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Background <p>We aimed to explore the value of prostate-specific membrane antigen (PSMA) and <sup>18</sup>F-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 (<sup>177</sup>Lu-EB-PSMA) therapy.</p> Methods <p>This study retrospectively enrolled 35 mCRPC patients who received <sup>177</sup>Lu-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 <sup>68</sup>Ga-PSMA and <sup>18</sup>F-FDG PET/CT with prostate-specific antigen (PSA) response rate, PSA progression-free survival (PSA-PFS), and overall survival (OS) were explored.</p> Results <p>Among the 35 patients, 27 and 15 received 2 and 3 cycles of <sup>177</sup>Lu-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]; <i>P</i> = 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]; <i>P</i> = 0.015). The newly emerged lesions after the first cycle of therapy on <sup>68</sup>Ga-PSMA PET/CT (NELs<sub>1−PSMA</sub>) 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]; <i>P</i> = 0.001; For OS, HR, 3.976 [95% CI, 2.015–9.433]; <i>P</i> = 0.001) .</p> Conclusion <p><sup>68</sup>Ga-PSMA PET/CT may provide valuable information for predicting long-term outcomes in patients undergoing <sup>177</sup>Lu-EB-PSMA therapy. These findings are hypothesis-generating; the potential role warrants prospective validation in larger, independent cohorts.</p> Trial registration <p>ClinicalTrials.gov, NCT03780075, Registered 19 December 2019, retrospectively registered, <a href="https://clinicaltrials.gov/study/NCT03780075">https://clinicaltrials.gov/study/NCT03780075</a>;</p>

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

  • 期刊论文

  • 发表日期：

    2026年7月1日

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

摘要

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 (NELs1−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;