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Monitoring of Disease in Patients Receiving 177LU-PSMA-617 Therapy in Routine Practice.

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Imaging patterns varied during lutetium-177 PSMA (LuPSMA) therapy for metastatic castration-resistant prostate cancer. Radiographic progression occurred without PSA changes in 10% of patients, highlighting the need for imaging in LuPSMA monitoring.

Keywords:
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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiopharmaceuticals

Background:

  • Lutetium-177 PSMA (LuPSMA) is an approved radiopharmaceutical for metastatic castration-resistant prostate cancer (mCRPC).
  • Multimodal disease monitoring is recommended during LuPSMA therapy, but imaging frequency and modality lack definitive guidelines.
  • This study describes current imaging utilization patterns in patients undergoing LuPSMA therapy.

Purpose of the Study:

  • To describe patterns in imaging utilization for disease monitoring during LuPSMA therapy.
  • To assess the association between clinical characteristics and restaging scans.
  • To evaluate the relationship between PSA50 response and overall survival.

Main Methods:

  • Retrospective review of 184 mCRPC patients treated with ≥ 2 cycles of LuPSMA (June 2022 - April 2024).
  • Extracted demographic, clinical, and imaging data.
  • Utilized competing risks and Cox regression models, and Kapan-Meier curves for survival analysis.

Main Results:

  • Significant heterogeneity observed in imaging modalities used during LuPSMA therapy.
  • 20% of patients received no imaging during therapy.
  • 10% of patients showed radiographic progression without PSA progression prior to treatment discontinuation.

Conclusions:

  • Marked heterogeneity exists in imaging use for LuPSMA therapy monitoring.
  • Prostate-specific antigen (PSA) alone may be insufficient for assessing treatment response.
  • Radiographic assessment is crucial for effective disease monitoring in LuPSMA-treated patients.