Prognostic Value of Comprehensive Analysis of Metastatic Prostate Tumor Changes from First to Last [Lu]Lu-PSMA Therapy Injections Through Serial High-Speed Whole-Body 360° Cadmium-Zinc-Telluride SPECT.

Fiche publication

Date publication

septembre 2025

Journal

Journal of nuclear medicine : official publication, Society of Nuclear Medicine

Auteurs

Membres identifiés du Cancéropôle Est :
Pr MARIE Pierre-Yves , Pr OLIVIER Pierre , Pr VERGER Antoine , Dr CLAUDIN Marine

Tous les auteurs :
Kunsch J, Zaragori T, Olivier P, Claudin M, Marie PY, Raymond P, Heyer S, Verger A, Imbert L, Boursier C

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/40935614

Résumé

Anger SPECT monitoring of [Lu]Lu-prostate-specific membrane antigen (PSMA) therapy provides significant prognostic information about patients with metastatic castration-resistant prostate cancer (mCRPC) but with 36- to 90-min recording times and partial body coverage. This study assesses the prognostic information from a comprehensive analysis of tumor changes from the first to the last [Lu]Lu-PSMA therapy injections, as provided by whole-body [Lu]Lu SPECT recordings from a high-speed 360° cadmium-zinc-telluride (CZT) camera of mCRPC patients. We included mCRPC patients treated by [Lu]Lu-PSMA-617 injections who underwent [Ga]Ga-PSMA-11 PET before treatment, whole-body 360° [Lu]Lu CZT SPECT recordings of only 18 min obtained 24 h after each [Lu]Lu-PSMA therapy injection, and plasma prostate-specific antigen (PSA) measurements before each injection. We used Cox proportional hazards models to predict overall survival (OS) according to PSA evolution during treatment, as well as tumor SUV, SUV, total uptake volume, and total lesion activity (TLA; total uptake volume × SUV) extracted from [Ga]Ga-PSMA-11 PET and the first and last [Lu]Lu SPECT scans. We included 72 patients with a median age of 71 y (interquartile range, 64-77 y), treated with up to 6 [Lu]Lu-PSMA injections. Among 57 patients with at least 2 [Lu]Lu-PSMA treatment cycles, 35 (61%) died during a follow-up of 12.0 mo (range, 4.9-17.5 mo) from the last [Lu]Lu-PSMA injection. Most PSA, PET, and SPECT variables were significant univariate predictors of OS. However, only 2 [Lu]Lu SPECT variables were selected as multivariate predictors: SPECT detection of new bone lesions during treatment ( < 0.0001) and final SPECT TLA ( = 0.0007). Means of survival times were 19.7 mo (95% CI, 16.6-22.8 mo) in the 19 patients who showed no new bone lesions and final TLA lower than the median of 750 mL·SUV, 14.4 mo (95% CI, 10.9-18.0 mo) in the 19 patients with only 1 of these 2 criteria, and 6.9 mo (95% CI, 4.5-9.6 mo) in the 19 patients with neither criterion. A comprehensive analysis of tumor changes from the first to the last [Lu]Lu-PSMA injections, obtained with fast whole-body 360° [Lu]Lu CZT SPECT recordings, provides strong prognostic information about mCRPC patients, outperforming conventional OS predictors such as PSA evolution and [Ga]Ga-PSMA-11 PET variables before treatment.