Kind Felix, Fassbender Thomas F, Andrieux Geoffroy, Boerries Melanie, Meyer Philipp T, Ruf Juri
Department of Nuclear Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Institute of Medical Bioinformatics and Systems Medicine, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Breisacher Str. 153, D-79110 Freiburg, Germany.
Cancers (Basel). 2021 Dec 29;14(1):149. doi: 10.3390/cancers14010149.
Radioligand therapy with [Lu]PSMA-617 (PSMA-RLT) is a promising therapeutic option for metastatic castration-resistant prostate cancer (mCPRP). This study assessed the prognostic value of early PSA measurements during PSMA-RLT.
27 patients with mCRPC scheduled for PSMA-RLT were prospectively enrolled for a serial short-interval PSA-assessment. Change in PSA (∆%PSA) during two treatment cycles was correlated with biochemical response (BR) and change in tumor volume on PET (TV) after 16 weeks (w16), as well as overall survival (OS). PCWG3 criteria and the recently recommended threshold of ∆%PSA ≤ -30% were assessed for their predictive value.
∆%PSA first correlated with BR, TV and OS after 4 weeks (c1w4). At c1w4, ∆%PSA ≤ -30% was associated with the biochemical response at w16 ( = 0.003) and a longer median OS ( = 0.025), whereas the PCWG3-derived threshold of ∆%PSA ≤ -50% showed no such correlation. In contrast, ∆%PSA ≥ 25% at c1w4 was associated with biochemical progression at w16 ( = 0.003) and a shorter median OS ( < 0.001).
PSA changes as early as four weeks after PSMA-RLT allow a significant prediction of later biochemical and PET-based imaging response, as well as OS. At this early time point, a more lenient threshold for a PSA decrease of at least 30% appears better-suited for the prediction of a positive biochemical response and longer OS. In contrast, the PCWG3-derived threshold for PSA increase (+25%) reliably anticipates biochemical progression and shorter OS.
使用[镥]PSMA - 617进行放射性配体治疗（PSMA - RLT）是转移性去势抵抗性前列腺癌（mCPRP）一种有前景的治疗选择。本研究评估了PSMA - RLT期间早期前列腺特异性抗原（PSA）测量的预后价值。
前瞻性纳入27例计划接受PSMA - RLT的mCRPC患者，进行系列短间隔PSA评估。两个治疗周期内PSA的变化（∆%PSA）与生化反应（BR）、16周（w16）后PET上肿瘤体积的变化（TV）以及总生存期（OS）相关。评估前列腺癌工作组3（PCWG3）标准和最近推荐的∆%PSA≤ - 30%的阈值的预测价值。
∆%PSA在4周（c1w4）后首次与BR、TV和OS相关。在c1w4时，∆%PSA≤ - 30%与w16时的生化反应相关（P = 0.003）且中位总生存期更长（P = 0.025），而PCWG3得出的∆%PSA≤ - 50%的阈值未显示出这种相关性。相反，c1w4时∆%PSA≥25%与w16时的生化进展相关（P = 0.003）且中位总生存期更短（P < 0.001）。
PSMA - RLT后早至4周的PSA变化能够显著预测后期的生化反应和基于PET的影像反应以及总生存期。在这个早期时间点，对于PSA至少降低30%采用更宽松的阈值似乎更适合预测阳性生化反应和更长的总生存期。相反，PCWG3得出的PSA升高（+25%）的阈值能可靠地预测生化进展和更短的总生存期。
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