ArticleEuropean journal of nuclear medicine and molecular imaging2022
mCRPC patients with PSA fluctuations under radioligand therapy have comparable survival benefits relative to patients with sustained PSA decrease.
Article in European journal of nuclear medicine and molecular imaging, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 17 citations in OpenAlex.
- Evaluation of the safety and efficacy ofEuropean radiology experimental · 2026Trial
- Baseline PSMA-ligand PET/CT as a predictive biomarker for early progression in metastatic castration-resistant prostate cancer patients undergoing [177Lu]Lu-PSMA-617 radioligand therapy.Annals of nuclear medicine · 2026Article
- Use ofWiener klinische Wochenschrift · 2025Article
- Visceral metastases, platelet dynamics, and PSA decline: from biomarkers to better outcomes in [Theranostics · 2025Article
- From Despair to Hope: First Arabic Experience ofCancers · 2024Article
- Quantification of biochemical PSA dynamics after radioligand therapy with [EJNMMI physics · 2024Article
- Early biochemical and radiographic response after one cycle of [European journal of nuclear medicine and molecular imaging · 2023Article
- SUVEuropean journal of nuclear medicine and molecular imaging · 2023Article
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Authors and funding
10 authors at 3 institutions in 2 countries.
Funding
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Abstract
introductionIn men with metastatic castration-resistant prostate cancer (mCRPC) scheduled for prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), biochemical response is assessed based on repeated measurements of prostate-specific antigen (PSA) levels. We aimed to determine overall survival (OS) in patients experiencing sustained PSA increase, decrease, or fluctuations during therapy. MATERIALS AND
methodsIn this bicentric study, we included 176 mCRPC patients treated with PSMA-directed RLT. PSA levels were determined using blood samples prior to the first RLT and on the admission days for the following cycles. We calculated relative changes in PSA levels compared to baseline. Kaplan-Meier curves as well as log-rank test were used to compare OS of different subgroups, including patients with sustained PSA increase, decrease, or fluctuations (defined as change after initial decrease or increase after the first cycle).
resultsSixty-one out of one hundred seventy-six (34.7%) patients showed a sustained increase and 86/176 (48.8%) a sustained decrease in PSA levels. PSA fluctuations were observed in the remaining 29/176 (16.5%). In this subgroup, 22/29 experienced initial PSA decrease followed by an increase (7/29, initial increase followed by a decrease). Median OS of patients with sustained decrease in PSA levels was significantly longer when compared to patients with sustained increase of PSA levels (19 vs. 8 months; HR 0.35, 95% CI 0.22-0.56; P < 0.001). Patients with PSA fluctuations showed a significantly longer median OS compared to patients with sustained increase of PSA levels (18 vs. 8 months; HR 0.49, 95% CI 0.30-0.80; P < 0.01), but no significant difference relative to men with sustained PSA decrease (18 vs. 19 months; HR 1.4, 95% CI 0.78-2.49; P = 0.20). In addition, in men experiencing PSA fluctuations, median OS did not differ significantly between patients with initial decrease or initial increase of tumor marker levels (16 vs. 18 months; HR 1.2, 95% CI 0.38-4.05; P = 0.68).
conclusionInitial increase or decrease of PSA levels is sustained in the majority of patients undergoing RLT. Sustained PSA decrease was linked to prolonged survival and men with PSA fluctuations under treatment experienced comparable survival benefits. As such, transient tumor marker oscillations under RLT should rather not lead to treatment discontinuation, especially in the absence of radiological progression.
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