Article Figures & Data
Figures
- FIGURE 1.
Correlation between age and percentage PSA changes (R2 = 0.149).
- FIGURE 2.
Correlation between platelet counts and percentage PSA changes (R2 = 0.274).
Tables
Characteristic No. of patients History (n) Ongoing (n) No history (n) Extent Gleason score 6 4 (10) 7 3 (7.5) 8 11 (27.5) 9 14 (35) 10 5 (12.5) Unknown 3 (7.5) Prior and ongoing therapies Prostatectomy 21 (52.5) 19 (47.5) Abiraterone*† 18 (45) 9 (22.5) 13 (32.5) Enzalutamide*† 10 (25) 15 (37.5) 15 (37.5) Chemotherapy 21 (52.5) 19 (47.5) Bisphosphonate or RANKL inhibitor 3 (7.5) 29 (72.5) 8 (20) 223Ra 14 (35) 26 (65) Regular need for analgesics 15 (37.5) Extent of disease in 40 patients, detected by 68Ga-PSMA PET/CT Local recurrence 17 (42.5) Bone met 40 (100) <6 met in 3 pts (7.5) 6–20 met in 2 pts (5) >20 met in 29 pts (72.5) Diffuse met in 6 pts (15) Lymph node met 33 (82.5) Ileal and abd in 14 pts (45.5) Thor in 2 pts (6) Ileal to thor in 16 pts (48.5) Liver met 8 (20) Singular met in 2 pts Multiple met in 6 pts Lung met 3 (7.5) Singular met in 2 pts Multiple met in 1 pt ↵* Five patients took neither abiretarone nor enzalutamide, and 3 patients took bicalutamide.
↵† All patients who were taking enzalutamide or abiraterone had increasing PSA under these medications.
RANKL = receptor activator of nuclear factor κ-B ligand; met = metastases; pts = patients; abd = abdominal; thor = thoracic.
Data in parentheses are percentages.
Parameter Minimum Maximum Mean Median Blood parameters WBCs (G/L) (norm, 3.6–10.5) 2.7 12.2 6.4 6.3 Hb (g/dL) (norm, 12.5–17.2) 6.0* 14.5 10.9 11.0 Plt (G/L) (norm, 160–370) 62 557 278.9 262.5 Renal parameters Creatinine (mg/dL) (norm, 0.6–1.3) 0.53 2.54 0.95 0.9 GFR (mL/min) (norm, > 70) 50 >70† Liver function tests Bilirubin total (mg/dL) (norm, 0.2–1.0) 0.21 1.20 0.41 0.40 ALT (U/L) (norm, <50) 8 67 18.9 16.5 AST(U/L) (norm, <50) 10 302 37.5 24 GGT (U/L) (norm, <55) 17 425 67.6 40 Albumin (g/L) (norm, 35–52) 25.8 46.9 37.6 37.6 ↵* Seven patients had received blood transfusion before therapy because of grade 3 tumor anemia 10–180 d before 177Lu-PSMA therapy (median, 21 d); 1 of the patients had another blood transfusion 1 d before therapy because of an Hb of 6 g/dL.
↵† Thirty-two patients (80%) had a GFR greater than 70 mL/min.
WBCs = white blood cells; Hb = hemoglobin; Plt = platelets; GFR = glomerular fraction rate; ALT = alanine transaminase; AST = aspartate transaminase; GGT = γ-glutamyl transferase.
Parameter Minimum Maximum Mean Median ALP (U/L) (norm, 34–117) 38 1,607 247.3 176.5 LDH (U/L) (norm, <248) 147 1,875 411.4 257 CRP (mg/L) (norm, <3) 0.2 128 24.9 16.2 PSA (ng/mL) 4.73 2,360 495.1 325.5 ALP = alkaline phosphatase; LDH = lactate dehydrogenase.
Parameter Minimum Maximum Mean Median SUVmaxBN 4.50 100.68 26.07 20.76 SUVmaxBN/liver 0.60 13.51 4.17 3.66 SUVmaxBN/spleen 0.69 19.55 4.27 2.98 SUVmaxLn 4.0 98.60 26.24 14.10 SUVmaxLn/liver 0.41 15.91 3.76 2.53 SUVmaxLn/spleen 0.38 33.65 4.95 2.10 - TABLE 5
Linear Regression Analysis of Different Pretherapeutic Parameters and Their Impact on PSA Change
Parameter P Parameter P Amount of activity (MBq) NS Creatinine NS Activity (MBq)/weight (Kg) NS Total bilirubin NS Abiretarone NS Hb NS Enzalutamide NS RBC NS Chemotherapy NS WBCs NS 223Ra NS PSA level NS Bisphosphonate or denosumab NS SUVmax (bone) NS Number of bone metastases NS SUVmax (lymph node) NS Extent of lymph node metastases NS SUVmax bone/liver NS Existence of liver metastases NS SUVmax bone/spleen NS ECOG performance status NS SUVmax lymph node/liver NS Albumin NS SUVmax lymph node/spleen NS AST and ALT NS Plt 0.0005 ALP NS CRP 0.0203 GGT NS Age 0.0139 LDH NS Gleason score 0.0096 GFR NS Regular need for pain medication 0.0050 NS = not significant; Hb = hemoglobin; RBC = red blood cells; WBCs = white blood cells; AST = aspartate aminotransferase; ALT = alanine transaminase; Plt = platelets; ALP = alkaline phosphatase; LDH = lactate dehydrogenase; GFR = glomerular filtration rate.
- TABLE 6
Univariate and Multivariate Analyses of Different Pretherapeutic Parameters Regarding Any PSA Decline
Parameter Odds ratio 95% CI P P multivariate analysis Activity (MBq)/weight (kg) 0.989 0.944–1.035 0.62 Abiretarone 0.846 0.368–1.944 0.69 Enzalutamide 0.932 0.398–2.181 0.87 Chemotherapy 0.828 0.426–1.609 0.57 223Ra 0.436 0.097–1.958 0.27 Bisphosphonate or denosumab 0.848 0.231–3.109 0.80 No. of bone metastases 1.165 0.444–3.061 0.75 Extent of lymph node metastases 1.281 0.731–2.243 0.38 Existence of liver metastases 1.114 0.202–6.158 0.90 ECOG performance status 1.685 0.761–3.733 0.19 Albumin 0.987 0.847–1.149 0.86 AST 1.018 0.988–1.048 0.23 ALT 1.043 0.976–1.115 0.21 GGT 1.024 1.006–1.041 0.008 NS ALP 1.003 0.999–1.006 0.15 LDH 1.002 1.000–1.005 0.04 NS Creatinine 4.714 0.464–47.907 0.19 Total bilirubin 0.014 <0.001–7.401 0.18 Hb 0.574 0.341–0.967 0.04 NS RBC 0.429 0.127–1.444 0.17 WBCs 1.220 0.890–1.674 0.21 PSA level 0.999 0.997–1.000 0.15 SUVmax (bone) 0.974 0.931–1.020 0.26 SUVmax (lymph node) 0.980 0.944–1.018 0.30 SUVmax bone/liver 0.746 0.529–1.053 0.09 SUVmax bone/spleen 0.635 0.394–1.022 0.06 SUVmax lymph node/liver 0.752 0.501–1.130 0.16 SUVmax lymph node/spleen 0.828 0.612–1.120 0.22 Plt 1.010 1.001–1.018 0.02 0.01 CRP 1.047 1.011–1.085 0.009 NS Age 0.885 0.805–0.972 0.01 NS Gleason score 4.121 1.304–13.016 0.01 NS Regular need for pain medication 0.091 0.017–0.501 0.005 0.0018 CI = confidence interval; NS = not significant; AST = aspartate aminotransferase; ALT = alanine transaminase; ALP = alkaline phosphatase; LDH = lactate dehydrogenase; Hb = hemoglobin; RBC = red blood cells; WBCs = white blood cells; Plt = platelets.
- TABLE 7
Univariate and Multivariate Analysis of Different Pretherapeutic Parameters Regarding PSA Decline of More Than 50%
Parameter Odds ratio 95% CI P P multivariate analysis Activity (MBq)/weight (kg) 1.028 0.979–1.079 0.26 Abiretarone 0.986 0.427–2.280 0.97 Enzalutamide 0.738 0.315–1.728 0.48 Chemotherapy 1.526 0.775–3.005 0.22 223Ra 1.324 0.322–5.439 0.69 Bisphosphonate or denosumab 1.179 0.322–4.320 0.80 No. of bone metastases 1.351 0.538–3.392 0.52 Extent of lymph node metastases 1.189 0.721–1.961 0.49 Existence of liver metastases 0.661 0.088–4.956 0.68 ECOG performance status 2.150 0.918–5.036 0.07 Albumin 1.042 0.894–1.215 0.59 AST 1.009 0.983–1.035 0.49 ALT 1.017 0.948–1.092 0.63 GGT 1.013 0.995–1.033 0.16 ALP 1.002 0.998–1.006 0.36 LDH 1.005 0.999–1.010 0.12 Creatinine 3.031 0.218–42.194 0.40 Total bilirubin 0.024 <0.001–1.908 0.09 Hb 0.868 0.560–1.345 0.52 RBC 1.014 0.326–3.158 0.98 WBCs 1.377 0.956–1.984 0.08 PSA level 1.000 0.999–1.001 0.77 SUVmax (bone) 1.023 0.979–1.070 0.30 SUVmax (lymph node) 0.988 0.960–1.016 0.39 SUVmax bone/liver 1.199 0.900–1.597 0.21 SUVmax bone/spleen 1.120 0.898–1.398 0.31 SUVmax lymph node/liver 0.971 0.785–1.200 0.78 SUVmax lymph node/spleen 0.990 0.896–1.094 0.84 Plt 1.007 0.999–1.015 0.10 CRP 1.051 0.995–1.110 0.07 Age 0.953 0.876–1.036 0.25 Gleason score 1.598 0.853–2.991 0.01 NS Regular need for pain medication 0.156 0.036–0.669 0.01 0.01 CI = confidence interval; AST = aspartate aminotransferase; ALT = alanine transaminase; ALP = alkaline phosphatase; LDH = lactate dehydrogenase; Hb = hemoglobin; RBC = red blood cells; Plt = platelets; WBCs = white blood cells; NS = not significant.
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