Linking Baseline PSMA PET–Derived Parameters to Toxicity, Adverse Events, Pain, and Quality of Life in Patients Treated with 177 LuLu-PSMA-617: A Single-Center Retrospective Study

This study aimed to investigate whether quantitative parameters derived from baseline prostate-specific membrane antigen (PSMA) PET imaging can predict hematologic toxicity and patient-reported outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with 177Lu-PSMA-617. Methods: This retrospective study analyzed data from the U.S. expanded-access program at UCLA (NCT04825652). We included 61 patients with mCRPC who received 177Lu-PSMA-617 between May 2021 and March 2022 and had available baseline PSMA PET scans, hematologic toxicity data, and patient-reported outcomes. Questionnaires included the Functional Assessment of Cancer Therapy-Prostate (FACT-P), the Brief Pain Inventory-Short Form (BPI-SF), and a xerostomia assessment, all completed at each treatment cycle. Baseline PSMA PET parameters-including volume, SUVmean, SUVmax, and total lesion PSMA (TLP; calculated by multiplying SUVmean by volume) for whole-body disease, bone disease, and salivary glands-were quantified using TRAQinform IQ. Associations between these imaging metrics and clinical outcomes were assessed using univariate and multivariate models. Results: Multivariate Cox regression analysis showed that higher baseline bone tumor SUVmean was significantly associated with delayed onset of grade 3 or 4 hematologic toxicity (hazard ratio HR, 0.59; 95% CI, 0.36-0.98; P = 0.040), suggesting a protective effect. Conversely, higher bone TLP was associated with earlier onset of severe toxicity (HR, 1.31; 95% CI, 1.00-1.71; P = 0.049). Elevated whole-body SUVmean at baseline was predictive of delayed deterioration in both FACT-P total scores (HR, 0.59; 95% CI, 0.43-0.83; P = 0.002) and BPI-SF pain intensity (HR, 0.66; 95% CI, 0.46-0.93; P = 0.019). Additionally, higher salivary gland SUVmean, SUVmax, and TLP were significantly associated with increased xerostomia severity (P = 0.002, P = 0.006, and P = 0.015, respectively) in multivariate linear mixed-effects modeling. Conclusion: In this retrospective analysis of patients with mCRPC treated with 177Lu-PSMA-617, baseline quantitative PSMA PET parameters were associated with both treatment-related toxicities and patient-reported outcomes. Validation in a larger, prospective, multicenter cohort is warranted.