Pretherapeutic PSMA PET-Derived Semiquantitative Parameters as Predictors of PSA Response in Patients with mCRPC Receiving [ ¹⁷⁷ Lu]Lu-PSMA-617 Radioligand Therapy.

IF 0.9 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Indian Journal of Radiology and Imaging Pub Date : 2024-02-23 eCollection Date: 2024-10-01 DOI:10.1055/s-0044-1779634

Dheeratama Siripongsatian, Attapon Jantarato, Chetsadaporn Promteangtrong, Anchisa Kunawudhi, Peerapon Kiatkittikul, Natphimol Boonkawin, Sukanya Yaset, Sirinsuda Somboon, Chanisa Chotipanich

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Abstract

Objective [ ¹⁷⁷ Lu]Lu-prostate-specific membrane antigen (PSMA)-617 radioligand therapy (RLT) shows promise for metastatic castration-resistant prostate cancer (mCRPC) patients with positive PSMA positron emission tomography (PET) imaging. Identifying high-risk patients is crucial. We evaluated pretherapeutic PSMA PET-derived parameters to predict prostate-specific antigen (PSA) response in patients undergoing [ ¹⁷⁷ Lu]Lu-PSMA-617 RLT. Materials and Methods We conducted a retrospective analysis among 27 patients (mean age: 71.0 ± 9.5 years; range: 52-85 years) who underwent PSMA PET/computed tomography (CT) and subsequent [ ¹⁷⁷ Lu]Lu-PSMA-617 RLT between March 2019 and January 2023. After excluding patients with liver metastases, the number of patients left for analysis was 21 (14 responders and 7 nonresponders). Tumors were semiautomatically delineated with calculation of total tumor volume (PSMA-TV), lesion uptake (PSMA-TLU = PSMA-TV * standardized uptake value [SUV]mean), and lesion quotient (PSMA-TLQ = PSMA-TV/SUVmean) for each patient. Semiquantitative parameters were analyzed only in patients with mCRPC and no liver metastasis. Results In total, 17/27 patients (62.96%) had a decline in PSA levels; 15/27 patients (55.56%) experienced a decline of > 50%. Pretherapeutic PSMA PET/CT results revealed significant differences in PSMA-TV ( p = 0.003), PSMA-TLU ( p = 0.013), and PSMA-TLQ ( p = 0.011) between responders and nonresponders. SUVmax was significantly correlated to the best percentage change in PSA response after ¹⁷⁷ Lu-PSMA-617 treatment ( r = -0.79, p = 0.006). No association was observed between PSMA-TV ( p = 0.367), PSMA-TLU ( p = 0.128), and PSMA-TLQ ( p = 0.556), with the best percentage change in PSA response after ¹⁷⁷ Lu-PSMA-617 therapy. Conclusion Pretherapeutic PSMA PET-derived PSMA-TV, PSMA-TLU, and PSMA-TLQ were significant negative predictors of PSA response in patients with mCRPC and no liver metastasis receiving [ ¹⁷⁷ Lu]Lu-PSMA-617 RLT.

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接受[177 Lu]Lu-PSMA-617 放射性配体治疗的 mCRPC 患者治疗前 PSMA PET 衍生的半定量参数可预测 PSA 反应。

目的[177 Lu]Lu-前列腺特异性膜抗原（PSMA）-617放射性配体疗法（RLT）有望用于PSMA正电子发射断层扫描（PET）成像呈阳性的转移性阉割耐药前列腺癌（mCRPC）患者。识别高危患者至关重要。我们评估了接受[177 Lu]Lu-PSMA-617 RLT治疗患者的治疗前PSMA PET衍生参数，以预测前列腺特异性抗原（PSA）反应。材料与方法我们对2019年3月至2023年1月期间接受PSMA PET/计算机断层扫描（CT）和随后接受[177 Lu]Lu-PSMA-617 RLT的27名患者（平均年龄：71.0 ± 9.5岁；范围：52-85岁）进行了回顾性分析。排除肝转移患者后，剩下的分析患者为 21 人（14 人应答，7 人未应答）。通过计算每位患者的肿瘤总体积（PSMA-TV）、病灶摄取率（PSMA-TLU = PSMA-TV * 标准化摄取值 [SUV] 平均值）和病灶商数（PSMA-TLQ = PSMA-TV/SUVmean ），对肿瘤进行半自动划分。半定量参数仅对mCRPC且无肝转移的患者进行分析。结果共有 17/27 例患者（62.96%）的 PSA 水平有所下降；其中 15/27 例患者（55.56%）的下降幅度大于 50%。治疗前 PSMA PET/CT 结果显示，PSMA-TV（p = 0.003）、PSMA-TLU（p = 0.013）和 PSMA-TLQ （p = 0.011）在有反应者和无反应者之间存在显著差异。SUVmax与177 Lu-PSMA-617治疗后PSA反应的最佳百分比变化有明显相关性（r = -0.79，p = 0.006）。PSMA-TV ( p = 0.367)、PSMA-TLU ( p = 0.128) 和 PSMA-TLQ ( p = 0.556) 与 177 Lu-PSMA-617 治疗后 PSA 反应的最佳百分比变化之间没有关联。结论治疗前 PSMA PET 衍生的 PSMA-TV、PSMA-TLU 和 PSMA-TLQ 是接受[177 Lu]Lu-PSMA-617 RLT 治疗的无肝转移 mCRPC 患者 PSA 反应的显著负向预测因子。

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