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This month's editor's favorite is Rosar and colleagues' “225Ac-PSMA-617 Augmentation in High-Risk mCRPC Undergoing 177Lu-PSMA-617 Radioligand Therapy Pilot Experience From a Prospective Registry​".

This prospective pilot study investigates the efficacy and safety profile as well as predictive biomarkers of 225Ac-PSMA-617–augmented 177Lu-PSMA- 617 radioligand therapy (RLT) in 33 high-risk patients with metastatic castration-resistant prostate cancer (mCRPC), enrolled in registry (NCT 04833517).

Participants received 177Lu-PSMA-617 RLT, augmented by 1 or more cycles of 225Ac- PSMA-617. Response was assessed by prostate-specific antigen (PSA) serum value after 2 cycles of treatment. Overall survival (OS) and PSA based progression-free survival were evaluated using Kaplan-Meier analysis.

Common Terminology Criteria for Adverse Events were analyzed along with 12 potential pretherapeutic biomarkers for association with OS.

The median decrease in serum PSA value was −49.1%, and 16/33 (48.5%) patients experienced a partial response after 2 RLT cycles. Median PSA-based progression-free survival and median OS were 7.2 and 14.8 months, respectively.

Alkaline phosphatase (P < 0.001), lactate dehydrogenase (P = 0.035), Eastern European Oncology Group Performance Score (P = 0.037), and the presence of visceral metastases (P = 0.029) revealed significant association with OS in Kaplan-Meier analysis (log-rank test). Most of the recorded adverse events were rated as mild or moderate.

Higher-grade adverse events were very limited with only 1 case (3.0%) of grade 3 anemia. Treatment-related mild xerostomia was recorded in 6/33 (18.2%) patients.

The authors concluded that  225Ac-PSMA-617 augmentation in high-risk mCRPC undergoing 177Lu-PSMA-617 RLT appears to be an effective treatment option with a favorable safety profile. The pretherapeutic values of alkaline phosphatase, lactate dehydrogenase, the Eastern European Oncology Group Performance Score, and the presence of visceral metastases may be appropriate biomarkers predicting survival outcome of this treatment regimen.

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Reducing False-Positives Due to Urinary Stagnation in the Prostatic Urethra on 18F-DCFPyL PSMA PET/CT With MRI

Gelikman, David G.; Mena, Esther; Lindenberg, Liza; More

Clinical Nuclear Medicine. 49(7):630-636, July 2024.

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