Prognostic Value of Interim Post-Treatment Spect/Ct Following Lutetium-177 (177Lu)-Psma Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis Publisher

Summary: Can scans flag poor prostate cancer outcomes? A seven-study review linked new lesions and growing tumor volume on PSMA SPECT/CT to shorter survival. #ProstateCancer #Imaging

Shamshirgaran A ; Samadi M H ; Aboutalebi F ; Zahedian S ; Sahafi P ; Saeed M ; Rizzo A ; Treglia G ; Sadeghi R ; Aghaee A ; Askari E
Source: Frontiers in Medicine Published:2026

Abstract

Background – Lutetium-177 (177Lu)-PSMA radioligand therapy (RLT) is established for metastatic castration-resistant prostate cancer (mCRPC), but radiologic monitoring during the treatment lacks standardization. While interim PSMA PET/CT offers accuracy, post-treatment 177Lu-PSMA SPECT/CT provides practical advantages for early response assessment. This systematic review and meta-analysis evaluates the prognostic value of interim post-treatment SPECT/CT parameters on survival outcomes in mCRPC patients. Methods – Following PRISMA guidelines and PICO framework, PubMed/MEDLINE, Scopus, and Google Scholar were searched up to December 2025 for studies on mCRPC patients receiving 177Lu-PSMA RLT with early post-treatment SPECT/CT. Inclusion required cohort designs reporting hazard ratios (HRs) for overall survival (OS) and PSA-progression-free survival (PSA-PFS). Data extraction included study characteristics, imaging protocols, and outcomes. Quality was assessed using the Oxford CEBM tool. Random-effects meta-analysis pooled HRs; heterogeneity (I2) and publication bias (funnel plots, Egger’s test, trim-and-fill) were evaluated. Results – Seven studies (648 patients) were included. Pooled HRs showed emerging new lesions associated with worse OS (HR = 2.78, 95% CI: 1.91–4.06, p < 0.001) and PSA-PFS (HR = 4.72, 95% CI: 1.57–14.15, p = 0.006). Total tumor volume (TTV) increases predicted inferior OS (HR = 1.80, 95% CI: 1.29–2.50, p < 0.001) and PSA-PFS (HR = 2.86, 95% CI: 2.12–3.85, p < 0.001). SUVmean and SUVmax reductions were non-significant. Heterogeneity was low-moderate and publication bias had minimal impact post-adjustment. Conclusion – Interim 177Lu-PSMA SPECT/CT offers prognostic insights, with new lesions and TTV increases signaling poor outcomes. Standardization and prospective validation are needed to integrate it into clinical practice. Copyright © 2026 Shamshirgaran, Samadi, Aboutalebi, Zahedian, Sahafi, Saeed, Rizzo, Treglia, Sadeghi, Aghaee and Askari.