{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:58:14Z","timestamp":1785437894854,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Recep Tayyip Erdogan University Development Foundation","award":["02026003018200"],"award-info":[{"award-number":["02026003018200"]}]},{"award":["02026003018200"],"award-info":[{"award-number":["02026003018200"]}],"id":[{"id":"https:\/\/ror.org\/0468j1635","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study aimed to assess the impact of PSMA-PET\/CT fusion imaging on target volume delineation in prostate cancer RT and to evaluate its effects on dosimetric parameters and PSA response, including intraprostatic boost. Methods: This single-center, retrospective study included 138 prostate cancer patients treated with definitive RT. Patients were evaluated according to the use of PSMA-PET\/CT fusion-based planning and an intraprostatic focal boost, and dosimetric parameters for target volumes and organs at risk were compared. Results: PSMA-PET\/CT fusion-based planning significantly increased the minimum dose coverage of the prostate target volume (96.7% vs. 95.5%, p = 0.003) while reducing the maximum dose (104.8% vs. 106.1%, p &lt; 0.001). At 1 year after RT, the median change in PSA from baseline was 0.08 ng\/mL (range, \u22120.44\u20132.12) in patients who underwent PSMA PET imaging-based fusion planning compared with 0.01 ng\/mL (range, \u22120.049\u20134.07) in those who did not (p = 0.010). In patients receiving the intraprostatic focal boost with PSMA-PET\/CT fusion, rectal maximum dose percentages were significantly lower than in those without the boost (103.2% [98.9\u2013106.7] vs. 103.8% [95.7\u2013107.4], p = 0.026). Rectal V65 and V50 values were also significantly reduced in the fusion group (7.0% [0.7\u201319.8] vs. 5.2% [1.2\u201321.7], p = 0.007; and 13.6% [6.3\u201321.9] vs. 11.4% [4.4\u201329.2], p = 0.027, respectively). Bladder maximum dose percentages were significantly lower in patients receiving the PSMA-PET\/CT fusion-guided intraprostatic boost compared with those without the boost (102.6% [99.7\u2013107.9] vs. 104.5% [99.1\u2013108.5], p = 0.001). Conclusions: PSMA-PET\/CT fusion-based planning improves biologically guided target delineation and dose homogeneity and suggests potential for better early biochemical response while reducing normal tissue exposure, whereas the intraprostatic focal boost improves dose distribution but is not associated with a significant short-term (1-year) PSA benefit.<\/jats:p>","DOI":"10.3390\/jcm15093394","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:31:56Z","timestamp":1777465916000},"page":"3394","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Impact of PSMA PET Fusion-Based RT Planning on Dosimetry and PSA Response in Prostate Cancer"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5543-9761","authenticated-orcid":false,"given":"Sema Yilmaz","family":"Rakici","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2584-1386","authenticated-orcid":false,"given":"Sibel","family":"Goksel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Faculty of Medicine, Adnan Menderes University, 09010 Aydin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0210-3153","authenticated-orcid":false,"given":"Esra","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.radonc.2006.05.012","article-title":"Guidelines for primary radiotherapy of patients with prostate cancer","volume":"79","author":"Boehmer","year":"2006","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"308","DOI":"10.21037\/tau.2017.12.37","article-title":"Image-guided radiotherapy for prostate cancer","volume":"7","author":"Dang","year":"2018","journal-title":"Transl. Androl. Urol."},{"key":"ref_3","first-page":"713","article-title":"Imaging of Prostate Cancer","volume":"118","author":"Schlemmer","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0090-4295(98)00278-7","article-title":"Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases","volume":"52","author":"Sweat","year":"1998","journal-title":"Urology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40644-022-00518-7","article-title":"Variability of radiotherapy volume delineation: PSMA PET\/MRI and MRI based clinical target volume and lymph node target volume for high-risk prostate cancer","volume":"23","author":"Liu","year":"2023","journal-title":"Cancer Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6300","DOI":"10.1158\/1078-0432.CCR-18-0768","article-title":"PSMA Ligand PET\/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact","volume":"24","author":"Baltzer","year":"2018","journal-title":"Clin. Cancer Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ijrobp.2025.03.033","article-title":"PSMA-PET Guided Intraprostatic Boost in Prostate SBRT (PROBE): A Phase 2 Trial","volume":"125","author":"Singh","year":"2025","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.adro.2019.09.004","article-title":"Dosimetric Evaluation of PSMA PET-Delineated Dominant Intraprostatic Lesion Simultaneous Infield Boosts","volume":"5","author":"Goodman","year":"2020","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1016\/S0140-6736(21)01790-6","article-title":"The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology\/RTOG 0534 SPPORT): An international, multicentre, randomised phase 3 trial","volume":"399","author":"Pollack","year":"2022","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1200\/JCO.2009.25.8475","article-title":"Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: Long-term results from proton radiation oncology group\/american college of radiology 95-09","volume":"28","author":"Zietman","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1200\/JCO.23.02445","article-title":"Long-Term Analysis of NRG Oncology RTOG 0415: A Randomized Phase III Noninferiority Study Comparing Two Fractionation Schedules in Patients with Low-Risk Prostate Cancer","volume":"42","author":"Lee","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijrobp.2015.10.049","article-title":"NRG Oncology RTOG 0415: A Randomized Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients with Low-Risk Prostate Cancer","volume":"94","author":"Lee","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"902","DOI":"10.2967\/jnumed.122.265025","article-title":"68Ga-PSMA PET\/CT-Based Atlas for Prostate Bed Recurrence After Radical Prostatectomy: Clinical Implications for Salvage Radiation Therapy Contouring Guidelines","volume":"64","author":"Sonni","year":"2023","journal-title":"J. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Haworth, A., Rowshanfarzad, P., and Ebert, M.A. (2023). Focal Boost in Prostate Cancer Radiotherapy: A Review of Planning Studies and Clinical Trials. Cancers, 15.","DOI":"10.3390\/cancers15194888"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20190845","DOI":"10.1259\/bjr.20190845","article-title":"A planning study of focal dose escalations to multiparametric MRI-defined dominant intraprostatic lesions in prostate proton radiation therapy","volume":"93","author":"Wang","year":"2020","journal-title":"Br. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Barone, B., Napolitano, L., Calace, F.P., Del Biondo, D., Napodano, G., Grillo, M., Reccia, P., De Luca, L., Prezioso, D., and Muto, M. (2023). Reliability of Multiparametric Magnetic Resonance Imaging in Patients with a Previous Negative Biopsy: Comparison with Biopsy-Na\u00efve Patients in the Detection of Clinically Significant Prostate Cancer. Diagnostics, 13.","DOI":"10.3390\/diagnostics13111939"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1159\/000516681","article-title":"The Comparison of Imaging and Clinical Methods to Estimate Prostate Volume: A Single-Centre Retrospective Study","volume":"105","author":"Massanova","year":"2021","journal-title":"Urol. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2797","DOI":"10.1016\/j.acra.2024.11.029","article-title":"PSMA PET vs. mpMRI for Lymph Node Metastasis of Prostate Cancer: A Systematic Review and Head-to-Head Comparative Meta-analysis","volume":"32","author":"Yang","year":"2025","journal-title":"Acad. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s00345-019-02846-z","article-title":"68Ga-PSMA PET\/CT compared with MRI\/CT and diffusion-weighted MRI for primary lymph node staging prior to definitive radiotherapy in prostate cancer: A prospective diagnostic test accuracy study","volume":"38","author":"Petersen","year":"2020","journal-title":"World J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s00259-015-3206-3","article-title":"Comparison of hybrid 68Ga-PSMA PET\/MRI and 68Ga-PSMA PET\/CT in the evaluation of lymph node and bone metastases of prostate cancer","volume":"43","author":"Freitag","year":"2016","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1200\/JCO-25-00274","article-title":"Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients with Localized Prostate Cancer: 10-Year Outcomes of the FLAME Trial","volume":"43","author":"Draulans","year":"2025","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Li, R., Lin, M.H., Nguyen, N.C., Su, F.C., Parsons, D., Salcedo, E., Phillips, E., Domal, S., Garant, A., and Hannan, R. (2025). Clinical Implementation of PSMA-PET Guided Tumor Response-Based Boost Adaptation in Online Adaptive Radiotherapy for High-Risk Prostate Cancer. Cancers, 17.","DOI":"10.3390\/cancers17172893"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/nrurol.2015.50","article-title":"Synergistic action of image-guided radiotherapy and androgen deprivation therapy","volume":"12","author":"Locke","year":"2015","journal-title":"Nat. Rev. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2340\/1651-226X.2025.44211","article-title":"Ultra-hypofractionated radiotherapy with focal boost for high-risk localized prostate cancer (HYPO-RT-PC-boost): In silico evaluation with histological reference","volume":"64","author":"Nilsson","year":"2025","journal-title":"Acta Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.meddos.2022.09.003","article-title":"VMAT partial arc technique decreases dose to organs at risk in whole pelvic radiotherapy for prostate cancer when compared to full arc VMAT and IMRT","volume":"48","author":"Bartlett","year":"2023","journal-title":"Med. Dosim."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.2967\/jnumed.118.209387","article-title":"Potential Impact of 68Ga-PSMA-11 PET\/CT on the Planning of Definitive Radiation Therapy for Prostate Cancer","volume":"59","author":"Calais","year":"2018","journal-title":"J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1007\/s00259-018-3954-y","article-title":"68Ga-PSMA-PET\/CT imaging of localized primary prostate cancer patients for intensity modulated radiation therapy treatment planning with integrated boost","volume":"45","author":"Thomas","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"20250143","DOI":"10.1002\/VIW.20250143","article-title":"PSMA PET-directed radiotherapy for prostate cancer: From precision planning to future innovations","volume":"7","author":"Huang","year":"2025","journal-title":"VIEW"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e14079","DOI":"10.1111\/and.14079","article-title":"Identification of docetaxel-related biomarkers for prostate cancer","volume":"53","author":"Peng","year":"2021","journal-title":"Andrologia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e13734","DOI":"10.1111\/and.13734","article-title":"Can the combination of biparametric magnetic resonance imaging and PSA-related indicators predict the prostate biopsy outcome?","volume":"52","author":"Zhu","year":"2020","journal-title":"Andrologia"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Peng, Y., Song, Y., and Wang, H. (2021). Systematic Elucidation of the Aneuploidy Landscape and Identification of Aneuploidy Driver Genes in Prostate Cancer. Front. Cell Dev. Biol., 9.","DOI":"10.3389\/fcell.2021.723466"},{"key":"ref_32","first-page":"31","article-title":"Integrated multi-omics profiling of immune microenvironment and drug resistance signatures for precision prognosis in prostate cancer","volume":"8","author":"Li","year":"2025","journal-title":"Cancer Drug Resist."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3750","DOI":"10.1007\/s00259-023-06332-y","article-title":"Is PSMA PET\/CT cost-effective for the primary staging in prostate cancer? First results for European countries and the USA based on the proPSMA trial","volume":"50","author":"Holzgreve","year":"2023","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3159","DOI":"10.1007\/s00259-025-07190-6","article-title":"A cost-effectiveness study of PSMA-PET\/CT for the detection of clinically significant prostate cancer","volume":"52","author":"Govers","year":"2025","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"963","DOI":"10.21873\/invivo.14252","article-title":"Cost-Effectiveness of PSMA PET\/CT as Single Procedure for Diagnosis and Staging High-Grade Prostate Cancer: A Single Center Experience","volume":"40","author":"Pepe","year":"2026","journal-title":"In Vivo"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/17562872261436874","article-title":"Cost-effectiveness of PSMA-PET imaging technology in diagnosing and staging of prostate cancer: A systematic review","volume":"18","author":"Sanyal","year":"2026","journal-title":"Ther. Adv. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3394\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:21:03Z","timestamp":1777468863000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093394"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093394","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}