{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:45:16Z","timestamp":1785908716562,"version":"3.56.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) using Terbium-161 [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]-labeled compounds has recently been investigated in patients with metastatic castration-resistant prostate cancer (mCRPC). We performed a systematic review and meta-analysis to evaluate the efficacy and safety of [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]Tb-PSMA RLT in this clinical setting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a comprehensive literature search across PubMed\/MEDLINE, Embase, and the Cochrane databases to retrieve published articles on the efficacy and safety of [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]Tb-PSMA RLT in mCRPC. Studies reporting the use of [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]Tb-PSMA RLT in mCRPC patients were eligible for inclusion. Pooled estimates of disease control rate (DCR), objective response rate (ORR), and adverse event rate were calculated using a random-effects model. Statistical heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six studies published between 2024 and 2026, including 80 mCRPC patients treated with 291\u202fcycles of [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]Tb-PSMA RLT, were included. Most patients had pretreated disease and had previously received PSMA-targeted radionuclide therapy. The pooled DCR was 83.9% (95% confidence interval [CI]: 76.0\u201392.0%) with no significant heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f0%). The pooled ORR was 50.2% (95% CI: 27.0\u201374.0%), although significant heterogeneity was observed (I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f81%). Across all studies, 124 adverse events were reported, corresponding to a pooled adverse event rate of 41%, but high grade were only 18.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Current evidence suggests that [\n                      <jats:sup>161<\/jats:sup>\n                      Tb]Tb-PSMA RLT is a promising therapeutic option for patients with mCRPC, demonstrating encouraging disease control and an acceptable safety profile. Nevertheless, defining its precise role requires larger-scale, comparative trials conducted across multiple centers over longer observation periods.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1925657","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:54:10Z","timestamp":1785905650000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of [161Tb]Tb-PSMA radioligand therapy in metastatic castration resistant prostate cancer: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Domenico","family":"Albano","sequence":"first","affiliation":[{"name":"Nuclear Medicine, University of Brescia","place":["Brescia, Italy"]},{"name":"Nuclear Medicine Department, ASST Spedali Civili di Brescia","place":["Brescia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Paone","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Ente Ospedaliero Cantonale","place":["Bellinzona and Lugano, Switzerland"]},{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera italiana","place":["Lugano, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Treglia","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Ente Ospedaliero Cantonale","place":["Bellinzona and Lugano, Switzerland"]},{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera italiana","place":["Lugano, Switzerland"]},{"name":"Faculty of Biology and Medicine, University of Lausanne","place":["Lausanne, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"102398","DOI":"10.1016\/j.clgc.2025.102398","article-title":"Safety and efficacy of Lutetium-177 PSMA therapy for metastatic castration-resistant prostate Cancer: a systematic review and Meta-analysis of randomized controlled trials","volume":"23","author":"Belabaci","year":"2025","journal-title":"Clin Genitourin Cancer"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00259-025-07438-1","article-title":"Efficacy and safety of rechallenge therapy with [177Lu]Lu-PSMA in metastatic castration-resistant prostate cancer: a systematic review and meta-analysis","volume":"53","author":"Belabaci","year":"2025","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3181","DOI":"10.1007\/s00259-023-06316-y","article-title":"Opportunities and potential challenges of using terbium-161 for targeted radionuclide therapy in clinics","volume":"50","author":"M\u00fcller","year":"2023","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1007\/s13139-023-00804-7","article-title":"161Tb-PSMA unleashed: a promising new player in the Theranostics of prostate Cancer","volume":"57","author":"Al-Ibraheem","year":"2023","journal-title":"Nucl Med Mol Imaging"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1186\/s12885-026-15900-y","article-title":"Beyond [177Lu]Lu-PSMA: a meta-analysis of safety and efficacy of emerging PSMA radioligand therapy agents","volume":"26","author":"Abdlkadir","year":"2026","journal-title":"BMC Cancer"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2020","journal-title":"BMJ"},{"key":"ref8","year":"2019"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s40336-016-0219-2","article-title":"Systematic reviews and metaanalyses of diagnostic studies: a practical guideline","volume":"5","author":"Sadeghi","year":"2017","journal-title":"Clin Translat Imaging"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.7150\/thno.92273","article-title":"[161Tb]Tb-PSMA-617 radioligand therapy in patients with mCRPC: preliminary dosimetry results and intra-individual head-to-head comparison to [177Lu]Lu-PSMA-617","volume":"14","author":"Schaefer-Schuler","year":"2024","journal-title":"Theranostics"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.3390\/cancers16111974","article-title":"From despair to hope: first Arabic experience of 177Lu-PSMA and 161Tb-PSMA therapy for metastatic castration-resistant prostate cancer","volume":"16","author":"Al-Ibraheem","year":"2024","journal-title":"Cancers"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/S1470-2045(25)00332-8","article-title":"First-in-human results of terbium-161 [161Tb]Tb-PSMA-I&T dual beta-auger radioligand therapy in patients with metastatic castration-resistant prostate cancer (VIOLET): a single-Centre, single-arm, phase 1\/2 study","volume":"26","author":"Buteau","year":"2025","journal-title":"Lancet Oncol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"9019","DOI":"10.7150\/thno.115831","article-title":"Pilot experience of [161Tb]Tb-PSMA-617 RLT in mCRPC patients after conventional PSMA RLT within a prospective registry","volume":"15","author":"Rosar","year":"2025","journal-title":"Theranostics"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.2967\/jnumed.125.270952","article-title":"Initial multicenter experience with [161Tb]Tb-PSMA in [177Lu]Lu-PSMA-refractory metastatic castration-resistant prostate cancer: preliminary results","volume":"66","author":"Kucuk","year":"2025","journal-title":"J Nucl Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e356","DOI":"10.1097\/RLU.0000000000006384","article-title":"Outcome and safety of Radioligand therapy with [161 Tb]Tb-PSMA-617 after re-progression in mCRPC patients previously treated with [177 Lu]Lu-PSMA-617","volume":"51","author":"Rosar","year":"2026","journal-title":"Clin Nucl Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1007\/s12149-025-02026-7","article-title":"The prognostic role of staging [18F]PSMA-1007 PET\/CT volumetric and dissemination features in prostate cancer","volume":"39","author":"Albano","year":"2025","journal-title":"Ann Nucl Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1080\/09553002.2020.1831706","article-title":"Advancements in the use of auger electrons in science and medicine during the period 2015-2019","volume":"99","author":"Howell","year":"2023","journal-title":"Int J Radiat Biol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1007\/s00259-019-04345-0","article-title":"Terbium-161 for PSMA-targeted radionuclide therapy of prostate cancer","volume":"46","author":"M\u00fcller","year":"2019","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1080\/07357907.2020.1811301","article-title":"A walk with Lu-177 PSMA: how close we have reached from bench to bedside?","volume":"38","author":"Gupta","year":"2020","journal-title":"Cancer Investig"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3963","DOI":"10.21037\/tau-20-1135","article-title":"Narrative review: prostate-specific membrane antigen-radioligand therapy in metastatic castration-resistant prostate cancer","volume":"10","author":"Lunger","year":"2021","journal-title":"Transl Androl Urol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.2967\/jnumed.123.265414","article-title":"[177Lu]Lu-PSMA-Radioligand therapy efficacy outcomes in Taxane-na\u00efve versus Taxane-treated patients with metastatic castration-resistant prostate Cancer: a systematic review and metaanalysis","volume":"64","author":"Satapathy","year":"2023","journal-title":"J Nucl Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1827510","DOI":"10.3389\/fmed.2026.1827510","article-title":"Detection rate of [99mTc]Tc-PSMA SPECT\/CT in prostate cancer: a systematic 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