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Outcome of Patients with PSMA PET/CT Screen Failure by VISION Criteria and Treated with 177Lu-PSMA Therapy: A Multicenter Retrospective Analysis

Masatoshi Hotta, Andrei Gafita, Johannes Czernin and Jeremie Calais
Journal of Nuclear Medicine October 2022, 63 (10) 1484-1488; DOI: https://doi.org/10.2967/jnumed.121.263441

Article Figures & Data

Figures

  • Figure
  • FIGURE 1.
    FIGURE 1.

    Baseline PSMA PET maximum-intensity projection of patient with metastatic castration-resistant prostate cancer categorized as VISION-PET-SF because of low PSMA expression (i.e., no PSMA-positive [>liver] metastatic lesion). SUVmax of liver and highest-uptake lesion were 9.6 and 6.4, respectively.

  • FIGURE 2.
    FIGURE 2.

    Baseline PSMA PET maximum-intensity projection (A), CT image (B), and PSMA PET/CT image (C) of patient with metastatic castration-resistant prostate cancer categorized as VISION-PET-SF because of PSMA-negative lesion (i.e., PSMA-negative metastatic lesion: liver metastasis ≥ 1.0 cm, uptake ≤ liver). One liver metastasis (arrow) showed lower uptake (SUVmax, 4.1) than liver parenchyma (SUVmax, 6.3).

  • FIGURE 3.
    FIGURE 3.

    Kaplan–Meier curves of PSA PFS (A) and OS (B) comparing VISION-PET-E and VISION-PET-SF patients. HR = hazard ratio.

  • FIGURE 4.
    FIGURE 4.

    Kaplan–Meier curves of PSA PFS (A) and OS (B) comparing patients with low PSMA expression and PSMA-negative lesion. HR = hazard ratio.

Tables

  • TABLE 1.

    Patient Characteristics

    CharacteristicVISION-PET-EVISION-PET-SFP
    n27229
    Median age (y)72 (range, 66–76)73 (range, 65–76)0.91
    Median PSA (ng/mL)116.6 (interquartile range, 28.4–340.0)74.0 (interquartile range, 17.5–198.3)0.069
    Treatment history
     Previous docetaxel218 (80.1%)25 (86.2%)0.62
     Second-line chemotherapy95 (34.9%)8 (27.6%)0.54
     Androgen receptor signaling inhibitor257 (94.5%)27 (93.1%)0.67
    Extent of disease on PSMA PET/CT
     Number of metastases ≥ 20194 (71.3%)16 (55.2%)0.089
     Number of metastases < 2078 (28.7%)13 (44.8%)
    Sites of disease on PSMA PET/CT
     Node only (N1 or M1a)21 (7.7%)1 (3.4%)0.71
     Bone only (M1b)60 (22.1%)3 (10.3%)0.23
     Node + bone (M1b and [N1 or M1a])122 (44.9%)8 (27.6%)0.08
     Viscera (any M1c)69 (25.4%)17 (58.6%)<0.001
    Number of cycles of 177Lu-PSMA received
     138 (14.0%)5 (17.2%)0.065
     268 (25.0%)13 (44.8%)
     337 (13.6%)5 (17.2%)
     491 (33.5%)5 (17.2%)
     >438 (13.9%)1 (3.4%)
    Median injected activity per cycle (GBq)7.4 (interquartile range, 5.7–8.9)7.4 (interquartile range, 6.0–8.5)0.30
  • TABLE 2.

    Outcomes of VISION-PET-E and VISION-PET-SF Patients

    OutcomeVISION- PET-EVISION- PET-SFP
    n27229
    ≥50% PSA decline
     n131 (50.3%)6 (20.7%)0.005
     Odds ratio10.28 (95%CI, 0.11–0.71)0.007
    Any PSA decline
     n194 (71.3%)12 (41.4%)0.003
     Odds ratio10.28 (95%CI, 0.13–0.62)<0.001
    PSA PFS
     Median months4.9 (95%CI, 4.0–5.8)2.1 (95%CI, 1.4–3.3)0.023
     Hazard ratio11.6 (95%CI, 1.1–2.5)0.025
    OS
     Median months14.2 (95%CI, 12.6–15.9)9.6 (95%CI, 4.7–14.0)0.16
     Hazard ratio11.4 (95%CI, 0.89–2.3)0.16

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