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. 2025 Jun 16.
doi: 10.1007/s00259-025-07407-8. Online ahead of print.

The additive value of 68Ga-RM26 PET/CT to 68Ga-PSMA-617 PET/CT in assessing Post-treatment outcomes of ARSIs in mCRPC patients

Xuhao Liu  1 , Lin Qi  1 , Xiaomei Gao  2 , Shuo Hu  3   4 , Yongxiang Tang  5   6 , Minfeng Chen  7   8 , Yi Cai  9   10
Affiliations

The additive value of 68Ga-RM26 PET/CT to 68Ga-PSMA-617 PET/CT in assessing Post-treatment outcomes of ARSIs in mCRPC patients

Xuhao Liu et al. Eur J Nucl Med Mol Imaging. .

Abstract

Background: Besides its potential as a PET/CT tracer, the Gastrin-Releasing Peptide Receptor (GRPR) has been shown to predict the prognosis of Prostate Cancer (PCa). Herein, we aimed to evaluate the additive ability of 68Ga-RM26 PET/CT as a tracer to predict the prognosis of patients with metastatic Castration-Resistant Prostate Cancer (mCRPC) following Androgen Receptor Signal Inhibitors (ARSIs) therapy.

Methods: This retrospective single-center study involved patients who underwent both 68Ga-PSMA-617 PET/CT and 68Ga-RM26 PET/CT scans. Based on the GRPR status of their lesions (positive/negative), the patients were stratified into two cohorts, and their actual prognosis was assessed by comparing their maximum Prostate-Specific Antigen (PSA) response rates and Progression-Free Survival (PFS) durations following ARSI therapy.

Results: This study involved 44 patients. Among them, 41 and 23 showed PSMA uptake and GRPR uptake, respectively, with 3 exhibiting GRPR uptake alone. The GRPR + group had an median PSA response rate of 37.78% and a median PFS duration of 8.9 months, both of which were significantly lower than those of GRPR- patients, whose corresponding values were 69.39% and 14.37 months, respectively. According to the multivariate analysis results, GRPR status, distant Lymph Node Metastasis (LNM) and PSMA SUVmax of bone metastases lesions were significant predictors of the PSA response rate. Furthermore, the GRPR status and PSMA SUVmax of regional lymph node metastases were significant predictors of PFS.

Conclusion: Compared to GRPR- patients, mCRPC patients with GRPR + lesions exhibited a lower median maximum PSA response rate and a shorter median PFS duration following ARSI treatment, implying a poorer response to therapy and relatively worse prognosis in the latter subgroup.

Keywords: ARSI; GRPR; PSMA; Prognosis; mCRPC.

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Conflict of interest statement

Declarations. Statement of ethics: All patients gave their written informed consents for the publication of all data and images. Ethics approval: The study protocol was approved by the Ethics Committee of Xiangya Hospital. The study adheres to the principles of the Helsinki Declaration and is meticulously executed according to established protocols. Informed consent: All patients provided written informed consent. Consent for publication: All authors approved the final version of the manuscript. All the co-authors of this article have consented to its publication. Consent to participate: We comprehensively introduced the purpose and relevant contents of this study to the patients, ensuring full protection of patiens’ privacy. All patients participated in this study voluntarily. Conflict of interest: None declared. Clinical trial number: Not applicable.

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