A novel, efficient method for scintigraphy-based monitoring enables doctors to quickly and accurately evaluate the progression or improvement of prostate cancer during treatment. This valuable prognostic data allows for tailored treatment plans based on how the tumor evolves, greatly influencing patients' overall survival.
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This research was published online in The Journal of Nuclear Medicine.
177Lu-PSMA is a precisely directed radiopharmaceutical therapy for metastatic castration-resistant prostate cancer (mCRPC). Traditional methods of monitoring during177Lu-PSMA treatment involves evaluating the patient's medical status and measuring prostate-specific antigen (PSA) levels.
PSMA PET/CT is also conducted prior to and throughout the course of treatment.177SPECT imaging of Lu after each injection has demonstrated promise for tracking treatment, although it typically requires extended scanning periods.
This disadvantage makes it difficult to consistently carry out SPECT following each177"Lu-PSMA injection, particularly following the final dose, could offer the most significant prognostic insights," stated Laetitia Imbert, Ph.D., a physicist at the Regional University Hospital Center in Nancy, France.
However, this technical challenge can now be largely addressed with the introduction of high-sensitivity 360 cadmium zinc telluride (CZT) SPECT systems, allowing for whole-body SPECT imaging in less than 20 minutes. Our research aimed to further investigate this new SPECT method in terms of177Lu PSMA treatment monitoring."
The study looked at 72 patients with mCRPC who were given a maximum of six treatments.177Lu-PSMA therapy. All patients received68Ga-PSMA-11 PET prior to starting treatment, had their PSA levels checked before each injection, and underwent177Lu-PSMA CZT SPECT following each injection. Quantitative image analysis and statistical image processing were conducted to forecast overall survival.
Most PSA, PET, and CZT SPECT variables served as significant single-variable predictors of overall survival. However, only two177Lu CZT SPECT variables served as multivariate predictors: identification of new bone lesions throughout treatment and the overall lesion activity at the end (TLA).
The average survival time was 19.7 months for the 19 patients who had no new bone lesions and low TLA levels; 14.4 months for the 19 patients who met only one of the two criteria; and 6.9 months for the 19 patients who did not meet either criterion.
"Combating cancer is a race against time, since the illness can progress quickly. This new scintigraphy camera will help in adjusting treatment strategies for patients who don't respond effectively, as early as possible," said Caroline Boursier, MD, a doctor at the Regional University Hospital Center in Nancy, France.
Enhancements might be possible by modifying the introduced level of activity177Lu-PSMA, replacing this radioactive therapeutic agent with another option, or using it in conjunction with other cancer therapies like chemotherapy, external radiation therapy, immunotherapy, or anti-angiogenic medications.
She stated, "From a logistical standpoint, tracking patients using CZT SPECT is straightforward to arrange due to the extremely quick imaging process and the absence of the need for an extra tracer injection. As a result, scintigraphy imaging can start immediately upon the patient's arrival at the nuclear medicine department, and according to our experience, they can depart within 30 minutes."
More information:Julien Kunsch et al., Prognostic Significance of Detailed Analysis of Metastatic Prostate Tumor Changes from Initial to Final Stage [177Lu]Lu-PSMA Therapy Injections via Serial High-Speed Whole-Body 360° Cadmium-Zinc-Telluride SPECT,Journal of Nuclear Medicine (2025). DOI: 10.2967/jnumed.125.270358
Supplied by the Society of Nuclear Medicine and Molecular Imaging
This narrative was first released onMedical Xpress.