The Journal of Nuclear Medicine最新文献

{"title":"Prognostic Value of a Composite Score Incorporating Baseline [18F]FDG PET/CT and [68Ga]Ga-PSMA-11 PET/CT When Screening for [177Lu]Lu-PSMA Treatment Eligibility (PROFILE Study)","authors":"Adrien Jougla, Prescillia Nunes, Anne-Laure Giraudet, Anaïs Olivier, Julie Blanc, Alexandre Cochet, Sylvain Ladoire, Jean-Marc Vrigneaud, Lavinia Vija-Racaru, Clément Drouet","doi":"10.2967/jnumed.126.272368","DOIUrl":"https://doi.org/10.2967/jnumed.126.272368","url":null,"abstract":"<p>We investigated the prognostic value of baseline [¹⁸F]FDG and [⁶⁸Ga]Ga-PSMA-11 PET/CT in patients with metastatic castration-resistant prostate cancer treated with [¹⁷⁷Lu]Lu-PSMA-617. <strong>Methods:</strong> In this multicenter retrospective study, the associations between several clinical, biologic, and radiologic parameters and overall survival (OS) were tested in a development cohort using univariable analyses, followed by the construction of a multivariable Cox model. The PROFILE prognostic score was subsequently derived from this model, internally validated, and externally validated in an independent cohort. <strong>Results:</strong> Data from 174 patients from 3 centers were used to construct the multivariable Cox model. Five independent adverse prognostic factors were identified and incorporated into the PROFILE score: an SUV_max exceeding 300% of the PERCIST threshold on [¹⁸F]FDG PET/CT, a “nonhigh” classification on [⁶⁸Ga]Ga-PSMA-11 PET/CT using the visual PSMA tumor–to–salivary gland ratio, a baseline hemoglobin level of 11 g/dL or less, a baseline alkaline phosphatase level of greater than 220 IU/L, and a disease duration not exceeding 100 mo. The PROFILE score stratified patients into 3 risk groups and achieved a Harrell C-index of 0.67 (95% CI, 0.62–0.72). The median OS in the low-, intermediate-, and high-risk groups was 17.2, 13.0, and 8.6 mo, respectively (<em>P</em> &lt; 0.0001). These results were confirmed in 114 patients in an independent, single-center validation cohort, with median OS of 20.4, 14.3, and 8.8 mo (<em>P</em> &lt; 0.0001), respectively, and a C-index of 0.73 (95% CI, 0.68–0.78). <strong>Conclusion:</strong> The PROFILE score offers valuable prognostic information for patients with metastatic castration-resistant prostate cancer when considering the use of [¹⁷⁷Lu]Lu-PSMA-617 therapy.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148461834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Immunologist's Path Toward Advancing the Scientific Mission of the Prostate Cancer Foundation: Andrea Miyahira Talks with Johannes Czernin About the Role of the Prostate Cancer Foundation and Cancer Treatment.","authors":"Andrea Miyahira,Johannes Czernin","doi":"10.2967/jnumed.126.273264","DOIUrl":"https://doi.org/10.2967/jnumed.126.273264","url":null,"abstract":"","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Biopsy-Free Diagnosis of Prostate Cancer: Potential of Combined 18F-Flotufolastat PSMA PET and mpMRI.","authors":"Türkay Hekimsoy,Andreas P Sauter,Robert Tauber,Thomas Horn,Matthias Jahnen,Fabian Horné,Julian Q Petzold,Daniel Sasse,Isabel Rauscher,Matthias Eiber,Wolfgang A Weber,Bernd M Erber","doi":"10.2967/jnumed.125.271916","DOIUrl":"https://doi.org/10.2967/jnumed.125.271916","url":null,"abstract":"This retrospective analysis aimed to evaluate the diagnostic performance of 18F-flotufolastat PET/MRI for the detection of clinically significant prostate cancer (csPCa). The primary objective of the study was to assess the proportion of patients for whom a prostate biopsy could be safely circumvented by combining the Prostate Imaging Reporting and Data System (PI-RADS) from multiparametric MRI and quantitative data from PET. Methods: This study included 79 patients with suspicion of csPCa based on elevated prostate-specific antigen (>4 ng/mL) who underwent 18F-flotufolastat PET/MRI before biopsy or surgical resection of the prostate. Analytic methods included receiver operating characteristic analysis, logistic regression, and threshold-based evaluation of PI-RADS and of SUVmax Imaging findings were compared against histopathology. Results: csPCa (International Society of Urological Pathology grade group ≥ 2) was confirmed in 42 patients, whereas histopathology excluded csPCa in 37 patients. The combination of PI-RADS and SUVmax resulted in an area under the curve (AUC) of 87.1%, outperforming PI-RADS alone (AUC of 75.2%) and SUVmax alone (AUC of 80.7); however, differences were not statistically significant. A PI-RADS score of at least 3 and 18F-flotufolastat PET showed comparable sensitivity (0.90 vs. 0.91) and specificity (0.42 vs. 0.32) in the detection of csPCa, when applying a low SUVmax threshold (>4.5). Using a high SUVmax threshold (>10.0) increased the specificity of 18F-flotufolastat PET to 100%. Furthermore, combined PET/MRI increased the number of patients for whom csPCa can be reliably diagnosed to 28%, as well as increasing to 29% the number of patients for whom csPCa can be ruled out with a very high degree of certainty. Conclusion: This retrospective analysis suggests that prostate-specific membrane antigen PET/MRI can stratify patients with suspected prostate cancer into 3 groups: one with a very high likelihood of csPCa who may undergo definitive therapy without biopsy, one with a very low risk for csPCa who may not require biopsy, and an indeterminate group who still need biopsy. Overall, in our cohort, prostate biopsy would have been avoided in 57% of patients. Therefore, there is an urgent need for prospective studies on prostate-specific membrane antigen PET/MRI to reduce the number of unnecessary biopsies in men with suspected prostate cancer.","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"365 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall Survival with [177Lu]Lu-PSMA-617 Versus [177Lu]Lu-PSMA I&T: A Propensity Score-Matched Real-World Analysis.","authors":"Natalie Hasenauer,Charlotte Probst,Wiebke Schloetelburg,Tim Jedamzik,Marieke Heinrich,Nicole Zindler,Andreas K Buck,Anna Katharina Seitz,Philipp E Hartrampf","doi":"10.2967/jnumed.126.272415","DOIUrl":"https://doi.org/10.2967/jnumed.126.272415","url":null,"abstract":"In this study, we compared clinical outcomes and safety profiles of radiopharmaceutical therapy with [177Lu]Lu-PSMA-617 and [177Lu]Lu-PSMA I&T in patients with metastatic castration-resistant prostate cancer under real-world conditions. Methods: This single-center retrospective matched-pair analysis included 140 chemotherapy-pretreated patients with metastatic castration-resistant prostate cancer treated with commercially available [177Lu]Lu-PSMA-617 (7.4 GBq every 6 wk) (n = 70) or in-house produced [177Lu]Lu-PSMA I&T (6.0 GBq every 8 wk) (n = 70). Propensity score matching was performed on the basis of age, baseline prostate-specific antigen (PSA), and PSA-positive tumor volume and stratified by Gleason score. Overall survival (OS), biochemical response, prognostic factors, and treatment-related toxicity were analyzed. Results: Median OS was comparable between matched cohorts ([177Lu]Lu-PSMA I&T: 14 mo; range, 9-16 mo; [177Lu]Lu-PSMA-617: 15 mo; range, 10-21 mo); hazard ratio, 1.18; 95% CI, 0.79-1.78; P = 0.42). Early PSA response was strongly associated with prolonged OS in both cohorts (P < 0.01). Patients treated with [177Lu]Lu-PSMA-617 demonstrated a greater median PSA decline (-58% vs. -14%, P = 0.02) and higher biochemical response rates (70% vs. 54%). Although quantitative hematologic changes were more pronounced with [177Lu]Lu-PSMA-617, Common Terminology Criteria for Adverse Events-graded toxicity remained comparable between cohorts. Multivariable analysis revealed that higher baseline levels of lactate dehydrogenase were significantly associated with shorter OS in both cohorts (hazard ratio, 1.03-1.04 per 10 U/L, P < 0.01). Conclusion: Treatment with [177Lu]Lu-PSMA I&T and [177Lu]Lu-PSMA-617 resulted in comparable survival outcomes despite different treatment protocols. Greater biochemical responses and subclinical hematologic changes with [177Lu]Lu-PSMA-617 may reflect higher cumulative radiation exposure, although patient-specific dosimetry data were not available to confirm this hypothesis.","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSMA PET/CT-Targeted Biopsy in Men with Negative or Equivocal Multiparametric MRI and Exploratory Dynamic Total-Body PET: The FUPERMAN Study.","authors":"Andrea Farolfi,Caterina Maria Paola Sgro,Irene Brusa,Daniele Dall'Olio,Francesco Romei,Massimiliano Presutti,Matteo Droghetti,Andrea Di Giorgio,Riccardo Mei,Beniamino Corcioni,Caterina Gaudiano,Cristina Mosconi,Riccardo Schiavina,Paolo Castellucci,Stefano Fanti,Lorenzo Bianchi","doi":"10.2967/jnumed.126.272108","DOIUrl":"https://doi.org/10.2967/jnumed.126.272108","url":null,"abstract":"Prostate-specific membrane antigen (PSMA) PET/CT may enhance detection of clinically significant prostate cancer (csPCa) in men with negative or equivocal multiparametric MRI (mpMRI), a setting where diagnostic uncertainty persists. This study assessed the diagnostic performance of PSMA PET/CT-guided targeted biopsy (PET-TB) versus systematic biopsy (SB) and explored the value of semiquantitative (SUVmax) and dynamic total-body PET parameters in predicting csPCa. Methods: This is a prospective, single-center study that enrolled 63 men with PI-RADS 2-3 mpMRI findings between March 2023 and July 2025. All underwent [68Ga]Ga-PSMA-11 PET/CT followed by transperineal prostate biopsy. A subset of 11 patients underwent dynamic total-body PET. The primary endpoint was detection of csPCa (International Society of Urological Pathology score of ≥2). We compared diagnostic yields of PET-TB and SB, evaluated predictors via logistic regression, and analyzed dynamic PET data using kinetic modeling. Results: PET-TB detected significantly more csPCa than did SB (37% vs. 21%; P = 0.021), achieving a sensitivity of 96%, a specificity of 49%, a positive predictive value of 57%, and a negative predictive value of 95%. Combining PET-TB with SB increased the csPCa detection rate to 41%. SUVmax independently predicted csPCa (odds ratio, 51.2; 95% CI, 5.6-2713.9; P = 0.015), with a threshold of 11.4 yielding 100% specificity. In dynamic PET analysis, csPCa showed irreversible kinetics, and Ki /k 3 parameters improved lesion discrimination beyond SUV, especially in equivocal (PRIMARY score 3) lesions. Conclusion: PSMA PET/CT-guided targeted biopsy enhances csPCa detection in men with negative or equivocal mpMRI, with added predictive value from SUVmax and dynamic PET metrics. These promising findings should be validated in larger multicenter trials.","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAR T-Cell Therapy for Cancer: Updates and Challenges for Response Assessment","authors":"Dorine de Jong, Jeremy P. McGale, Timothy J. Robinson, Matthew J. Liao, Jeeban P. Das, Ajay Major, Kathleen M. Capaccione, Colton Ladbury, Jorge Mansilla-Soto, Hong Ma, Karine A. Al Feghali, Andre H. Goy, Egesta Lopci, Ran Reshef, Lawrence H. Schwartz, Roch Houot, Laurent Dercle","doi":"10.2967/jnumed.123.266605","DOIUrl":"https://doi.org/10.2967/jnumed.123.266605","url":null,"abstract":"<p>Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment landscape for multiple hematologic malignancies, demonstrating a clear curative potential in select cases. Since 2017, 7 CAR T-cell products have indications approved by the Food and Drug Administration, and research is continuously evolving with the intent of enhancing CAR T-cell efficacy while reducing side effects and the risk of relapse. Nuclear medicine has played a crucial role throughout this optimization process, assisting initial staging, treatment response assessment, and adverse-effect monitoring. This review provides an introduction to CAR T-cell therapy and highlights gold-standard nuclear medicine practices and imaging innovations for use in the care of oncology patients. Additionally, it emphasizes the need for continuing innovation in medical imaging as the field progresses.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation-Induced Senescence in Radiopharmaceutical Therapy: Mechanisms and Therapeutic Implications","authors":"Marcus J. Lindsey, Reinier Hernandez","doi":"10.2967/jnumed.126.272389","DOIUrl":"https://doi.org/10.2967/jnumed.126.272389","url":null,"abstract":"<p>Radiopharmaceutical therapy (RPT) has emerged as a radiation therapy modality with the distinctive ability to systemically treat metastatic disease by targeting specific biologic features expressed on cancer cells. Although the radiobiology of RPT remains incompletely understood, the low absorbed dose rates associated with RPT render these treatments prone to sublethal radiation damage, leading to alternative cell fates, such as senescence. In oncology, senescence—a stable state of proliferative cellular arrest—has been shown to act as a double-edged sword, providing both protumor and antitumor effects. The role of senescence in radiation therapy is of increasing interest as a mechanism of treatment resistance that, if targeted, may enhance tumor control and improve long-term treatment outcomes. Most current literature has focused on senescence induced by external beam radiation therapy, with few reports examining its role in the context of RPT. To our knowledge, this is the first review to contextualize RPT radiobiology within the molecular underpinnings of senescence, consolidate existing evidence, and propose a framework that recognizes RPT as an intrinsically senogenic radiation modality. Further, this review discusses opportunities for the combination of senescence-targeting drugs (“senotherapeutics”) with RPT as a means of enhancing treatment efficacy by tackling the radiation-induced senescent burden and minimizing the deleterious effects of senescence.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SSTR-Targeted Radiotheranostics in Breast Cancer: A Comparison of [68Ga]Ga-DOTATOC and [68Ga]Ga-SSO120 with [18F]FDG PET","authors":"Alina T. Küper, Lalith Kumar Shiyam Sundar, Loíc Djaileb, Justin Roschlak, Kim M. Pabst, Ieva Ciuciulkaite, Sofia Carrilho Vaz, Anja Welt, Noah Hammersen, Michael Nader, Lale Umutlu, Martin Schuler, Ken Herrmann, Wolfgang P. Fendler, Sherko Kümmel, David Kersting","doi":"10.2967/jnumed.126.272521","DOIUrl":"https://doi.org/10.2967/jnumed.126.272521","url":null,"abstract":"<p>Somatostatin receptor (SSTR)–targeting radiotracers hold promise for theranostic applications in breast cancer (BC). This retrospective single-center study aimed to assess the proportion of SSTR-positive BC and its relevance for peptide receptor radionuclide therapy. SSTR-agonist– and SSTR-antagonist–based PET tracers are compared. <strong>Methods:</strong> Patients with BC who underwent PET imaging with SSTR agonist [⁶⁸Ga]Ga-DOTATOC or SSTR antagonist [⁶⁸Ga]Ga-SSO120 (February 2023 to February 2025) for initial or follow-up staging were included. All patients underwent [¹⁸F]FDG PET, which was used as the reference standard. Mean administered activities and uptake times were 88 MBq for 64 min with [⁶⁸Ga]Ga-DOTATOC and 131 MBq for 66 min with [⁶⁸Ga]Ga-SSO120, respectively. PET-positive lesions were reported in 6 anatomic categories. Tumors were segmented; SUVs, tumor-to-liver ratios, and tumor volumes were calculated. Time to progression stratified by SSTR expression was assessed using the log-rank test. <strong>Results:</strong> In total, 37 patients with BC (26 estrogen-receptor [ER]–positive, 11 triple negative [TN]) were identified; final analysis was limited to 30 patients after excluding 7 with no detectable tumor. Most had metastatic disease (M1) at staging (26/36). On the patient level, SSTR-positive tumor (≥1 lesion) was detected in 80% of ER-positive BC (16/20) and in 50% of patients with TNBC (5/10). In ER-positive disease, positivity was comparable for [⁶⁸Ga]Ga-DOTATOC (85%) and [⁶⁸Ga]Ga-SSO120 (71%), whereas in TNBC, positivity was observed with [⁶⁸Ga]Ga-DOTATOC (83%) only. On the region level, 60% (31/52) of [¹⁸F]FDG-positive regions in ER-positive BC and 33% (7/21) in TNBC were SSTR-positive. Region-based mean SUV_max was generally lower with SSTR imaging: 7.2 ± 3.4 versus 9.3 ± 4.3 ([⁶⁸Ga]Ga-DOTATOC vs. [¹⁸F]FDG) and 4.5 ± 1.4 versus 8.1 ± 3.2 ([⁶⁸Ga]Ga-SSO120 vs. [¹⁸F]FDG) in ER-positive BC and 4.1 ± 0.6 versus 19.8 ± 3.3 ([⁶⁸Ga]Ga-DOTATOC vs. [¹⁸F]FDG), with absent [⁶⁸Ga]Ga-SSO120 uptake in patients with TNBC. One patient reached a Krenning score of 3, indicating technical eligibility for peptide receptor radionuclide therapy. SSTR positivity did not correlate with time to progression. <strong>Conclusion:</strong> SSTR may serve as a promising radiotheranostic target in a small subset of patients with advanced metastatic ER-positive BC. Tumor uptake was mostly moderate, without substantial difference between [⁶⁸Ga]Ga-DOTATOC and [⁶⁸Ga]Ga-SSO120. For imaging, [¹⁸F]FDG PET outperformed [⁶⁸Ga]Ga-SSTR PET in patients with ER-positive BC and TNBC.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discovery of a Thermostable Nigerose Phosphorylase for the Efficient Chemoenzymatic Radiosynthesis of a S. aureus–Targeted 18F-Disaccharide","authors":"Jung Min Kim, Sang Hee Lee, Shari Dhaene, Adolfo Ancona, Jaelim Kim, Marina López-Álvarez, Alexandre M. Sorlin, Joseph Blecha, Wenxing Zou, Kiel D. Neumann, Giuseppe Felice Mangiatordi, Eunsung Lee, Bernd Nidetky, Robert R. Flavell, Youngho Seo, Joanne Engel, Michael A. Ohliger, Tom Desmet, David M. Wilson","doi":"10.2967/jnumed.125.271829","DOIUrl":"https://doi.org/10.2967/jnumed.125.271829","url":null,"abstract":"<sec><st>Visual Abstract</st><p><fig loc=\"float\"><link locator=\"jnumed.125.271829absf1\"></fig></p></sec>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Restaging [18F]FDG PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer Undergoing [177Lu]Lu-PSMA-617 Therapy","authors":"Raghava Kashyap, James P. Buteau, Nathan Papa, Narjess Ayati, Michal Eifer, Vicky Betech-Antar, Timothy Akhurst, Ramin Alipour, Grace Kong, Javad Saghebi, Aravind S. Ravi Kumar, Anthony Cardin, Shahneen Sandhu, Ben Tran, Arun A. Azad, Declan G. Murphy, Michael S. Hofman","doi":"10.2967/jnumed.126.272531","DOIUrl":"https://doi.org/10.2967/jnumed.126.272531","url":null,"abstract":"<p>We analyzed the prognostic value of an interim [¹⁸F]FDG PET/CT performed after cycle 3 of [¹⁷⁷Lu]Lu-PSMA-617 ([¹⁷⁷Lu]Lu-PSMA) for patients undergoing therapy for metastatic castration-resistant prostate cancer (mCRPC). <strong>Methods:</strong> We retrospectively reviewed the data of patients with mCRPC in the ProsTIC Registry (NCT04769817) receiving [¹⁷⁷Lu]Lu-PSMA who underwent [¹⁸F]FDG PET/CT at both baseline and after cycle 3. Parameters included visual response assessment (progression vs. no progression) and metabolic tumor volume (MTV) (≥20% increase vs. &lt;20% increase or any decrease). Outcomes were measured against reductions of 50% or greater in prostate-specific antigen (PSA) levels (PSA-50) by Fisher exact test and time-to-event outcomes. PSA progression-free survival (PFS) and overall survival (OS) were defined relative to cycle 3, using Kaplan–Meier estimation. <strong>Results:</strong> Thirty-four patients (median age, 72 y; interquartile range, 66–77 y) were eligible for study inclusion. Their median PSA was 58 ng/mL (interquartile range, 17–176 ng/mL) before treatment. All patients had prior treatment with androgen receptor pathway inhibitors, and 33 had received at least 1 line of chemotherapy. Visual progression on interim [¹⁸F]FDG PET was observed in 18 patients (53%) and was associated with shorter median PFS after cycle 3 (1.2 mo; 95% CI, 0.7–2.0) compared with those patients without visual progression (5.2 mo; 95% CI, 3.6–7.0) (<em>P</em> = 0.0005) and lower achievement of PSA-50 (28% vs. 75%, <em>P</em> = 0.015). Median OS did not significantly differ between those with and without visual progression (10.3 mo; 95% CI, 6.1–17.1 mo vs. 16.4 mo; 95% CI, 10.5–21.4 mo, respectively) (<em>P</em> = 0.090). An increase of at least 20% in MTV was observed in 11 patients (32%) who, when compared with those whose MTV increased or decreased by less than 20%, had a shorter median PFS (0.7 mo; 95% CI, 0.6–1.4 mo vs. 4.9 mo; 95% CI, 2.2–6.6 mo; <em>P</em> &lt; 0.0001) and OS (10.8 mo; 95% CI, 2.1–17.1 mo vs. 16.4 mo; 95% CI, 10.3–20.1 mo; <em>P</em> = 0.069) and lower PSA-50 response (9.1% vs. 70%, <em>P</em> = 0.002). <strong>Conclusion:</strong> Visual and quantified changes on interim [¹⁸F]FDG PET appeared prognostic for PFS in patients undergoing [¹⁷⁷Lu]Lu-PSMA therapy and correlated with PSA response. Further studies are needed to determine whether [¹⁸F]FDG PET could serve as an independent biomarker to guide treatment intensification or de-escalation, including treatment pauses.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}