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

Authors

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

Published in

Annals of nuclear medicine. Jul 01, 2026. Epub Jul 01, 2026.

Abstract

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

PMID:
42384311
Bibliographic data and abstract were imported from PubMed on 01 Jul 2026.

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