Advanced Image Analysis to Select Patients for Prostate Specific Membrane Antigen Radioligand Therapy and Assess Treatment Response

Introduction: Although quantitative imaging metrics (e.g.whole-tumor mean standardized uptake value, SUV mean ) are predictive of response to prostate specific membrane antigen radioligand therapy (PSMA-RLT), they are clinically underutilized.Here we present a series of patients treated with PSMA-RLT analyzed with an automated image analysis tool (TRAQinformIQ) that provides quantitative metrics and compares multiple scans.Methods: Images from three cases were analyzed with TRAQinformIQ; a patient with an excellent PSMA-RLT response, a patient who progressed on treatment, and a patient who progressed immediately after treatment.In the first two cases pre-treatment PET/CT images were analyzed.For the second and third cases pre-and post-treatment PET/CT images were analyzed.Results: Cases one and two demonstrate the ability of TRAQinformIQ to provide quantitative metrics from pre-treatment PET/CT scans, including PSMA SUV mean , and compare different imaging modalities (PET and CT in the first case, PSMA and FDG PET in the second case).In these cases, pre-treatment metrics correlated with disease response/progression.The third case demonstrates the utility of using multiple imaging modalities (FDG and PSMA PET) to assess response/progression, and the automated tool's ability to compare these scans across multiple time points.Conclusion: Automated image analysis tools that provide quantitative imaging metrics and comparisons between scans could be a valuable aid in evaluating patient appropriateness for RLT and assessing treatment response.