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. 2025 Aug 2.
doi: 10.1007/s00259-025-07492-9. Online ahead of print.

Bellmunt risk score enables survival prediction in men with metastatic castration resistant prostate cancer (mCRPC) undergoing PSMA-targeted radioligand therapy (LUMEN)

Thomas Büttner #  1 , Milka Marinova #  2 , Florian C Gaertner  3 , Barbara Kreppel  3 , Leander Fritsche  1 , Christian Immanuel  3 , Gerd Geraths  3 , Stefan Kürpig  3 , Jim Küppers  3 , Ingo G H Schmidt-Wolf  4 , Markus Essler  3 , Manuel Ritter  1 , Philipp Krausewitz  1
Affiliations

Bellmunt risk score enables survival prediction in men with metastatic castration resistant prostate cancer (mCRPC) undergoing PSMA-targeted radioligand therapy (LUMEN)

Thomas Büttner et al. Eur J Nucl Med Mol Imaging. .

Abstract

Purpose: [177Lu]Lu-PSMA-617 therapy has emerged as a promising radioligand treatment for metastatic castration-resistant prostate cancer (mCRPC). Given the overall poor prognosis of mCRPC, accurately predicting the key endpoint overall survival (OS) remains an ongoing challenge, crucial for optimizing risk/benefit assessment prior to treatment. This study investigates the prognostic utility of the simple designed Bellmunt Risk Score (BRS) in mCRPC patients treated with [177Lu]Lu-PSMA-617.

Methods: We retrospectively evaluated data from 386 mCRPC patients who had received [177Lu]Lu-PSMA-617 therapy at our center. BRS was constructed by attributing one point for each of the following risk factors: ECOG performance status (ECOG PS) > 0, hemoglobin < 10 g/dL, and the presence of liver metastases. Additionally, an enhanced version of the score including C-reactive protein (CRP) > 30 mg/dL and a modified version utilizing a semi-quantitative ECOG PS were developed. Statistical analysis included Cox regression, Kaplan-Meier estimates, concordance indices and time-dependent area under the curve (tAUC).

Results: The BRS served as an independent predictor of OS in multivariable analysis. The estimated median OS was 17.6, 10.9, 6.6, and 2.7 months for patients with scores of 0, 1, 2 and 3, respectively (Log-Rank P < 0.001). The tAUC values for predicting 1-year and 2-year OS were 71.6% and 74.4%, respectively. The CRP-enhanced score further improved prognostic accuracy, achieving tAUCs of 75.7% for 1-year OS and 78.1% for 2-year OS.

Conclusion: The Bellmunt Risk Score effectively stratifies mCRPC patients undergoing [177Lu]Lu-PSMA-617 therapy. Its straightforward design, based on readily accessible clinical parameters, ensures practicality and utility in real-world clinical settings.

Keywords: Bellmunt Risk Score; Lutetium; PSMA; Prediction; Survival; mCRPC.

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Conflict of interest statement

Declarations. Ethics approval: This is an observational study. The responsible ethic committee at the Medical Faculty of University Bonn has confirmed that no ethical approval and informed consent is required (vote no. 2024-19-BO). Competing interests: Thomas Büttner received speaker honorary from Astellas. Philipp Krausewitz received speaker honorary from Novartis and Johnson and Johnson. All other authors have no competing interests to declare that are relevant to the content of this article.

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