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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 579-587
DOI: 10.1055/s-0044-1779634
Original Article

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

Dheeratama Siripongsatian 
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Attapon Jantarato
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Chetsadaporn Promteangtrong
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Anchisa Kunawudhi
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Peerapon Kiatkittikul
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Natphimol Boonkawin
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Sukanya Yaset
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Sirinsuda Somboon
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
,
Chanisa Chotipanich
1   National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
› Author Affiliations Funding None.
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Abstract

Objective [177Lu]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 [177Lu]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 [177Lu]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 177Lu-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 177Lu-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 [177Lu]Lu-PSMA-617 RLT.

Keywords

pretherapeutic PSMA PET - metastatic castration-resistant prostate cancer - liver metastasis - [177Lu]Lu-PSMA-617 - radioligand therapy

Supplementary Material



Publication History

Article published online:
23 February 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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