{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:03:37Z","timestamp":1784081017315,"version":"3.55.0"},"reference-count":58,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>PSMA PET\/CT imaging biomarkers are increasingly investigated as predictors of response and survival outcomes following [177Lu]Lu-PSMA radioligand therapy in prostate cancer. This review summarizes the current evidence and clinical relevance of these biomarkers. As [177Lu]Lu-PSMA radioligand therapy is increasingly being introduced into earlier treatment lines of prostate cancer management, the identification of reliable imaging biomarkers for response prediction and outcome assessment is becoming increasingly important. Quantitative PSMA PET\/CT parameters such as whole-body (WB) mean standardized uptake value (SUVmean), WB PSMA-positive tumor volume, and tumor load, as well as qualitative features including disease distribution and phenotype (e.g., visceral metastases and FDG-avid, PSMA-negative discordant lesions), have been associated with treatment response, progression-free survival, and overall survival. However, the clinical utility of these imaging biomarkers is limited by heterogeneous study designs, small cohorts, and a lack of standardization in image acquisition, quantification, and cutoff definitions. This review critically appraises available data on baseline PSMA PET\/CT-based prognostic and potentially predictive biomarkers for RLT and identifies the methodological barriers that must be addressed before these biomarkers can be implemented in clinical practice.<\/jats:p>","DOI":"10.3390\/ph19071084","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:05:58Z","timestamp":1784077558000},"page":"1084","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline PSMA PET\/CT Biomarkers for Patient Selection in [177Lu]Lu-PSMA Radioligand Therapy: Clinical Promise, Methodological Heterogeneity and Future Standardization"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8680-6470","authenticated-orcid":false,"given":"Gryt\u0117","family":"Galnaitien\u0117","sequence":"first","affiliation":[{"name":"Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matas","family":"\u0160imkus","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2764-1834","authenticated-orcid":false,"given":"Ieva","family":"Bal\u010di\u016bnait\u0117","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1704-1669","authenticated-orcid":false,"given":"Kornelija","family":"Lu\u0161ait\u0117","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department Urology and Pediatric Urology, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6351-8056","authenticated-orcid":false,"given":"Matthias","family":"Saar","sequence":"additional","affiliation":[{"name":"Department Urology and Pediatric Urology, University Hospital RWTH Aachen, 52074 Aachen, Germany"},{"name":"Center for Integrated Oncology (CIO), University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7212-6521","authenticated-orcid":false,"given":"Felix M.","family":"Mottaghy","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany"},{"name":"Center for Integrated Oncology (CIO), University Hospital RWTH Aachen, 52074 Aachen, Germany"},{"name":"Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6202 Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3769-3520","authenticated-orcid":false,"given":"Donatas","family":"Vajauskas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"L\u00fctje","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany"},{"name":"Center for Integrated Oncology (CIO), University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1056\/NEJMoa2107322","article-title":"Lutetium-177\u2013PSMA-617 for Metastatic Castration-Resistant Prostate Cancer","volume":"385","author":"Sartor","year":"2021","journal-title":"N. 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