Andrew J. Armstrong, MD, Details PSMA-PET Scan Parameters Indicating Better Survival Outcomes With 177Lu-PSMA-617 in mCRPC

Data from a substudy of the phase 3 VISION trial presented at 2022 ASCO Annual Meeting showed that higher standard mean uptake value by PSMA-PET is strongly associated with outcomes for patients with metastatic castration-resistant prostate cancer.

At the 2022 American Society of Clinical Oncology Annual Meeting, CancerNetwork® spoke with Andrew J. Armstrong, MD, professor of medicine, surgery, and pharmacology and cancer biology at Duke University School of Medicine, as well as a member of the Duke Cancer Institute in Durham, North Carolina, about results from a substudy of the phase 3 VISION trial (NCT03511664) that set out to identify parameters by prostate-specific membrane antigen (PSMA)-PET that were indicative of better outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) who were treated with 177Lu-PSMA-617 (Pluvicto).1 The phase 3 trial compared the targeted radioligand therapy with best standard of care in this setting and led to the approval of this agent in this setting.2


The VISION study led to the FDA approval of 177Lu-PSMA-617 for patients with metastatic prostate cancer who have developed castration resistance and have PSMA positivity on a PSMA-PET scan. These patients were largely refractory to [androgen receptor] AR therapy and chemotherapy. The purpose of the oral abstract was to look at the characteristics of PSMA-PET scans to see how that associates with the outcomes of patients treated with this radioligand nuclear therapy. Not surprisingly, the brighter the PSMA-PET scan was, as measured by the standardized uptake value, or SUV, whole body uptake at a mean level was associated better progression-free and overall survival. The brighter the scan, the better the outcomes. Even patients with relatively weak uptake still seem to have better outcomes than you’d expect with a second AR inhibitor. The brighter the scan, the better the target engagement was, with more radiation being delivered to the tumor with the patients benefiting to an even greater degree in that setting.


  1. Kuo P, Hesterman J, Rahbar K, et al. [68Ga]Ga-PSMA-11 PET baseline imaging as a prognostic tool for clinical outcomes to [177Lu]Lu-PSMA-617 in patients with mCRPC: a VISION substudy. J Clin Oncol. 2022;40(suppl 16):5002. doi:10.1200/JCO.2022.40.16_suppl.5002
  2. FDA approves Pluvicto for metastatic castration-resistant prostate cancer. News release. FDA. March 23, 2022. Accessed August 3, 2022.