ArticleAnnals of nuclear medicine2026
Is early imaging a pitfall? Effect of [⁶⁸Ga]Ga-PSMA PET/CT timing after biopsy on SUVmax and adverse pathology prediction in low-to-intermediate risk prostate cancer.
Article in Annals of nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate the effect of the biopsy-to-imaging interval on intraprostatic maximum standardized uptake value (SUVmax) and adverse pathology (AP) prediction in patients with low-to-intermediate risk prostate cancer (PCa) undergoing [⁶⁸Ga]Ga-PSMA PET/CT.
methodsIn this retrospective study, 120 patients with ISUP grade 1-2 PCa who underwent [⁶⁸Ga]Ga-PSMA PET/CT followed by radical prostatectomy between February 2022 and June 2025 were analyzed. Patients were classified into an early (≤ 6 weeks, n = 68) and a late group (> 6 weeks, n = 52) by the biopsy-to-PET/CT interval. AP was defined as ISUP grade ≥ 3 or extracapsular disease on the surgical specimen. Predictors of AP were assessed by binary logistic regression.
resultsAP was detected in 47 patients (39.2%). The median biopsy-to-PET/CT interval was 39 days (range 10-198). Intraprostatic SUVmax was significantly higher and more variable in the early than the late group (5.9 ± 3.4 vs. 4.7 ± 2.2; p = 0.014; Levene p = 0.026). On univariable analysis, SUVmax (OR 1.19 per unit, 95% CI 1.04-1.36; p = 0.010), PSA density (OR 1.53 per 0.1 ng/mL/cc; p = 0.018), PI-RADS (OR 1.69 per point; p = 0.009) and non-fulfillment of NCCN active-surveillance (AS) criteria (OR 2.59; p = 0.013) were associated with AP, but none of these variables retained significance in the multivariable model, in which SUVmax showed the strongest trend (OR 1.13; p = 0.080). In subgroup analysis, SUVmax significantly predicted AP in the late group (OR 1.36 per unit; p = 0.038) but not in the early group (OR 1.13 per unit; p = 0.099) suggesting that delayed imaging may improve the prediction of AP.
conclusionBiopsy-to-PET/CT timing may influence the distribution and predictive performance of SUVmax in low-to-intermediate-risk prostate cancer. The association between SUVmax and adverse pathology was evident only beyond 6 weeks after biopsy, suggesting that delayed imaging may improve the clinical interpretability of SUVmax, although prospective validation is warranted.
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