LVD and 129 patients (63%) had HVD, differing significantly in PSMA-TV (median: 60 vs. 483\u2009mL) and OS (median: 69 vs. 41 months). PSMA-TV was a robust predictor of OS (HR\u2009=\u20091.39 per doubling,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), independent of WHO-PS (HR\u2009=\u20091.69 per score increase,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and treatment. A model combining PSMA-TV and WHO-PS achieved a C-index of 0.71 (95% CI 0.66\u20130.77) after bootstrapping. In an exploratory post hoc analysis, the optimal threshold for PSMA-TV-based high-volume disease was PSMA-TV\u2009\u2265\u2009150\u2009mL or any visceral metastasis, which performed similarly to MDT-based classification (HR\u2009=\u20093.01 vs. HR\u2009=\u20092.68).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While MDT-based stratification of mHSPC patients was adequate, incorporating PSMA-TV can further improve risk assessment. Instead of dichotomising, we propose using a model with PSMA-TV as a continuous variable to guide treatment decisions. Multicentre validation is needed before clinical implementation.<\/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>As PSMA PET\/CT replaces conventional imaging for staging metastatic hormone-sensitive prostate cancer, revised PSMA PET\/CT-based metastatic burden classifications are needed to guide treatment decisions<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>PSMA-total tumour volume (PSMA-TV) was a robust predictor of overall survival, and a model combining PSMA-TV with performance status achieved a C-index of 0.71 after bootstrapping<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Quantitative tumour burden assessment with PSMA PET\/CT can improve prognostic stratification in metastatic hormone-sensitive prostate cancer, supporting more individualised treatment selection<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12875-z","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:29:21Z","timestamp":1789572561000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of baseline PSMA PET\/CT for survival in synchronous metastatic hormone-sensitive prostate cancer: towards redefining low- and high-volume disease"],"prefix":"10.1007","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":"Linda","family":"Heijmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemieke","family":"Witteveen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiki","family":"van Duuren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Zuidgeest","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits","family":"Smit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lioe-Fee","family":"de Geus-Oei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"van der Hulle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"12875_CR1","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1016\/S0140-6736(18)32486-3","volume":"392","author":"CC Parker","year":"2018","unstructured":"Parker CC, James ND, Brawley CD et al (2018) Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. 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Therefore, it was exempt from review by the Committee.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Not applicable.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}