Efficacy of 177Lu-PSMA-617 Therapy in mCRPC Patients with Liver Metastases: Insights into Survival Outcomes and Predictors of Response

<b>Objectives:</b> Metastatic castration-resistant prostate cancer (mCRPC) is associated with poor prognosis, particularly in cases of liver metastases. ¹⁷⁷Lu-PSMA-617 (commercially known as Pluvicto) is an FDA-approved radioligand therapy for mCRPC patients. This study aimed to evaluate the efficacy of ¹⁷⁷Lu-PSMA-617 radioligand therapy (RLT) in mCRPC patients with liver metastases, focusing on progression-free survival (PFS), overall survival (OS), and factors influencing treatment response. <b>Materials and Methods:</b> This retrospective study included mCRPC patients (n = 32) with liver metastases treated with Lu-PSMA-617. Patient data, including prostate-specific antigen (PSA) levels, liver SUVmax values, Lutetium-PSMA therapy cycles, and survival outcomes, were collected. Kaplan-Meier survival analysis was used to calculate PFS and OS, while regression analysis was employed to identify factors associated with treatment response. <b>Results:</b> The median PFS and OS were 6 and 9 months, respectively. Partial regression was observed in patients with significantly lower PSA levels (median: 90.0 ng/mL, range: 22-699 ng/mL, <i>p</i> = 0.001) and liver SUVmax values (median: 17.9, range: 8.3-57.0, <i>p</i> = 0.008). A higher number of Lutetium-PSMA cycles correlated with improved treatment response (<i>p</i> = 0.010) and reduced liver SUVmax values (<i>p</i> = 0.043). <b>Conclusions:</b> Lu-PSMA-617 therapy is effective in managing mCRPC with liver metastases. Increased intensity of therapy exposure, reflected by a higher number of treatment cycles, is associated with a greater biochemical response, as indicated by reduced PSA levels, thereby supporting the rationale for personalized treatment strategies. These findings support the use of Lu-PSMA-617 in mCRPC patients with liver metastases, warranting further prospective studies.