Prostat kanserinde Lutetium-177-PSMA tedavisi: tek merkezli gerçek yaşam deneyimi

Year 2025, Volume: 16 Issue: 3, 459 - 464, 30.09.2025

Orhun Akdoğan , Osman Sütçüoğlu , Seda Gülbahar Ateş , Fatih Gürler , Uğuray Aydos , Gözde Savaş , Ümit Akdemır , Aytuğ Üner , Lütfiye Özlem Atay , Uğur Coşkun , Ozan Yazıcı , Ahmet Özet , Nuriye Yıldırım Özdemir

https://doi.org/10.18663/tjcl.1716124

Abstract

Amaç: Lutetium-177 ile işaretli PSMA hedefli radyoligand tedavi, metastatik kastrasyona dirençli prostat kanseri (m-KRPK) için umut verici bir seçenek olarak ortaya çıkmıştır. Ancak gerçek yaşam verileri sınırlıdır. Bu çalışmada, tek merkezde Lu-177-PSMA tedavisi alan m-KRPK hastalarının klinik özellikleri, tedavi desenleri ve yanıt öngördürücü faktörleri değerlendirildi.
Gereç ve Yöntemler: Ocak 2020- Ocak 2025 arasında Lu-177-PSMA tedavisi alan 49 hastanın retrospektif analizi yapılmıştır. Tedavi yanıtı PSA’da ≥%50 düşüş (PSA50) ile değerlendirildi. Temel değişkenlerin PSA50 yanıtı ile ilişkisi Mann–Whitney U testi ile, biyobelirteçlerin prediktif gücü ROC eğrisi analizi ile incelendi.
Bulgular: PSA50 yanıt oranı %41,7 idi. Daha düşük başlangıç PSA, ALP ve LDH düzeyleri ile daha yüksek hemoglobin seviyeleri yanıtla anlamlı ilişkili bulundu. Hemoglobin ROC analizinde orta düzeyde ayırt edici güce sahipti (AUC = 0,692). Tedavi genellikle iyi tolere edildi ve ciddi hematolojik toksisite yalnızca bir hastada görüldü.
Sonuç: Lu-177-PSMA tedavisi, m-KRPK hastalarında gerçek yaşam pratiğinde klinik fayda sağlamaktadır. Başlangıç hemoglobin düzeyi tedavi yanıtını öngörmede pratik bir biyobelirteç olabilir. Ancak prospektif çalışmalara ihtiyaç vardır.
Anahtar Kelimeler: Lutetium-177-PSMA, m-KRPK, radyoligand tedavi, PSA50, biyobelirteçler

Keywords

Lutetium-177-PSMA , m-KRPK , radyoligand tedavi , PSA50 , biyobelirteçler

Ethical Statement

This study was approved by the Gazi University Clinical Research Ethics Committee (Approval No: E-77082166-604.01.02-835138).

Prostat kanserinde Lutetium-177-PSMA tedavisi: tek merkezli gerçek yaşam deneyimi

Abstract

Aim: Lutetium-177–labeled PSMA radioligand therapy has emerged as a promising option in metastatic castration-resistant prostate cancer (mCRPC), yet real-world data remain limited. This study aimed to evaluate clinical features, treatment patterns, and predictors of response in patients treated with Lutetium-177-PSMA therapy at a single academic center.
Material and Methods: We retrospectively analyzed 49 patients with mCRPC who received Lutetium-177-PSMA between January 2020 and January 2025. Treatment response was defined as a ≥50% decline in PSA (PSA50). Associations between baseline variables and PSA50 were examined using Mann–Whitney U tests, and predictive biomarkers were evaluated by receiver operating characteristic (ROC) analysis.
Results: The PSA50 response rate was 41.7%. Lower baseline PSA (p = 0.023), ALP (p = 0.037), and LDH (p = 0.004) levels, and higher hemoglobin (p = 0.024), were significantly associated with response. Hemoglobin demonstrated the highest discriminatory performance (AUC = 0.692), while PSA, ALP, and LDH showed significant but limited predictive value. Treatment was well tolerated, with only one case of grade 3-4 hematologic toxicity.
Conclusion: Lutetium-177-PSMA therapy provides clinical benefit in real-world mCRPC patients. Lower tumor burden and preserved hematologic status may predict better biochemical response, with hemoglobin serving as a moderately accurate biomarker. Prospective validation is warranted.

Keywords

lutetium-177-PSMA , metastatic castration-resistant prostate cancer , radioligand therapy , PSA50 , predictive biomarkers

Ethical Statement

This study was approved by the Gazi University Clinical Research Ethics Committee (Approval No: E-77082166-604.01.02-835138).

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