The efficacy of radioligand therapy (RLT) targeting prostate-specific membrane antigen (PSMA) is currently being investigated for its application in patients with early-stage prostate cancer (PCa). However, little is known about PSMA expression in healthy organs in this cohort. Collectively, 202 [68Ga]Ga-PSMA-11 positron emission tomography (PET) scans from 152 patients were studied. Of these, 102 PET scans were from patients with primary PCa and hormone-sensitive biochemically recurrent PCa and 50 PET scans were from patients with metastatic castration-resistant PCa (mCRPC) before and after three cycles of [177Lu]Lu-PSMA-RLT. PSMA-standardized uptake values (SUV) were measured in multiple organs and PSMA-total tumor volume (PSMA-TTV) was determined in all cohorts. The measured PET parameters of the different cohorts were normalized to the bloodpool and compared using t- or Mann–Whitney U tests. Patients with early-stage PCa had lower PSMA-TTVs (10.39 mL vs. 462.42 mL,p< 0.001) and showed different SUVs in the thyroid, submandibular glands, heart, liver, kidneys, intestine, testes and bone marrow compared to patients with advanced CRPC, with all tests showingp< 0.05. Despite the differences in the PSMA-TTV of patients with mCRPC before and after [177Lu]Lu-PSMA-RLT (462.42 mL vs. 276.29 mL,p= 0.023), no significant organ differences in PET parameters were detected. These suggest different degrees of PSMA-ligand binding among patients with different stages of PCa that could influence radiotoxicity during earlier stages of disease in different organs when PSMA-RLT is administered.
针对前列腺特异性膜抗原（PSMA）的放射性配体疗法（RLT）在早期前列腺癌（PCa）患者中的应用疗效目前正在研究中。然而，对于该患者群体健康器官中PSMA的表达情况知之甚少。本研究共分析了来自152名患者的202次[68Ga]Ga-PSMA-11正电子发射断层扫描（PET）。其中，102次PET扫描来自原发性PCa和激素敏感性生化复发PCa患者，50次PET扫描来自转移性去势抵抗性前列腺癌（mCRPC）患者，分别在[177Lu]Lu-PSMA-RLT三个周期治疗前后进行。研究测量了多个器官的PSMA标准化摄取值（SUV），并在所有队列中确定了PSMA总肿瘤体积（PSMA-TTV）。将不同队列测得的PET参数以血池为基准进行标准化，并使用t检验或Mann-Whitney U检验进行比较。与晚期CRPC患者相比，早期PCa患者的PSMA-TTV较低（10.39 mL vs. 462.42 mL, p < 0.001），并且在甲状腺、颌下腺、心脏、肝脏、肾脏、肠道、睾丸和骨髓中显示出不同的SUV，所有检验均显示p < 0.05。尽管mCRPC患者在[177Lu]Lu-PSMA-RLT治疗前后的PSMA-TTV存在差异（462.42 mL vs. 276.29 mL, p = 0.023），但未检测到PET参数的显著器官差异。这些结果表明，不同阶段PCa患者的PSMA配体结合程度不同，这可能影响在疾病早期阶段施用PSMA-RLT时不同器官的放射毒性。
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