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Assessing Interlesional Tumor Response and Patient Outcomes with Sequential PSMA PET/CT in Metastatic

Chloé S Denis1, François Cousin2, Bram De Laere3,4

  • 1Medical Oncology Department, University Hospital of Liege, Liege, Belgium; chloe.denis@chuliege.be.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|July 31, 2025
PubMed
Summary

Prostate-specific membrane antigen (PSMA) PET/CT can predict outcomes in metastatic castration-resistant prostate cancer (mCRPC) by assessing global and interlesional tumor response. Heterogeneous tumor response indicates worse overall survival and progression-free survival.

Keywords:
ARPIPET/CTPSMAinterlesionalprostate cancer

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • Metastatic castration-resistant prostate cancer (mCRPC) treatment outcomes are influenced by heterogeneous tumor responses.
  • The role of prostate-specific membrane antigen (PSMA) PET/CT in evaluating interlesional tumor response in mCRPC is not well-defined.

Purpose of the Study:

  • To assess the impact of global and interlesional tumor response on patient outcomes in mCRPC using PSMA PET/CT.
  • To correlate PSMA PET/CT findings with overall survival (OS), prostate-specific antigen-progression-free survival (PSA-PFS), and other clinical endpoints.

Main Methods:

  • Retrospective analysis of 24 mCRPC patients treated with androgen receptor pathway inhibitors.
  • Sequential [68Ga]Ga-PSMA-11 PET/CT scans at baseline, week 4, and week 12.
  • Evaluation of global response (progressive disease vs. non-progressive disease) and interlesional response in PSMA-positive lesions.

Main Results:

  • Non-progressive disease on PSMA PET/CT correlated with significantly longer OS (51 vs. 22 months) and improved PFS outcomes.
  • Interlesional progression at week 12 was associated with significantly worse OS (16 vs. 52 months) and PSA-PFS (7 vs. not reached) compared to homogeneous response.
  • PSMA PET/CT response at week 12 remained a significant predictor of outcomes.

Conclusions:

  • Sequential PSMA PET/CT is valuable for assessing both global and interlesional tumor response in mCRPC.
  • Interlesional tumor response assessment by PSMA PET/CT at week 12 can identify patients with poorer outcomes.
  • PSMA PET/CT findings provide prognostic information for patients with mCRPC treated with androgen receptor pathway inhibitors.