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Dynamic Changes in Tumor Burden in Patients Undergoing PSMA RLT.

Moein Moradpour¹, Chae Moon Hong², Sobia Khan³

¹Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.

European Urology Oncology

|June 30, 2026

Summary

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Quantitative changes in total tumor volume (TTV) using SPECT/CT can guide prostate-specific membrane antigen radioligand therapy (PSMA RLT) for metastatic castration-resistant prostate cancer. Early responders show significant TTV reduction, informing treatment strategies.

Area of Science:

Nuclear medicine
Oncology
Radiology

Background:

Metastatic castration-resistant prostate cancer (mCRPC) poses significant treatment challenges.
Prostate-specific membrane antigen radioligand therapy (PSMA RLT) is an emerging treatment for mCRPC.
Monitoring treatment response quantitatively is crucial for optimizing PSMA RLT.

Purpose of the Study:

To evaluate quantitative changes in total metastatic tumor burden in mCRPC patients undergoing PSMA RLT.
To assess the utility of SPECT/CT imaging in monitoring treatment response.
To correlate imaging findings with prostate-specific antigen (PSA) levels.

Main Methods:

Retrospective analysis of 331 mCRPC patients treated with PSMA RLT at two centers.
Quantitative measurements of SUVmean, SUVmax, and total tumor volume (TTV) using post-treatment SPECT/CT.

Keywords:

PSMA Prostate cancer Radioligand therapy SPECT Total tumor volume

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Calculation of median percentage changes in TTV and correlation with PSA response (PSA50).

Main Results:

58.4% of patients achieved PSA50 response.
Early responders (≥30% TTV reduction between cycles 1-2) showed a 61.3% TTV reduction at cycle 2.
Minimal responders (<30% TTV reduction) had gradual TTV decreases across cycles.
A modest correlation between PSA and TTV changes was observed (r=0.318), with 43.6% discordance.
Early responders had smaller tumor burden reductions in later cycles compared to minimal responders.

Conclusions:

Dynamic changes in TTV on SPECT/CT are valuable for assessing PSMA RLT efficacy.
SPECT/CT imaging can help identify early treatment responders and guide RLT strategy adjustments.
The discordance between PSA and TTV suggests that imaging provides complementary information for treatment monitoring.