Beyond the Tumor: Recurrence-Prone Radiomics for Prognostication in Negative PSMA PET/CT scans of Prostate Cancer

TL;DR

This study demonstrates that radiomics features from negative PSMA PET/CT scans can predict prostate cancer progression, improving prognostic accuracy when combined with clinical data, and are robust across different readers and external validation.

Contribution

It introduces a novel radiomics approach from negative scans that enhances prognostication in prostate cancer recurrence beyond traditional clinical variables.

Findings

Radiomics combined with clinical variables improves prognostic performance (C-index 0.74).

Model robustness is maintained across different readers and external validation.

Radiomics captures subclinical disease in visually negative scans.

Abstract

In patients with biochemical recurrence of prostate cancer and negative PSMA PET/CT, radiomics features extracted from recurrence-prone organs can predict clinical progression and progression-free survival. In a cohort of 132 patients, combining PET/CT radiomics with clinical variables significantly improved prognostic performance (C-index 0.74 vs. 0.65). Model performance was influenced by reader diagnostic certainty and remained robust on external validation. These findings suggest that radiomics from visually negative scans capture subclinical disease and provide added value for risk stratification.