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Updated: Aug 15, 2026
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A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy (PRRT): 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods
Published on: April 24, 2020
Association of Early Same-Day Posttherapy Whole-Body SPECT/CT Using Visual RECIP 1.0 with Overall Survival During
Hye Lim Park1,2, David Kersting3, Colin P Bergstrom4
1Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University Hospital, Stanford, California.
Summary
Early SPECT/CT imaging after [177Lu]Lu-PSMA-617 therapy predicts overall survival in metastatic castration-resistant prostate cancer (mCRPC). Combining imaging response, baseline tumor burden, and PSA50 improves survival prediction for mCRPC patients.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmaceutical Therapy
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) treatment involves [177Lu]Lu-PSMA-617 therapy.
- Assessing treatment response early is crucial for patient outcomes.
- Prostate-specific membrane antigen (PSMA) targeted therapies require robust response evaluation methods.
Purpose of the Study:
- To evaluate the association between early posttherapy SPECT/CT imaging and overall survival (OS) in mCRPC patients treated with [177Lu]Lu-PSMA-617.
- To assess concordance between SPECT/CT, PSMA PET/CT, and prostate-specific antigen (PSA) response.
- To determine if integrating imaging response, baseline tumor burden, and PSA response improves survival stratification.
Main Methods:
- Retrospective analysis of 158 mCRPC patients receiving [177Lu]Lu-PSMA-617.
- Same-day posttherapy SPECT/CT performed after each cycle; early response assessed after cycle 2 using visual RECIP 1.0.
- Kaplan-Meier, log-rank, and Cox regression analyses for OS; concordance evaluated for SPECT/CT, PSMA PET/CT, and PSA.
Main Results:
- Early SPECT response after cycle 2 was significantly associated with longer OS (21.5 vs. 11.3 months, P < 0.001).
- High-volume disease and absence of PSA50 were linked to shorter OS.
- Concordance between SPECT, PET, and PSA responses was 59.8%; discordant findings highlighted imaging timing, sensitivity, and heterogeneity.
Conclusions:
- Early same-day posttherapy SPECT/CT, assessed by visual RECIP 1.0, is a significant predictor of OS in mCRPC patients treated with [177Lu]Lu-PSMA-617.
- Integrating early SPECT response, baseline tumor burden, and PSA50 provides improved survival stratification.
- SPECT/CT plays a complementary role in treatment response assessment, alongside PSMA PET/CT and PSA.
