PSMA PET Tumor-to-Salivary Gland Ratio to Predict Response to [177Lu]PSMA Radioligand Therapy: An International Multicenter Retrospective Study
- Author(s)
- Hotta, M; Gafita, A; Murthy, V; Benz, MR; Sonni, I; Burger, IA; Eiber, M; Emmett, L; Farolfi, A; Fendler, WP; Weber, MM; Hofman, MS; Hope, TA; Kratochwil, C; Czernin, J; Calais, J;
- Details
- Publication Year 2023-07,Volume 64,Issue #7,Page 1024-1029
- Journal Title
- Journal of Nuclear Medicine
- Publication Type
- Research article
- Abstract
- Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy can improve the outcome of patients with advanced metastatic castration-resistant prostate cancer, but patients do not respond uniformly. We hypothesized that using the salivary glands as a reference organ can enable selective patient stratification. We aimed to establish a PSMA PET tumor-to-salivary gland ratio (PSG score) to predict outcomes after [(177)Lu]PSMA. Methods: In total, 237 men with metastatic castration-resistant prostate cancer treated with [(177)Lu]PSMA were included. A quantitative PSG (qPSG) score (SUV(mean) ratio of whole-body tumor to parotid glands) was semiautomatically calculated on baseline [(68)Ga]PSMA-11 PET images. Patients were divided into 3 groups: high (qPSG > 1.5), intermediate (qPSG = 0.5-1.5), and low (qPSG < 0.5) scores. Ten readers interpreted the 3-dimensional maximum-intensity-projection baseline [(68)Ga]PSMA-11 PET images and classified patients into 3 groups based on visual PSG (vPSG) score: high (most of the lesions showed higher uptake than the parotid glands) intermediate (neither low nor high), and low (most of the lesions showed lower uptake than the parotid glands). Outcome data included a more than 50% prostate-specific antigen decline, prostate-specific antigen (PSA) progression-free survival, and overall survival (OS). Results: Of the 237 patients, the numbers in the high, intermediate, and low groups were 56 (23.6%), 163 (68.8%), and 18 (7.6%), respectively, for qPSG score and 106 (44.7%), 96 (40.5%), and 35 (14.8%), respectively, for vPSG score. The interreader reproducibility of the vPSG score was substantial (Fleiss weighted kappa, 0.68). The more than 50% prostate-specific antigen decline was better in patients with a higher PSG score (high vs. intermediate vs. low, 69.6% vs. 38.7% vs. 16.7%, respectively, for qPSG [P < 0.001] and 63.2% vs 33.3% vs 16.1%, respectively, for vPSG [P < 0.001]). The median PSA progression-free survival of the high, intermediate, and low groups by qPSG score was 7.2, 4.0, and 1.9 mo (P < 0.001), respectively, by qPSG score and 6.7, 3.8, and 1.9 mo (P < 0.001), respectively, by vPSG score. The median OS of the high, intermediate, and low groups was 15.0, 11.2, and 13.9 mo (P = 0.017), respectively, by qPSG score and 14.3, 9.6, and 12.9 mo (P = 0.018), respectively, by vPSG score. Conclusion: The PSG score was prognostic for PSA response and OS after [(177)Lu]PSMA. The visual PSG score assessed on 3-dimensional maximum-intensity-projection PET images yielded substantial reproducibility and comparable prognostic value to the quantitative score.
- Publisher
- Society of Nuclear Medicine and Molecular Imaging
- Keywords
- Male; Humans; *Prostate-Specific Antigen; *Prostatic Neoplasms, Castration-Resistant/diagnostic imaging/radiotherapy; Retrospective Studies; Gallium Radioisotopes; Reproducibility of Results; Radiopharmaceuticals/therapeutic use; Dipeptides/therapeutic use; Salivary Glands; Lutetium; Heterocyclic Compounds, 1-Ring/adverse effects; Treatment Outcome; Psma pet; [177Lu]PSMA; parotid glands; radioligand therapy; visual criteria
- Department(s)
- Cancer Imaging
- PubMed ID
- 36997329
- Publisher's Version
- https://doi.org/10.2967/jnumed.122.265242
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-09-19 07:39:54
Last Modified: 2024-07-09 04:47:38