{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:05:34Z","timestamp":1792760734983,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Metastatic castration resistance prostate cancer (mCRPC) is a challenging disease with a significant burden of mortality and morbidity. Most of the patients attain resistance to the available treatments, necessitating further novel therapies in this clinical setting. Actinium 225 (<jats:sup>225<\/jats:sup>Ac) prostate\u2010specific membrane antigen (PSMA) radioligand therapy has emerged as a promising option and has been utilized for the last decade. Although a few meta\u2010analyses were performed on the efficacy and safety of <jats:sup>225<\/jats:sup>Ac\u2010PSMA RLT in mCRPC patients, several current studies have been added to the literature since the latest meta\u2010analysis. We aimed to gather all individual studies to perform up\u2010to\u2010date meta\u2010analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the literature using Pubmed\u2010Medline, Web of Science, Elsevier\u2010Sceince Direct, and Cochrane\u2010Central databases. The data for any PSA decline, over 50% PSA decline, overall survival (OS), progression\u2010free survival (PFS), and toxicity profile were captured from the studies eligible for meta\u2010analysis. We utilized the random effect model to generate pooled estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The sixteen eligible studies contained 1102 patients. Sixty\u2010three percent of patients achieved more than 50% PSA decline, while 82% had any PSA decline after the completion of therapy. The pooled mean OS and PFS were 12.72 months (9.52\u201315.91) and 11.02 months (6.88\u201315.15), respectively. The most common adverse event was xerostomia, with a pooled proportion of 84%. Grade \u2265\u20093 anemia, thrombocytopenia, leucopenia, and nephrotoxicity were encountered in 9%, 5%, 4%, and 4% of the patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:sup>225<\/jats:sup>Ac\u2010PSMA RLT is an efficacious and safe treatment for mCRPC. Future well\u2010designed randomized controlled studies comparing <jats:sup>225<\/jats:sup>Ac\u2010PSMA RLT with other approved therapeutic options would better comprehend the exact role of this therapy in the treatment sequence of mCRPC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pros.24857","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:30:23Z","timestamp":1737952223000},"page":"541-557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Safety and Efficacy of Targeted Alpha Therapy, Ac\u2010225 Prostate\u2010Specific Membrane Antigen, in Patients With Metastatic Castration\u2010Resistant Prostate Cancer: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7459-584X","authenticated-orcid":false,"given":"Huseyin","family":"Besiroglu","sequence":"first","affiliation":[{"name":"Department of Urology Istanbul University\u2010Cerrahpa\u015fa, Cerrahpa\u015fa Faculty of Medicine Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Kadihasanoglu","sequence":"additional","affiliation":[{"name":"Department of Urology Istanbul University\u2010Cerrahpa\u015fa, Cerrahpa\u015fa Faculty of Medicine Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.08.005"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31384"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2016.26"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.123.265414"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30198-0"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.4044"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1213755"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.116.178673"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.117.191395"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.121.262017"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000531246"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.123.267206"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(23)00638-1"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.123.265546"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-023-06340-y"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.121.263618"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-022-05778-w"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000003925"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12149-021-01617-4"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.120.251017"},{"issue":"10","key":"e_1_2_11_23_1","article-title":"Clinical Outcomes and Molecular Profiling of Advanced Metastatic Castration\u2010Resistant Prostate Cancer Patients Treated With (225)Ac\u2010PSMA\u2010617 Targeted Alpha\u2010Radiation Therapy","volume":"39","author":"Doelen M. 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