The Prognostic Value of 68Ga-PSMA and 18F-FDG PET/CT in Metastatic Castration-Resistant Prostate Cancer Treated with 177Lu-EB-PSMA

IF 2.4 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Annals of Nuclear Medicine Pub Date : 2026-07-01 DOI:10.1007/s12149-026-02250-9

Xingting Chen, Yumeng Peng, Qingming Zheng, Yuxin Lai, Hongfei Cheng, Zhaohui Zhu, Guochang Wang, Jie Zang

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引用次数: 0

Abstract

Background

We aimed to explore the value of prostate-specific membrane antigen (PSMA) and ¹⁸F-FDG PET/CT in efficacy evaluation and prognosis analysis for patients with metastatic castration-resistant prostate cancer (mCRPC) who underwent Lutetium-177-labeled Evans blue-modified PSMA (¹⁷⁷Lu-EB-PSMA) therapy.

Methods

This study retrospectively enrolled 35 mCRPC patients who received ¹⁷⁷Lu-EB-PSMA therapy between January 2019 and April 2022, with follow-up data until December 2024. The correlation and predictive value of parameters derived from ⁶⁸Ga-PSMA and ¹⁸F-FDG PET/CT with prostate-specific antigen (PSA) response rate, PSA progression-free survival (PSA-PFS), and overall survival (OS) were explored.

Results

Among the 35 patients, 27 and 15 received 2 and 3 cycles of ¹⁷⁷Lu-EB-PSMA therapy, respectively. The best PSA response rate was 54.3% (19/35 patients), the median PSA-PFS was 4.8 months (95% confidence interval [CI] 4.2–7.2), and the median OS was 13.9 months (95% CI 11.5–17.3). Multivariable analysis demonstrated that baseline PSMA-positive tumor volume (hazard ratio [HR], 1.223 [95% CI, 1.065–1.404]; P = 0.011) was an independent prognostic factors of PSA-PFS and higher baseline total lesion PSMA for OS (HR, 1.180 [95% CI, 1.065–1.390]; P = 0.015). The newly emerged lesions after the first cycle of therapy on ⁶⁸Ga-PSMA PET/CT (NELs_1−PSMA) were identified as an early on-treatment progression indicator associated with worse outcomes in exploratory analyses (For PSA-PFS, HR, 6.419 [95% CI, 1.880–19.437]; P = 0.001; For OS, HR, 3.976 [95% CI, 2.015–9.433]; P = 0.001) .

Conclusion

⁶⁸Ga-PSMA PET/CT may provide valuable information for predicting long-term outcomes in patients undergoing ¹⁷⁷Lu-EB-PSMA therapy. These findings are hypothesis-generating; the potential role warrants prospective validation in larger, independent cohorts.

Trial registration

ClinicalTrials.gov, NCT03780075, Registered 19 December 2019, retrospectively registered, https://clinicaltrials.gov/study/NCT03780075;

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68Ga-PSMA和18F-FDG PET/CT对177Lu-EB-PSMA治疗转移性去势抵抗性前列腺癌的预后价值

背景：我们旨在探讨前列腺特异性膜抗原（PSMA）和18F-FDG PET/CT在转移性去势抵抗性前列腺癌（mCRPC）患者接受luteum -177标记Evans蓝修饰PSMA （177Lu-EB-PSMA）治疗的疗效评估和预后分析中的价值。方法：本研究回顾性纳入了2019年1月至2022年4月期间接受177Lu-EB-PSMA治疗的35例mCRPC患者，随访数据至2024年12月。探讨68Ga-PSMA和18F-FDG PET/CT参数与前列腺特异性抗原（PSA）应答率、PSA无进展生存期（PSA- pfs）和总生存期（OS）的相关性和预测值。结果：35例患者中，27例和15例分别接受了2个和3个周期的177Lu-EB-PSMA治疗。最佳PSA缓解率为54.3%（19/35例患者），中位PSA- pfs为4.8个月（95%可信区间[CI] 4.2-7.2），中位OS为13.9个月（95% CI 11.5-17.3）。多变量分析显示，基线PSMA阳性肿瘤体积（风险比[HR]， 1.223 [95% CI, 1.065-1.404]; P = 0.011）是PSA-PFS的独立预后因素，而较高的基线病变总PSMA是OS的独立预后因素（HR, 1.180 [95% CI, 1.065-1.390]; P = 0.015）。在探索性分析中，首次68Ga-PSMA PET/CT （NELs1-PSMA）治疗后新出现的病变被确定为早期治疗进展指标，与较差的结果相关（对于PSA-PFS， HR为6.419 [95% CI, 1.880-19.437]；对于OS， HR为3.976 [95% CI, 2.015-9.433]; P = 0.001）。结论：68Ga-PSMA PET/CT可为预测接受177Lu-EB-PSMA治疗的患者的长期预后提供有价值的信息。这些发现是假设生成的；潜在的作用需要在更大的独立队列中进行前瞻性验证。试验注册：ClinicalTrials.gov, NCT03780075, 2019年12月19日注册，回顾性注册，https://clinicaltrials.gov/study/NCT03780075。

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来源期刊

Annals of Nuclear Medicine 医学-核医学

CiteScore

4.90

自引率

7.70%

发文量

111

审稿时长

4-8 weeks

期刊介绍： Annals of Nuclear Medicine is an official journal of the Japanese Society of Nuclear Medicine. It develops the appropriate application of radioactive substances and stable nuclides in the field of medicine. The journal promotes the exchange of ideas and information and research in nuclear medicine and includes the medical application of radionuclides and related subjects. It presents original articles, short communications, reviews and letters to the editor.