Imaging Modality and Outcomes of Metastasis-Directed Therapy in Oligometastatic Castration-Resistant Prostate Cancer: An Updated Analysis of the PRECISE-MDT Cohort

It is unclear whether the imaging modality used to guide metastasis-directed therapy (MDT) influences outcomes in oligometastatic castration-resistant prostate cancer (omCRPC). Methods: We performed an updated analysis of the PRECISE-MDT cohort, adding 27 patients to the original cohort. MDT guided by prostate-specific membrane antigen (PSMA) PET/CT, choline PET/CT, and conventional imaging was compared in 102 patients with omCRPC. The primary outcomes were biochemical recurrence–free survival and overall survival after adjustment for inverse probability of treatment weighting. Results: MDT was guided by conventional imaging in 20 (19.6%) patients, choline PET/CT in 56 (54.9%) patients, and PSMA PET/CT in 26 (25.5%) patients. PSMA PET/CT guidance yielded longer biochemical recurrence–free survival than did choline PET/CT (median not reached [NR] vs. 11.7 mo, P = 0.031) and conventional imaging (NR vs. 7.1 mo, P = 0.002). Overall survival favored PSMA PET/CT versus conventional imaging (NR vs. 46.0 mo, P = 0.036). Conclusion: PSMA PET/CT guidance was associated with improved clinical outcome, supporting its therapeutic relevance for MDT planning in omCRPC.