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Peer-reviewedCC BYWorld journal of urology

Survival outcomes with Lutetium-177-PSMA-617 in metastatic castration-resistant prostate cancer patient according to baseline tumor characteristics.

  • Mike Wenzel1
  • Quynh Chi Le2,3
  • Carolin Siech1
  • Benedikt Hoeh1,4
  • Konrad Klimek5
  • Christian Happel5
  • Fred Saad6
  • Felix Preisser7,8
  • Derya Tilki7,8,9
  • Markus Graefen7,8
  • Thomas Steuber7,8
  • Tobias Maurer7,8
5 more authors
  • Maximilian C Kriegmair10,11
  • Pierre I Karakiewicz6
  • Felix K H Chun1
  • Daniel Groener5
  • Philipp Mandel1,7
11 affiliations
  1. 1Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
  2. 2Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany. [email protected].
  3. 3Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada. [email protected].
  4. 4Department of Urology, Carl Gustav Carus University Dresden, University Hospital, Dresden, Germany.
  5. 5Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
  6. 6Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada.
  7. 7Martini-Klinik Prostate Cancer Center, University Hospital Hamburg- Eppendorf, Hamburg, Germany.
  8. 8Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  9. 9Department of Urology, Koc University Hospital, Istanbul, Turkey.
  10. 10Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Mannheim, Germany.
  11. 11Urological Hospital Munich-Planegg, Munich, Germany.
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Abstract

Purpose

To investigate cancer-control outcomes in metastatic castration-resistant prostate cancer (mCRPC) patients receiving Lutetium-177 Prostate-Specific Membrane Antigen-617 (Lu-177-PSMA) radioligand therapy according to initial baseline tumor characteristics.Methods

We relied on the FRAMCAP (FRAnkfurt Metastatic Cancer Database of the Prostate) database to assess progression-free survival (PFS) and overall survival (OS) in patients receiving Lu-177-PSMA as first to seventh mCRPC therapy line, according to initial time of metastasis (synchronous vs. metachronous), tumor grading (Gleason score [GS] 6-7 vs. 8-10) and M-stage (M1a vs. M1b vs. M1c) at initial metastatic hormone-sensitive prostate cancer (mHSPC). Kaplan-Meier curve analyses and multivariable Cox regression models were applied; multivariable models are additionally adjusted for ECOG status and line of Lu-177-PSMA therapy (1-2 L vs. 3 L vs. 4-7 L).Results

Of 344 Lu-177-PSMA mCRPC patients, 198 (58%) had synchronous vs. 146 (42%) metachronous mHSPC, 87 (29%) vs. 107 (62%) GS 6-7 vs. 8-10 and 15 (10%) vs. 121 (81%) vs. 13 (9%) M1a vs. M1b vs. M1c mHSPC disease. No significant differences were observed in PFS (12.1 vs. 13.0 months) or OS (14.9 vs. 18.3 months) between synchronous and metachronous patients (both p > = 0.09), or in PFS (12.9 vs. 11.8 months) and OS (21.4 vs. 15.1 months) between GS 6-7 and GS 8-10 (both p > = 0.3). M-stage-stratified analyses showed an OS difference (17.9 vs. 17.7 vs. 9.0 months for M1a vs. M1b vs. M1c, p = 0.01), but not for PFS (11.9 vs. 9.5 vs. 8.2 months, p = 0.08). After multivariable adjustment including ECOG status and treatment line, initial timing of metastasis, GS, and M-stage were not independently associated with PFS or OS. However, later treatment line was independently associated with worse OS (3 L vs. 1-2 L: HR 2.40, 95% CI 1.14-5.04, p = 0.021; 4-7 L vs. 1-2 L: HR 4.01, 95% CI 1.83-8.80, p < 0.001) as well as worse ECOG status (1-2 vs. 0: HR 2,60, 95% CI 1.38-4,91, p = 0.003).Conclusion

In this real-world cohort of mCRPC patients treated with Lu-177-PSMA, initial timing of metastatic disease, Gleason score, and M-stage were not independently associated with PFS or OS after multivariable adjustment including ECOG status and treatment line. These observational findings should not be interpreted as evidence of equivalent treatment efficacy across subgroups.

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Cite

BibTeXRIS
BibTeX
@article{wenzel2026survival,
  title = {{Survival outcomes with Lutetium-177-PSMA-617 in metastatic castration-resistant prostate cancer patient according to baseline tumor characteristics.}},
  author = {Mike Wenzel and Quynh Chi Le and Carolin Siech and Benedikt Hoeh and Konrad Klimek and Christian Happel and Fred Saad and Felix Preisser and Derya Tilki and Markus Graefen and Thomas Steuber and Tobias Maurer and Maximilian C Kriegmair and Pierre I Karakiewicz and Felix K H Chun and Daniel Groener and Philipp Mandel},
  journal = {World journal of urology},
  year = {2026},
  month = oct,
  doi = {10.1007/s00345-026-06849-5},
  url = {https://europepmc.org/article/MED/42900232},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Survival outcomes with Lutetium-177-PSMA-617 in metastatic castration-resistant prostate cancer patient according to baseline tumor characteristics.
AU  - Mike Wenzel
AU  - Quynh Chi Le
AU  - Carolin Siech
AU  - Benedikt Hoeh
AU  - Konrad Klimek
AU  - Christian Happel
AU  - Fred Saad
AU  - Felix Preisser
AU  - Derya Tilki
AU  - Markus Graefen
AU  - Thomas Steuber
AU  - Tobias Maurer
AU  - Maximilian C Kriegmair
AU  - Pierre I Karakiewicz
AU  - Felix K H Chun
AU  - Daniel Groener
AU  - Philipp Mandel
PY  - 2026
DA  - 2026/10/20
JO  - World journal of urology
DO  - 10.1007/s00345-026-06849-5
UR  - https://europepmc.org/article/MED/42900232
AB  - Purpose  To investigate cancer-control outcomes in metastatic castration-resistant prostate cancer (mCRPC) patients receiving Lutetium-177 Prostate-Specific Membrane Antigen-617 (Lu-177-PSMA) radioligand therapy according to initial baseline tumor characteristics.Methods  We relied on the FRAMCAP (FRAnkfurt Metastatic Cancer Database of the Prostate) database to assess progression-free survival (PFS) and overall survival (OS) in patients receiving Lu-177-PSMA as first to seventh mCRPC therapy line, according to initial time of metastasis (synchronous vs. metachronous), tumor grading (Gleason score [GS] 6-7 vs. 8-10) and M-stage (M1a vs. M1b vs. M1c) at initial metastatic hormone-sensitive prostate cancer (mHSPC). Kaplan-Meier curve analyses and multivariable Cox regression models were applied; multivariable models are additionally adjusted for ECOG status and line of Lu-177-PSMA therapy (1-2 L vs. 3 L vs. 4-7 L).Results  Of 344 Lu-177-PSMA mCRPC patients, 198 (58%) had synchronous vs. 146 (42%) metachronous mHSPC, 87 (29%) vs. 107 (62%) GS 6-7 vs. 8-10 and 15 (10%) vs. 121 (81%) vs. 13 (9%) M1a vs. M1b vs. M1c mHSPC disease. No significant differences were observed in PFS (12.1 vs. 13.0 months) or OS (14.9 vs. 18.3 months) between synchronous and metachronous patients (both p > = 0.09), or in PFS (12.9 vs. 11.8 months) and OS (21.4 vs. 15.1 months) between GS 6-7 and GS 8-10 (both p > = 0.3). M-stage-stratified analyses showed an OS difference (17.9 vs. 17.7 vs. 9.0 months for M1a vs. M1b vs. M1c, p = 0.01), but not for PFS (11.9 vs. 9.5 vs. 8.2 months, p = 0.08). After multivariable adjustment including ECOG status and treatment line, initial timing of metastasis, GS, and M-stage were not independently associated with PFS or OS. However, later treatment line was independently associated with worse OS (3 L vs. 1-2 L: HR 2.40, 95% CI 1.14-5.04, p = 0.021; 4-7 L vs. 1-2 L: HR 4.01, 95% CI 1.83-8.80, p < 0.001) as well as worse ECOG status (1-2 vs. 0: HR 2,60, 95% CI 1.38-4,91, p = 0.003).Conclusion  In this real-world cohort of mCRPC patients treated with Lu-177-PSMA, initial timing of metastatic disease, Gleason score, and M-stage were not independently associated with PFS or OS after multivariable adjustment including ECOG status and treatment line. These observational findings should not be interpreted as evidence of equivalent treatment efficacy across subgroups.
SN  - 0724-4983
SN  - 1433-8726
ER  -