What question did this study set out to answer?

Identify predictive parameters for renal and hematological adverse events in patients undergoing radioligand therapy for metastatic castration-resistant prostate cancer.

February 11, 2026Open Access

PET-based risk stratification for adverse events under 225AcAc-PSMA radioligand therapy

Key Points

Identify predictive parameters for renal and hematological adverse events in patients undergoing radioligand therapy for metastatic castration-resistant prostate cancer.
Retrospective analysis of 26 patients undergoing 225Ac-PSMA-I&T RLT
Pretherapeutic PET/CT utilized to assess renal standardized uptake values
Technetium-99m renal scintigraphy conducted for tubular extraction rates
Correlations analyzed between laboratory values (eGFR, Hb) and therapy outcomes
eGFR and Hb significantly declined during therapy (P = 0.0018 and P = 0.0002)
31% of patients experienced renal events, and 38% developed grade 3 anemia
PET-derived standardized uptake values correlated with eGFR and tubular extraction rates (r ≥ 0.413, P ≤ 0.036)
Baseline hemoglobin was the strongest predictor of grade 3 anemia (P = 0.002)

Abstract

Actinium-225 prostate-specific membrane antigen radioligand therapy ( 225 AcAc-PSMA RLT) is a promising salvage option for metastatic castration-resistant prostate cancer (mCRPC). This study aimed to identify predictive parameters for renal and hematological adverse events. Twenty-six patients undergoing 225 AcAc-PSMA-I each P ≤ 0.037) also contributed. In line, baseline Hb emerged as the strongest predictor of anemia-free survival ( P = 0.0007; osseous TV, P = 0.024). PET-derived renal SUV and osseous tumor volume are promising predictive markers for renal and hematological adverse events during 225 AcAc-PSMA-I&T RLT. These findings may support pretherapeutic risk stratification in this vulnerable patient population.

PET-based risk stratification for adverse events under 225AcAc-PSMA radioligand therapy

Key Points

Abstract

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