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PET combined with CT and prostate-specific membrane antigen (PSMA) ligands has gained significant interest for staging prostate cancer (PC). In this study, we propose 2 multimodal quantitative indices as imaging biomarkers for the assessment of osseous tumor burden using 68 Ga-PSMA PET/CT and present preliminary clinical data. Methods: We defined 2 bone PET indices (BPIs) that incorporate anatomic information from CT and functional information from 68 Ga-PSMA PET: BPI VOL is the percentage of bone volume affected by tumor and BPI SUV additionally considers the level of PSMA expression. We describe a semiautomatic computation method based on segmentation of bones in CT and of lesions in PET. Data from 45 patients with castration-resistant PC and bone metastases during 223 Ra-dichloride were retrospectively analyzed. We evaluated the computational stability and reproducibility of the proposed indices and explored their relation to the prostate-specific antigen blood value, the bone scan index (BSI), and disease classification using PERCIST. Results: On the technical side, BPI VOL and BPI SUV showed an interobserver maximum difference of 3.5%, and their computation took only a few minutes. On the clinical side, BPI VOL and BPI SUV showed significant correlations with BSI ( r = 0.76 and 0.74, respectively, P &lt; 0.001) and prostate-specific antigen values ( r = 0.57 and 0.54, respectively, P &lt; 0.01). When the proposed indices were compared against expert rating using PERCIST, BPI VOL and BPI SUV showed better agreement than BSI, indicating their potential for objective response evaluation. Conclusion: We propose the evaluation of BPI VOL and BPI SUV as imaging biomarkers for 68 Ga-PSMA PET/CT in a prospective study exploring their potential for outcome prediction in patients with bone metastases from PC.

Exploring New Multimodal Quantitative Imaging Indices for the Assessment of Osseous Tumor Burden in Prostate Cancer Using 68Ga-PSMA PET/CT

Exploring New Multimodal Quantitative Imaging Indices for the Assessment of Osseous Tumor Burden in Prostate Cancer Using ⁶⁸Ga-PSMA PET/CT