Quantitative PSMA PET Biomarkers for Predicting Response to ¹⁷⁷Lu-PSMA Therapy in Prostate Cancer: A Systematic...

Area of Science:

• Nuclear Medicine
• Oncology
• Radiopharmaceutical Therapy

Background:

• 177Lu-labeled prostate-specific membrane antigen (PSMA) radiopharmaceutical therapy (177Lu-PSMA-617) shows promise for metastatic castration-resistant prostate cancer (mCRPC).
• Patient response to 177Lu-PSMA therapy varies, necessitating improved patient selection strategies.
• Quantitative PSMA PET biomarkers are being explored for their prognostic capabilities in mCRPC.

Purpose of the Study:

• To systematically review and conduct a meta-analysis on the prognostic value of PSMA PET biomarkers for predicting response to 177Lu-PSMA therapy in mCRPC patients.
• To evaluate specific quantitative PSMA PET parameters, including SUVmean, tumor volume, and total lesion, as predictors of treatment outcomes.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, Scopus, Web of Science, Embase).
• Studies evaluating quantitative PSMA PET parameters as predictors of 177Lu-PSMA therapy response were included.
• Hazard ratios (HRs) and 95% CIs were extracted and synthesized using random-effects meta-analysis. Heterogeneity and publication bias were assessed.

Main Results:

• Twenty-three studies met the inclusion criteria.
• SUVmean, tumor volume (TV), and total lesion (TL) PSMA emerged as significant predictors of overall survival (OS), progression-free survival, and prostate-specific antigen response.
• Pooled HRs indicated predictive value for SUVmean (OS: 0.93), TV (HR: 1.37), and TL (HR: 1.04). SUVmax and SUVpeak showed limited predictive value.

Conclusions:

• Quantitative PSMA PET biomarkers, specifically SUVmean, TV, and TL, are valuable for prognosticating response to 177Lu-PSMA therapy in mCRPC.
• These biomarkers can aid in patient selection for targeted radiopharmaceutical therapy.
• Future research should integrate PET biomarkers with clinical and biochemical data for enhanced treatment decision-making.