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In this monocentric real-world study, we evaluated baseline parameters derived from PET scans prior to RPT in order to identify potential prognostic factors in mCRPC patients with visceral metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 320 men with mCRPC treated with in total 1077 cycles of [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA RPT (1\u201312 cycles\/patient). Baseline characteristics, including age, PSA level, Gleason score, metastatic sites, and prior treatments, were evaluated as potential prognostic factors in the overall cohort. 65 patients were diagnosed with visceral metastases. In this subgroup, we analyzed the PET-derived parameters whole body PSMA-positive tumor volume (PSMA-TV), SUVmax, SUVmean, miPSMA expression score and the metastatic pattern of visceral metastases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The estimated median overall survival (OS) for the entire cohort was 15 months. Presence of visceral metastases, Gleason score, and PSA level were significant negative prognostic baseline factors for the entire cohort in the multivariate Cox regression score. The estimated median OS for patients with visceral metastases was 10 months, which was significantly lower than the 16 months observed for patients without visceral metastases. PSMA-TV, miPSMA expression score, and the metastatic pattern were identified as independent prognostic factors in multivariate Cox regression analysis. Patients exhibiting two risk factors or more demonstrated a significantly poorer OS of 4 months compared to patients with a maximum of one risk factor, who showed an OS of 15 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study confirmed that visceral metastases represent a major risk factor in patients with mCRPC undergoing [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA RPT. Moreover, PSMA-PET-derived parameters assessed prior to RPT enabled the distinction between high-risk and low-risk subgroups among patients with visceral metastases. These prognostic factors may therefore contribute to improved therapy stratification in mCRPC patients with visceral metastases undergoing [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA RPT.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07712-2","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T07:56:29Z","timestamp":1768290989000},"page":"3590-3597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PET-imaging derived prognostic factors for prostate cancer patients with visceral metastases receiving [177Lu]Lu-PSMA radiopharmaceutical therapy (RPT)"],"prefix":"10.1007","volume":"53","author":[{"given":"Magdalena Sophie","family":"Sp\u00e4th","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Dittmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Spallek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Calder\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"M\u00fcck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Brendlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Rausch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"la Foug\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3397-6299","authenticated-orcid":false,"given":"Nils F.","family":"Trautwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"issue":"7","key":"7712_CR1","first-page":"645","volume":"378","author":"O Sartor","year":"2018","unstructured":"Sartor O, de Bono JS. 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Lancet Oncol. 2024;25(10):1267\u201376.","journal-title":"Lancet Oncol"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07712-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-025-07712-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07712-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:39:50Z","timestamp":1781627990000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00259-025-07712-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["7712"],"URL":"https:\/\/doi.org\/10.1007\/s00259-025-07712-2","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"26 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was retrospectively approved by the institutional Review Board of the University Hospital of Tuebingen (488\/2025BO2). The study was performed in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Steffen Rausch reports speaker honoraria, travel grants: Advanced Accelerator Applications Germany GmbH, Janssen-Cilag AG, Astellas Pharma, Pfizer Oncology, Novartis Pharma, Desitin Pharma, Bayer Oncology, Merck Serono Pharma, BMS Pharma, Eisai Pharma, Merck Sharpe & Dohme GmbH, Amgen Pharma, AstraZeneca Advisory board: Ambu A\/S, Merck Pharma and Ipsen Pharma. Nils F. Trautwein and Christian la Foug\u00e8re report honoraria (speaker and advisory) from Novartis and research funding from ABX.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}