{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T21:25:40Z","timestamp":1787865940483,"version":"build-2784847793"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC). However, current patient selection methods \u2013 largely based on qualitative imaging criteria \u2013 may impede precision and efficacy of treatment. We aimed to evaluate the predictive value of quantitative imaging biomarkers derived from dual-tracer [\n                      <jats:sup>68<\/jats:sup>\n                      \u00a0Ga]Ga-PSMA-11 and [\n                      <jats:sup>18<\/jats:sup>\n                      F]F-FDG PET\/CT, with a focus on concordant lesions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Thirty-seven mCRPC patients from two institutions underwent [\n                      <jats:sup>68<\/jats:sup>\n                      \u00a0Ga]Ga-PSMA-11 and [\n                      <jats:sup>18<\/jats:sup>\n                      F]F-FDG PET\/CT prior to receiving at least two cycles of [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA therapy. An automated pipeline enabled lesion segmentation, dual-tracer image fusion, and extraction of quantitative features from concordant (PSMA\u2009+\u2009\/FDG\u2009+) and non-concordant lesions. A decision tree model was developed on the Vienna cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924) and validated on an independent cohort from Augsburg (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913). SHAP analysis was used to identify key predictive features.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The decision tree achieved 95.8% accuracy in the training cohort and 84.6% in external validation. SUV\n                      <jats:sub>mean<\/jats:sub>\n                      of concordant lesions was the most predictive features. Patients with SUV\n                      <jats:sub>mean<\/jats:sub>\n                      [PSMA Concordant]\u2009\u2265\u200912.1\u00a0g\/mL were more likely to respond. Organ-specific analysis further identified high SUV\n                      <jats:sub>max<\/jats:sub>\n                      in bone metastases as a negative prognostic marker.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Quantitative metrics from dual-tracer PET, particularly those characterizing concordant lesions, show promise for predicting response to PSMA-RLT. These preliminary findings highlight the potential to move beyond binary eligibility criteria toward a more nuanced, biomarker-driven approach to patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07700-6","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:43:35Z","timestamp":1767595415000},"page":"3571-3580","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Quantitative dual-tracer PET\/CT biomarkers correlate concordant lesion uptake with PSMA-RLT outcomes in mCRPC: a dual-center study"],"prefix":"10.1007","volume":"53","author":[{"given":"Song","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Einspieler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijie","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Muin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Antic","family":"Nikolic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Baessler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gero","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrokh F.","family":"Shariat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Lapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sazan","family":"Rasul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0016-6233","authenticated-orcid":false,"given":"Xiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"7700_CR1","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/S0140-6736(21)00237-3","volume":"397","author":"MS Hofman","year":"2021","unstructured":"Hofman MS, Emmett L, Sandhu S, Iravani A, Joshua AM, Goh JC, et al. [177Lu] lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet. 2021;397:797\u2013804.","journal-title":"Lancet"},{"key":"7700_CR2","doi-asserted-by":"publisher","first-page":"735","DOI":"10.2967\/jnumed.123.266842","volume":"65","author":"AM Tuchayi","year":"2024","unstructured":"Tuchayi AM, Yadav S, Jiang F, Kim ST, Saelee RK, Morley A, et al. Real-world experience with 177Lu-PSMA-617 radioligand therapy after Food and Drug Administration approval. J Nucl Med. 2024;65:735\u20139.","journal-title":"J Nucl Med"},{"key":"7700_CR3","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1056\/NEJMoa2107322","volume":"385","author":"O Sartor","year":"2021","unstructured":"Sartor O, De Bono J, Chi KN, Fizazi K, Herrmann K, Rahbar K, et al. Lutetium-177\u2013PSMA-617 for metastatic castration-resistant prostate cancer. 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The study was approved by the Vienna General Hospital, Medical University of Vienna Institutional Review Board (Ethic No:1745\/2021).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All authors have read this manuscript and would like to have it considered exclusively for publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}