PSMA PET total tumor volume predicts outcome of patients with advanced prostate cancer receiving [ 177 Lu]Lu-PSMA-617 ra
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ORIGINAL ARTICLE
PSMA PET total tumor volume predicts outcome of patients with advanced prostate cancer receiving [177Lu]Lu-PSMA-617 radioligand therapy in a bicentric analysis Robert Seifert 1,2,3,4 & Katharina Kessel 1 & Katrin Schlack 3,5 & Manuel Weber 2,3,4 & Ken Herrmann 2,3,4 & Maximilian Spanke 2,3,4 & Wolfgang P. Fendler 2,3,4 & Boris Hadaschik 3,4,6 & Jens Kleesiek 4,7 & Michael Schäfers 1,3 & Matthias Weckesser 1,3 & Martin Boegemann 3,5 & Kambiz Rahbar 1,3 Received: 27 June 2020 / Accepted: 13 September 2020 # The Author(s) 2020
Abstract Introduction [177Lu]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 * SUVmean), and total lesion quotient (PSMA-TLQ = PSMA-TV / SUVmean) 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. Keywords PSMA . PET-CT . Total tumor volume . Lu-PSMA . mCRPC This article is part of the Topical Collection on Oncology - Genitourinary * Kambiz Rahbar [email protected] 1
Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
2
Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
3
West German Cancer Center (WTZ), Münster and Essen, Germany
4
German Cancer Consortium (DKTK), Essen, Germany
5
Department of Urology, University Hospital Münster, Münster, Germany
6
Department of Urology, University Hospital Essen, Essen, Germany
7
Division of Radiology, German Cancer Research Center
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