ArticleEuropean journal of nuclear medicine and molecular imaging2026
Quantitative dual-tracer PET/CT biomarkers correlate concordant lesion uptake with PSMA-RLT outcomes in mCRPC: a dual-center study.
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Real-world outcomes of [European journal of nuclear medicine and molecular imaging · 2026Article
- FDG/PSMA discordance in [Frontiers in oncology · 2026Review
- Artificial intelligence across oncologic theranostics: evidence for patient stratification, dosimetry, and adaptive radiopharmaceutical therapy.Frontiers in nuclear medicine · 2026Review
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12 authors.
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Abstract
Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC). However, current patient selection methods – largely based on qualitative imaging criteria – may impede precision and efficacy of treatment. We aimed to evaluate the predictive value of quantitative imaging biomarkers derived from dual-tracer [68 Ga]Ga-PSMA-11 and [18F]F-FDG PET/CT, with a focus on concordant lesions.
methodsThirty-seven mCRPC patients from two institutions underwent [68 Ga]Ga-PSMA-11 and [18F]F-FDG PET/CT prior to receiving at least two cycles of [177Lu]Lu-PSMA therapy. An automated pipeline enabled lesion segmentation, dual-tracer image fusion, and extraction of quantitative features from concordant (PSMA + /FDG +) and non-concordant lesions. A decision tree model was developed on the Vienna cohort (n = 24) and validated on an independent cohort from Augsburg (n = 13). SHAP analysis was used to identify key predictive features.
resultsThe decision tree achieved 95.8% accuracy in the training cohort and 84.6% in external validation. SUVmean of concordant lesions was the most predictive features. Patients with SUVmean[PSMA Concordant] ≥ 12.1 g/mL were more likely to respond. Organ-specific analysis further identified high SUVmax in bone metastases as a negative prognostic marker.
conclusionsQuantitative metrics from dual-tracer PET, particularly those characterizing concordant lesions, show promise for predicting response to PSMA-RLT. These preliminary findings highlight the potential to move beyond binary eligibility criteria toward a more nuanced, biomarker-driven approach to patient selection.
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