Cited by 160Radiopharmaceutical Chemistry and ApplicationsMedical Imaging Techniques and ApplicationsProstate Cancer Diagnosis and Treatment

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PSMA PET total tumor volume predicts outcome of patients with advanced prostate cancer receiving [177Lu]Lu-PSMA-617 radioligand therapy in a bicentric analysis

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Seifert, Robert, Kessel, Katharina, Schlack, Katrin, Weber, Manuel, Herrmann, Ken, Spanke, Maximilian, Fendler, Wolfgang P., Hadaschik, Boris, Kleesiek, Jens, Schäfers, Michael, Weckesser, Matthias, Boegemann, Martin, Rahbar, Kambiz·2021·European Journal of Nuclear Medicine and Molecular Imaging

DOI 10.1007/s00259-020-05040-1PMC PMC8041668

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Abstract Introduction [ 177 Lu]Lu-PSMA-617 (Lu-PSMA) radioligand therapy is an emerging treatment option for patients with end-stage prostate cancer. However, response to Lu-PSMA therapy is only achieved in approximately half of patients. It is clinically important to identify patients at risk of poor outcome. Therefore, the aim of this study was to evaluate pretherapeutic PSMA PET derived total tumor volume and related metrics as prognosticators of overall survival in patients receiving Lu-PSMA therapy. Methods A total number of 110 patients form the Departments of Nuclear Medicine Münster and Essen were included in this retrospective analysis. Baseline PSMA PET-CT was available for all patients. Employing a previously published approach, all tumor lesions were semi-automatically delineated in PSMA PET-CT acquisitions. Total lesion number, total tumor volume (PSMA-TV), total lesion uptake (PSMA-TLU = PSMA-TV * SUV mean ), and total lesion quotient (PSMA-TLQ = PSMA-TV / SUV mean) were quantified for each patient. Log2 transformation was used for regressions. Results Lesion number, PSMA-TV, and PSMA-TLQ were prognosticators of overall survival (HR = 1.255, p = 0.009; HR = 1.299, p = 0.005; HR = 1.326, p = 0.002). In a stepwise backward Cox regression including lesion number, PSMA-TV, PSA, LDH, and PSMA-TLQ, only the latter two remained independent and statistically significant negative prognosticators of overall survival (HR = 1.632, p = 0.011; HR = 1.239, p = 0.024). PSMA-TLQ and LDH were significant negative prognosticators in multivariate Cox regression in contrast to PSA value. Conclusion PSMA-TV was a statistically significant negative prognosticator of overall survival in patients receiving Lu-PSMA therapy. PSMA-TLQ was an independent and superior prognosticator of overall survival compared with PSMA-TV.

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Fig. 1 Quartiles of PSMA tumor volume and overall survival. (a) depicts boxplots of the PSMA tumor volume (PSMA-TV) quartile 1 to quartile 4. The overall survival is separately shown for each PSMA-TV quartile (b). Exemplary patients of each quartile were shown together with blood levels of prostate-specific antigen (PSA) (c–f)CC BY · PubMed Central

Fig. 2 Quartiles of PET and blood biomarkers and overall survival. Patients were stratified on the basis of PSMA-TLU quartiles (a), PSMA-TLQ quartiles (b), prostate-specific antigen blood level quartiles (c), and lactate dehydrogenase blood level quartiles (d)CC BY · PubMed Central

Fig. 3 PSMA-TV and PSMA-TLQ and overall survival. Quintile 1, quintiles 2–4, and quintile 5 of PSMA-TV (a) or PSMA-TLQ (b) were employed to stratify patients and compare the median estimated overall survival between the strata. Number at risk tables were given by (c) and (d), respectively. Boxplots of quintile 1, quintiles 2–4, and quintile 4 were separately shown for PSMA-TV (e) and PSMA-TLQ (f)CC BY · PubMed Central

Fig. 4 Stratification of PSMA-TV or PSMA-TLQ by ideal log rank cutoffs. A log rank cutoff finder was employed for PSMA-TV (a) or PSMA-TLQ (b) to form groups and compare the estimated median overall survival. Additionally, a number at risk tables were shown for PSMA-TV (c) and PSMA-TLQ (d). Boxplots of PSMA-TV (e) and PSMA-TLQ (f) were shown as wellCC BY · PubMed Central

Fig. 5 Baseline parameters and survival of Münster and Essen cohort. Patients form the university hospital Münster (UHM) or Essen (UHE) were compared with regard to overall survival (a), cumulated Lu-PSMA dose (b), prostate-specific antigen blood levels (c), and lactate dehydrogenase blood levels (d). No statistically significant differences were observedCC BY · PubMed Central

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Authors: Seifert, R., Kessel, K., Schlack, K., Weber, M., Herrmann, K., Spanke, M., Fendler, W. P., Hadaschik, B., Kleesiek, J., Schäfers, M., Weckesser, M., Boegemann, M., & Rahbar, K.
Affiliations: University Hospital Münster (DE)
Essen University Hospital (DE)
German Cancer Research Center (DE)
Corresponding author: Rahbar, Kambiz
ORCID: Seifert, Robert
Kessel, Katharina
Schlack, Katrin
Weber, Manuel
Herrmann, Ken
Fendler, Wolfgang P.
Hadaschik, Boris
Kleesiek, Jens
Schäfers, Michael
Weckesser, Matthias
Rahbar, Kambiz
Venue: European Journal of Nuclear Medicine and Molecular Imaging
Publisher: Springer Science and Business Media LLC
Published: 2020-09-24
Volume: 48
Issue: 4
Pages: 1200-1210
ISSN: 1619-7070 (ISSN-L)
1619-7089
DOI: 10.1007/s00259-020-05040-1
PMC: PMC8041668
OpenAlex: W3088497176
Cited by: 160
References: 26
Citations by year: 2026: 31 · 2025: 31 · 2024: 25 · 2023: 26 · 2022: 20 · 2021: 24 · 2020: 2
FWCI: 8.77
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
creativecommons.org/licenses/by/4.0 (vor)
Locations: European Journal of Nuclear Medicine and Molecular Imaging (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
Funders: Westfälische Wilhelms-Universität Münster
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Health Sciences › Medicine › Urology › Prostate Cancer Diagnosis and Treatment
Keywords: 177Lu-PSMA-617, radioligand therapy, advanced prostate cancer, PSMA PET/CT, total tumor volume, prognostic factors, overall survival, PSMA-617, PSMA-11, tumor volume measurement
MeSH terms: Positron Emission Tomography Computed Tomography, Dipeptides, Heterocyclic Compounds, 1-Ring, Humans, Male, Retrospective Studies, Treatment Outcome, Prostate-Specific Antigen, Tumor Burden, Prostatic Neoplasms, Castration-Resistant

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PSMA PET total tumor volume predicts outcome of patients with advanced prostate cancer receiving [177Lu]Lu-PSMA-617 radioligand therapy in a bicentric analysis

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