Stangl-Kremser Judith, Ricaurte-Fajardo Andres, Huicochea Castellanos Sandra, Martinez-Fundichely Alexander, Sun Michael, Osborne Joseph R, Nauseef Jones T, Tagawa Scott T, Bander Neil H
Department of Urology, Weill Cornell Medicine, New York City, New York, USA.
Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York City, New York, USA.
Prostate. 2025 Apr;85(5):502-509. doi: 10.1002/pros.24853. Epub 2025 Jan 23.
Actinium-225 labeled prostate-specific membrane antigen (PSMA) targeted radionuclide therapy has emerged as a potential treatment option in the management of men with metastatic castrate-resistant prostate cancer (mCRPC). This study investigated molecular imaging-derived parameters and compared imaging response of lesions categorized by tumor site.
Men with mCRPC treated with [225Ac]Ac-J591 from 2017 to 2022 at our center on two prospective trials (NCT03276572 and NCT04506567) with pre- and post-treatment [68Ga]Ga-PSMA-11 Positron Emission Tomography (PET) imaging studies available were included. SUVpeak of the 3 most- and 3 least-avid lesions of the tumor sites were manually assessed. The median change of the SUVpeak from pre- to post-treatment per tumor site was evaluated using the paired Wilcox test. An objective response (OR) in the follow-up image was defined as complete or partial response using PET Response Criteria in Solid Tumors (PERCIST) 1.0.
A total of 46 cases met the criteria for image review; most of them (n = 25, 54.3%) had more than one tumor site category. In total, 445 PSMA PET-positive lesions were assessed: 220 osseous, 163 nodal, 41 visceral, and 21 prostatic lesions. After treatment with [225Ac]Ac-J591, absolute SUVpeak values per tumor site declined significantly (p < 0.05) except for prostatic lesions (p = 1). The PERCIST-OR rate for osseous, nodal, visceral, and prostatic lesions was 53%, 28%, 56%, and 38%, respectively.
[225Ac]Ac-J591 is an active treatment in men with mCRPC. Tumor distribution patterns may influence treatment response and potentially prognosis. Our findings warrant further validation in a larger cohort but may be considered in treatment planning and trial design.
钋-225标记的前列腺特异性膜抗原（PSMA）靶向放射性核素治疗已成为转移性去势抵抗性前列腺癌（mCRPC）男性患者管理中的一种潜在治疗选择。本研究调查了分子影像衍生参数，并比较了按肿瘤部位分类的病变的影像反应。
纳入2017年至2022年在本中心接受[225Ac]Ac-J591治疗的mCRPC男性患者，这些患者参与了两项前瞻性试验（NCT03276572和NCT04506567），且有治疗前和治疗后的[68Ga]Ga-PSMA-11正电子发射断层扫描（PET）影像研究资料。人工评估肿瘤部位3个摄取最高和3个摄取最低的病变的SUVpeak。使用配对Wilcox检验评估每个肿瘤部位从治疗前到治疗后SUVpeak的中位数变化。根据实体瘤PET反应标准（PERCIST）1.0，将随访影像中的客观反应（OR）定义为完全或部分反应。
共有46例患者符合影像审查标准；其中大多数（n = 25，54.3%）有不止一种肿瘤部位分类。总共评估了445个PSMA PET阳性病变：220个骨病变、163个淋巴结病变、41个内脏病变和21个前列腺病变。用[225Ac]Ac-J591治疗后，除前列腺病变外（p = 1），每个肿瘤部位的绝对SUVpeak值均显著下降（p < 0.05）。骨、淋巴结、内脏和前列腺病变的PERCIST-OR率分别为53%、28%、56%和38%。
[225Ac]Ac-J591对mCRPC男性患者是一种有效的治疗方法。肿瘤分布模式可能影响治疗反应及潜在预后。我们的研究结果需要在更大队列中进一步验证，但可在治疗规划和试验设计中予以考虑。
