Pre-therapeutic PSMA PET Imaging Biomarkers Demonstrate Prognostic Value in Patients Undergoing [177Lu]Lu-PSMA Therapy: A Systematic Review and Meta-analysis
Abstract
Introduction: [177Lu]Lu-prostate-specific membrane antigen (PSMA) radioligand therapy can improve outcomes in patients with metastatic castration-resistant prostate cancer, though response is highly variable in clinical practice. We performed a systematic review and meta-analysis to evaluate the prognostic value of pre-therapeutic PSMA PET-derived imaging biomarkers to better inform patient selection for treatment.
Methods: PubMed, EMBASE, Web of Science, and Scopus were searched from inception to December 2025 in accordance with PRISMA guidelines (PROSPERO CRD420251074879). Pre-therapeutic PSMA PET biomarkers of interest were the mean and maximum standardised uptake value (SUVmean and SUVmax), PSMA tumour volume (PSMA-TV), total lesional uptake (PSMA-TLU), and total lesional quotient (PSMA-TLQ). Outcomes were overall survival (OS), prostate-specific antigen progression-free survival, and 50% reduction in prostate-specific antigen levels (PSA50). Random-effects meta-analyses were performed, prioritising multivariable-adjusted effect estimates. Risk of bias was assessed using the Quality In Prognosis Studies tool.
Results: Thirty-seven studies were included, with 33 contributing to quantitative synthesis (n = 2993). For each unit increase in SUVmean, there was a reduced risk of death (hazard ratio [HR] = 0.88, 95% CI, 0.85-0.92; P max showed limited prognostic value. Most studies were retrospective and were classified as having moderate risk of bias.
Conclusion: Baseline PSMA…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,993 participants or records.
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