The Role of SPECT/CT in 177 Lu-PSMA-617 Theranostics: Case-based Review of Response and Progression Patterns.

Lutetium-177 prostate-specific membrane antigen-617 (Lu-PSMA) has demonstrated efficacy in improving progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). Post-treatment single photon emission tomography/computed tomography (SPECT/CT) imaging is an emerging tool for monitoring treatment response, enabling the tracking of functional changes during therapy. While quantitative SPECT analysis can predict patient outcomes, qualitative assessments are more practical and time-efficient in clinical settings.

PET-Based TheraP Eligibility and Outcomes of VISION-Eligible Patients with Metastatic Castration-Resistant Prostate Cancer Who Received Lu-PSMA-617: Importance of F-FDG-Avid Discordant Findings.

The VISION and TheraP trials introduced different PET-based criteria for patient selection for treatment with Lu-PSMA-617 (LuPSMA). TheraP used a higher prostate-specific membrane antigen (PSMA) uptake threshold than VISION and required F-FDG PET to exclude patients with discordant findings. Although the screen-failed patients had shorter overall survival (OS) than those treated with LuPSMA, it remains unclear whether their outcomes might have been modified if they had been exposed to LuPSMA.

SPECT/CT in Early Response Assessment of Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Lu-PSMA-617.

Lu-PSMA-617 (LuPSMA) is a newly established treatment for patients with metastatic castration-resistant prostate cancer (mCRPC), but survival outcomes vary widely, and predictors of treatment responses are needed. This study investigated the role of total tumor volumes (TTVs) and new lesions (NLs) determined by LuPSMA SPECT/CT in early cycles to predict subsequent outcomes in a real-world practice setting. Between June and December 2022, consecutive patients with mCRPC who received at least 2 administrations of LuPSMA with SPECT/CT 24 h after treatment were retrospectively reviewed.