BACKGROUND: Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is a widely accepted treatment option for metastatic castration-resistant prostate cancer (mCRPC). However, synthesized evidence regarding potential prognostic factors for oncologic outcomes in patients treated with PSMA-RLT is lacking. We aimed to synthesize prognosticators of oncologic outcomes in patients with mCRPC treated with PSMA-RLT. METHODS: PubMed®, Web of Science™, and Embase® databases were systemically searched in March 2025 for studies. Eligible studies investigated pretreatment clinical, hematologic, or radiographical prognostic factors for oncologic outcomes, such as progression-free (PFS) or overall survivals (OS) in patients with mCRPC treated with PSMA-RLT. Only parameters assessed through multivariable analysis adjusting for potential confounders were synthesized. (CRD42024598718) RESULTS: A total of 39 studies (n = 4819) were included in the systematic review and 32 studies (n = 3038) were included in the meta-analysis. Prior chemotherapy (pooled HR: 1.43, 95%CI: 1.10-1.85), visceral metastases (pooled HR: 1.41, 95%CI: 1.05-1.89), and liver metastasis (pooled HR: 1.75, 95%CI: 1.37-2.25) were associated with worse PFS. Poor performance status (PS) (pooled HR: 1.99, 95%CI: 1.45-2.74), prior chemotherapy (pooled HR: 1.39, 95%CI: 1.19-1.63), visceral metastasis (pooled HR: 1.65, 95%CI: 1.33-2.05), bone metastasis (pooled HR: 2.09, 95%CI: 1.39-3.13), liver metastasis (pooled HR: 2.15, 95%CI: 1.84-2.50), and lower pretreatment hemoglobin levels (pooled HR: 1.25, 95%CI: 1.09-1.43) were associated with poorer OS. Higher pretreatment SUVmean was associated with improved OS benefit (pooled HR: 0.91, 95%CI: 0.85-0.97). PSA decline after treatment initiation, particularly ≥50%, was associated with improved PFS and OS. CONCLUSIONS: Prior chemotherapy use and location of metastases influence the prognosis of patients with mCRPC treated with PSMA-RLT. A higher pre-treatment SUVmean is predictive of better PSMA-RLT efficacy, and a greater PSA 'response is associated with improved survival outcomes. These findings may help guide clinical decision-making regarding PSMA-RLT and support prognostication of its oncological benefits.

2nd Department of Urology Centre of Postgraduate Medical Education Warsaw Poland

Bashamichi Sakura Clinic Yokohama Japan

Collegium Medicum Faculty of Medicine WSB University Dąbrowa Górnicza Poland

Department of Radiation Oncology University Medical Center Utrecht Netherlands

Department of Surgical Sciences Division of Urology AOU Città della Salute e della Scienza at Molinette Hospital and University of Turin Turin Italy

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Azienda Ospedaliero Universitaria Ospedali Riuniti Di Ancona Università Politecnica Delle Marche Ancona Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology La Croix Du Sud Hospital Quint Fonsegrives France

Department of Urology Semmelweis University Budapest Hungary

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Division of Urology Department of Special Surgery The University of Jordan Amman Jordan

ICON Cancer Centre Theranostics Perth WA Australia

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Jinsenkai MI Clinic Osaka Japan

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Research Center for Evidence Medicine Urology Department Tabriz University of Medical Sciences Tabriz Iran

Theranostics Yokohama Yokohama Japan

Zobrazit více v PubMed

Jang A, Kendi AT, Sartor O. Status of PSMA-targeted radioligand therapy in prostate cancer: current data and future trials. Ther Adv Med Oncol. 2023;15:17588359231157632. PubMed DOI PMC

Tilki D, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Part II-2024 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol. 2024;86:164–82. PubMed DOI

Kawada T, Yanagisawa T, Rajwa P, Sari Motlagh R, Mostafaei H, Quhal F, et al. Diagnostic Performance of Prostate-specific Membrane Antigen Positron Emission Tomography-targeted biopsy for Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2022;5:390–400. PubMed DOI

Kimura S, Abufaraj M, Janisch F, Iwata T, Parizi MK, Foerster B, et al. Performance of [(68)Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2020;23:1–10. PubMed DOI

Książek I, Ligęza A, Drzymała F, Borek A, Miszczyk M, Francuz MR, et al. Role of Lutetium Radioligand Therapy in Prostate Cancer. Cancers (Basel) 2024;16:2433.

Hofman MS, Emmett L, Sandhu S, Iravani A, Joshua AM, Goh JC, et al. [(177)Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet. 2021;397:797–804. PubMed DOI

Sartor O, de Bono J, Chi KN, Fizazi K, Herrmann K, Rahbar K, et al. Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med. 2021;385:1091–103. PubMed DOI PMC

Hofman MS, Emmett L, Sandhu S, Iravani A, Buteau JP, Joshua AM, et al. Overall survival with [(177)Lu]Lu-PSMA-617 versus cabazitaxel in metastatic castration-resistant prostate cancer (TheraP): secondary outcomes of a randomised, open-label, phase 2 trial. Lancet Oncol. 2024;25:99–107. PubMed DOI

Gafita A, Calais J, Grogan TR, Hadaschik B, Wang H, Weber M, et al. Nomograms to predict outcomes after (177)Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study. Lancet Oncol. 2021;22:1115–25. PubMed DOI

Buteau JP, Martin AJ, Emmett L, Iravani A, Sandhu S, Joshua AM, et al. PSMA and FDG-PET as predictive and prognostic biomarkers in patients given [(177)Lu]Lu-PSMA-617 versus cabazitaxel for metastatic castration-resistant prostate cancer (TheraP): a biomarker analysis from a randomised, open-label, phase 2 trial. Lancet Oncol. 2022;23:1389–97. PubMed DOI

Kuo PH, Morris MJ, Hesterman J, Kendi AT, Rahbar K, Wei XX, et al. Quantitative (68)Ga-PSMA-11 PET and Clinical Outcomes in Metastatic Castration-resistant Prostate Cancer Following (177)Lu-PSMA-617 (VISION Trial). Radiology. 2024;312:e233460. PubMed DOI

Chi KN, Kheoh T, Ryan CJ, Molina A, Bellmunt J, Vogelzang NJ, et al. A prognostic index model for predicting overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate after docetaxel. Ann Oncol. 2016;27:454–60. PubMed DOI

Mori K, Kimura S, Parizi MK, Enikeev DV, Glybochko PV, Seebacher V, et al. Prognostic Value of Lactate Dehydrogenase in Metastatic Prostate Cancer: A Systematic Review and Meta-analysis. Clin Genitourin Cancer. 2019;17:409–18. PubMed DOI

Yanagisawa T, Kawada T, Rajwa P, Mostafaei H, Motlagh RS, Quhal F, et al. Sequencing impact and prognostic factors in metastatic castration-resistant prostate cancer patients treated with cabazitaxel: A systematic review and meta-analysis. Urol Oncol. 2023;41:177–91. PubMed DOI

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100. PubMed DOI PMC

Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inf Decis Mak. 2007;7:16. DOI

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Bmj. 2016;355:i4919. PubMed DOI PMC

DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28:105–14. PubMed DOI

DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. PubMed DOI

Armstrong AJ, Sartor O, de Bono J, Chi K, Fizazi K, Krause BJ, et al. Association of Declining Prostate-specific Antigen Levels with Clinical Outcomes in Patients with Metastatic Castration-resistant Prostate Cancer Receiving [(177)Lu]Lu-PSMA-617 in the Phase 3 VISION Trial. Eur Urol 2024;86:552–62.

Calais J, Gafita A, Eiber M, Armstrong WR, Gartmann J, Thin P, et al. Prospective phase 2 trial of PSMA-targeted molecular RadiothErapy with (177)Lu-PSMA-617 for metastatic castration-reSISTant Prostate Cancer (RESIST-PC): efficacy results of the UCLA cohort. J Nucl Med. 2021;62:1440–6. PubMed DOI PMC

Pathmanandavel S, Crumbaker M, Nguyen A, Yam AO, Wilson P, Niman R, et al. The Prognostic Value of Posttreatment (68)Ga-PSMA-11 PET/CT and (18)F-FDG PET/CT in Metastatic Castration-Resistant Prostate Cancer Treated with (177)Lu-PSMA-617 and NOX66 in a Phase I/II Trial (LuPIN). J Nucl Med. 2023;64:69–74. PubMed DOI PMC

Satapathy S, Yadav MP, Ballal S, Sahoo RK, Bal C. [ DOI

Telli T, Tuncel M, Karabulut E, Aksoy S, Erman M, Akdogan B, et al. Prognostic factors of overall and prostate-specific antigen-progression-free survival in metastatic castration-resistant prostate cancer patients treated with (177) Lu-PSMA-617. A single-center prospective observational study. Prostate. 2023;83:792–800. PubMed DOI

Vanwelkenhuyzen J, Van Bos E, Van Bruwaene S, Lesage K, Maes A, Üstmert S, et al. AR and PI3K Genomic Profiling of Cell-free DNA Can Identify Poor Responders to Lutetium-177-PSMA Among Patients with Metastatic Castration-resistant Prostate Cancer. Eur Urol Open Sci. 2023;53:63–66. PubMed DOI PMC

Wang G, Zang J, Jiang Y, Liu Q, Sui H, Wang R, et al. A Single-Arm, Low-Dose, Prospective Study of (177)Lu-EB-PSMA Radioligand Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer. J Nucl Med. 2023;64:611–7. PubMed DOI

Ahmadzadehfar H, Matern R, Baum RP, Seifert R, Kessel K, Bögemann M, et al. The impact of the extent of the bone involvement on overall survival and toxicity in mCRPC patients receiving [(177)Lu]Lu-PSMA-617: a WARMTH multicentre study. Eur J Nucl Med Mol Imaging. 2021;48:4067–76. PubMed DOI

Ahmadzadehfar H, Rahbar K, Baum RP, Seifert R, Kessel K, Bögemann M, et al. Prior therapies as prognostic factors of overall survival in metastatic castration-resistant prostate cancer patients treated with [(177)Lu]Lu-PSMA-617. A WARMTH multicenter study (the 617 trial). Eur J Nucl Med Mol Imaging. 2021;48:113–22. PubMed DOI

Ballal S, Yadav MP, Satapathy S, Raju S, Tripathi M, Damle NA, et al. Long-term survival outcomes of salvage [(225)Ac]Ac-PSMA-617 targeted alpha therapy in patients with PSMA-expressing end-stage metastatic castration-resistant prostate cancer: a real-world study. Eur J Nucl Med Mol Imaging. 2023;50:3777–89. PubMed DOI

Barber TW, Singh A, Kulkarni HR, Niepsch K, Billah B, Baum RP. Clinical Outcomes of (177)Lu-PSMA Radioligand Therapy in Earlier and Later Phases of Metastatic Castration-Resistant Prostate Cancer Grouped by Previous Taxane Chemotherapy. J Nucl Med. 2019;60:955–62. PubMed DOI

Bülbül O, Ünek İT, Kefi A, Tuna EB, Bekiş R. Factors affecting overall survival and progression-free survival in patients with metastatic castration resistant prostate cancer received (177)Lu PSMA I&T therapy. Hell J Nucl Med. 2020;23:229–39. PubMed

Chua WM, Lam WW, Tong AK, Sultana R, Kua SMY, Kanesvaran R, et al. Outcomes and prognostic predictors of Lu-177 PSMA radioligand therapy in metastatic castration-resistant prostate cancer (Asian Population Study). Asia Pac J Clin Oncol. 2024;20:572–81.

Cytawa W, Hendel R, Tomasik B, Weinzierl FX, Bley T, Jassem J, et al. Early biochemical and radiographic response after one cycle of [(177)Lu]Lu-PSMA I&T radioligand therapy in metastatic castration-resistant prostate cancer patients. Eur J Nucl Med Mol Imaging. 2023;50:3765–76. PubMed DOI PMC

Eisazadeh R, Mirshahvalad SA, Schwieghofer-Zwink G, Hehenwarter L, Rendl G, Gampenrieder S, et al. Pre-treatment (68) Ga-PSMA-11 PET/CT Prognostic Value in Predicting Response to (177)Lu-PSMA-I&T Therapy and Patient Survival. Mol Imaging Biol. 2024;26:360–9. PubMed DOI PMC

Gaal S, Huang K, Rogasch JMM, Jochens HV, De Santis M, Erber B, et al. Prognostic Value of the De Ritis Ratio for Overall Survival in Patients with Metastatic Castration-Resistant Prostate Cancer Undergoing [(177)Lu]Lu-PSMA-617 Radioligand Therapy. Cancers (Basel) 2023;15:4907.

Handke A, Kesch C, Fendler WP, Telli T, Liu Y, Hakansson A, et al. Analysing the tumor transcriptome of prostate cancer to predict efficacy of Lu-PSMA therapy. J Immunother Cancer 2023;11:e007354.

Hartrampf PE, Hüttmann T, Seitz AK, Kübler H, Serfling SE, Higuchi T, et al. Prognostic Performance of RECIP 1.0 Based on [(18)F]PSMA-1007 PET in Prostate Cancer Patients Treated with [(177)Lu]Lu-PSMA I&T. J Nucl Med. 2024;65:560–5. PubMed DOI

Hein C, Burgard C, Blickle A, Bastian MB, Maus S, Schaefer-Schuler A, et al. Analysis of Molecular Imaging and Laboratory Baseline Biomarkers in PSMA-RLT: Whole-Body Total Lesion PSMA (TLP) Predicts Overall Survival. Cancers (Basel) 2024;16:2670.

Hotta M, Gafita A, Murthy V, Benz MR, Sonni I, Burger IA, et al. PSMA PET Tumor-to-Salivary Gland Ratio to Predict Response to [(177)Lu]PSMA Radioligand Therapy: An International Multicenter Retrospective Study. J Nucl Med. 2023;64:1024–9. PubMed DOI PMC

John N, Pathmanandavel S, Crumbaker M, Counter W, Ho B, Yam AO, et al. 177)Lu-PSMA SPECT Quantitation at 6 Weeks (Dose 2) Predicts Short Progression-Free Survival for Patients Undergoing (177)Lu-PSMA-I&T Therapy. J Nucl Med. 2023;64:410–5. PubMed DOI

Kafka M, Horninger A, di Santo G, Virgolini I, Neuwirt H, Unterrainer LM, et al. Real-world Outcomes and Predictive Biomarkers for (177)Lutetium Prostate-specific Membrane Antigen Ligand Treatment in Metastatic Castration-resistant Prostate Cancer: A European Association of Urology Young Academic Urologists Prostate Cancer Working Group Multi-institutional Observational Study. Eur Urol Oncol. 2024;7:421–9. PubMed DOI

Karimzadeh A, Heck M, Tauber R, Knorr K, Haller B, D’Alessandria C, et al. 177)Lu-PSMA-I&T for Treatment of Metastatic Castration-Resistant Prostate Cancer: Prognostic Value of Scintigraphic and Clinical Biomarkers. J Nucl Med. 2023;64:402–9. PubMed DOI

Kemppainen J, Kangasmäki A, Malaspina S, Pape B, Jalomäki J, Kairemo K, et al. Single Center Experience with a 4-Week (177)Lu-PSMA-617 Treatment Interval in Patients with Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2022;14:6155.

Kim M, Seifert R, Fragemann J, Kersting D, Murray J, Jonske F, et al. Evaluation of thresholding methods for the quantification of [(68)Ga]Ga-PSMA-11 PET molecular tumor volume and their effect on survival prediction in patients with advanced prostate cancer undergoing [(177)Lu]Lu-PSMA-617 radioligand therapy. Eur J Nucl Med Mol Imaging. 2023;50:2196–209. PubMed DOI PMC

Kind F, Fassbender TF, Andrieux G, Boerries M, Meyer PT, Ruf J Early PSA Change after [(177)Lu]PSMA-617 Radioligand Therapy as a Predicator of Biochemical Response and Overall Survival. Cancers (Basel) 2021;14:149.

Kinikoglu O, Öven BB, Çelik S, Selçuk NA, Beydagi G, Akçay K, et al. Investigating Combination Therapy: The Role of Lutetium-177 PSMA-617 Radioligand Therapy and Androgen Receptor Pathway Inhibitors in Metastatic Castration-Resistant Prostate Cancer. Journal Clin Med. 2024;13:14. DOI

Michalski K, Kosmala A, Werner RA, Serfling SE, Seitz AK, Lapa C, et al. Comparison of PET/CT-based eligibility according to VISION and TheraP trial criteria in end-stage prostate cancer patients undergoing radioligand therapy. Ann Nucl Med. 2024;38:87–95. PubMed DOI

Michalski K, Ruf J, Goetz C, Seitz AK, Buck AK, Lapa C, et al. Prognostic implications of dual tracer PET/CT: PSMA ligand and [(18)F]FDG PET/CT in patients undergoing [(177)Lu]PSMA radioligand therapy. Eur J Nucl Med Mol Imaging. 2021;48:2024–30. PubMed DOI

Neubauer MC, Nicolas GP, Bauman A, Fani M, Nitzsche E, Afshar-Oromieh A, et al. Early response monitoring during [(177)Lu]Lu-PSMA I&T therapy with quantitated SPECT/CT predicts overall survival of mCRPC patients: subgroup analysis of a Swiss-wide prospective registry study. Eur J Nucl Med Mol Imaging. 2024;51:1185–93. PubMed DOI

Raychaudhuri R, Mo G, Tuchayi AM, Graham L, Gulati R, Pritchard CC, et al. Genomic Correlates of Prostate-Specific Membrane Antigen Expression and Response to (177)Lu-PSMA-617: A Retrospective Multicenter Cohort Study. JCO Precis Oncol. 2024;8:e2300634. PubMed DOI

Sahin E, Kefeli U, Zorlu S, Seyyar M, Akdag MO, Sanci PC, et al. Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and pan-immune-inflammation value in metastatic castration-resistant prostate cancer patients who underwent <SUP>177</SUP>Lu-PSMA-617. Medicine. 2023;102:8. DOI

Sathekge MM, Lawal I, Bal C, Bruchertseifer F, Ballal S, Cardaci G, et al. Actinium-225-PSMA radioligand therapy of metastatic castration-resistant prostate cancer (WARMTH Act): a multicentre, retrospective study. Lancet Oncol. 2024;25:175–83. PubMed DOI

Slootbeek PHJ, Luna-Velez MV, Privé BM, van der Doelen MJ, Kloots ISH, Naga SP, et al. Impact of TP53 loss-of-function alterations on the response to PSMA radioligand therapy in metastatic castration-resistant prostate cancer patients. Theranostics. 2024;14:4555–69. PubMed DOI PMC

Stangl-Kremser J, Sun M, Ho B, Thomas J, Nauseef JT, Osborne JR, et al. Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic castration-resistant prostate cancer receiving prostate-specific membrane antigen targeted radionuclide therapy. Prostate. 2023;83:1351–7. PubMed

Tauber R, Knorr K, Retz M, Rauscher I, Grigorascu S, Hansen K, et al. Safety and Efficacy of [(177)Lu]-PSMA-I&T Radioligand Therapy in Octogenarians with Metastatic Castration-Resistant Prostate Cancer: Report on 80 Patients over the Age of 80 Years. J Nucl Med. 2023;64:1244–51. PubMed DOI

Thaiss W, Zengerling F, Friedrich J, Hechler V, Grunert M, Bolenz C, et al. Personalized 177Lu Lutetium-PSMA Therapy for Patients with Pre-Treated Castration-Resistant Prostate Cancer: A Single Institution Experience from a Comprehensive Cancer Centre. Cancers. 2023;15:13. DOI

Wrenger R, Jüptner M, Marx M, Zhao Y, Zuhayra M, Caliebe A, et al. Pre- and intratherapeutic predictors of overall survival in patients with advanced metastasized castration-resistant prostate cancer receiving Lu-177-PSMA-617 radioligand therapy. BMC Urol. 2022;22:96. PubMed DOI PMC

Yadav MP, Ballal S, Sahoo RK, Tripathi M, Damle NA, Shamim SA, et al. Long-term outcome of <SUP>177</SUP>Lu-PSMA-617 radioligand therapy in heavily pre-treated metastatic castration-resistant prostate cancer patients. Plos One. 2021;16:19. DOI

Zarehparvar, Moghadam S, Askari E, Divband G, Shakeri S, Aryana K. Efficacy, safety and prognostic factors affecting overall survival among metastatic prostate cancer patients undergoing treatment with (177)Lu-PSMA-617: A single center study. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2022;41:239–46.

Kratochwil C, Fendler WP, Eiber M, Hofman MS, Emmett L, Calais J, et al. Joint EANM/SNMMI procedure guideline for the use of (177)Lu-labeled PSMA-targeted radioligand-therapy ((177)Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging. 2023;50:2830–45. PubMed DOI PMC

Morris MJ, Castellano D, Herrmann K, de Bono JS, Shore ND, Chi KN, et al. 177)Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet. 2024;404:1227–39. PubMed DOI PMC

Azad AA, Bressel M, Tan H, Voskoboynik M, Suder A, Weickhardt AJ, et al. Sequential [(177)Lu]Lu-PSMA-617 and docetaxel versus docetaxel in patients with metastatic hormone-sensitive prostate cancer (UpFrontPSMA): a multicentre, open-label, randomised, phase 2 study. Lancet Oncol. 2024;25:1267–76. PubMed DOI

Emmett L, Subramaniam S, Crumbaker M, Nguyen A, Joshua AM, Weickhardt A, et al. [(177)Lu]Lu-PSMA-617 plus enzalutamide in patients with metastatic castration-resistant prostate cancer (ENZA-p): an open-label, multicentre, randomised, phase 2 trial. Lancet Oncol. 2024;25:563–71. PubMed DOI

Gandaglia G, Karakiewicz PI, Briganti A, Passoni NM, Schiffmann J, Trudeau V, et al. Impact of the Site of Metastases on Survival in Patients with Metastatic Prostate Cancer. Eur Urol. 2015;68:325–34. PubMed DOI

Halabi S, Kelly WK, Ma H, Zhou H, Solomon NC, Fizazi K, et al. Meta-Analysis Evaluating the Impact of Site of Metastasis on Overall Survival in Men With Castration-Resistant Prostate Cancer. J Clin Oncol. 2016;34:1652–9. PubMed DOI PMC

Yanagisawa T, Rajwa P, Kawada T, Mori K, Fukuokaya W, Petrov P, et al. Efficacy of Systemic Treatment in Prostate Cancer Patients With Visceral Metastasis: A Systematic Review, Meta-analysis, and Network Meta-analysis. J Urol. 2023;210:416–29. PubMed DOI

Fan L, Wang X, Chi C, Wang Y, Cai W, Shao X, et al. Prognostic nutritional index predicts initial response to treatment and prognosis in metastatic castration-resistant prostate cancer patients treated with abiraterone. Prostate. 2017;77:1233–41. PubMed DOI

Iwamoto H, Kano H, Shimada T, Naito R, Makino T, Kadomoto S, et al. Sarcopenia and Visceral Metastasis at Cabazitaxel Initiation Predict Prognosis in Patients With Castration-resistant Prostate Cancer Receiving Cabazitaxel Chemotherapy. Vivo. 2021;35:1703–9. DOI

Liu J, Cundy TP, Woon DTS, Lawrentschuk N A Systematic Review on Artificial Intelligence Evaluating Metastatic Prostatic Cancer and Lymph Nodes on PSMA PET Scans. Cancers (Basel) 2024;16:486.

Shimomura T, Otsuka N, Urabe F, Muramoto K, Yanagisawa T, Fukuokaya W, et al. PSA Absolute Value Versus PSA Response Rate: Which Is More Valuable for Estimating Survival Outcomes With ARPI Treatment for Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) in Real-World Analyses? Prostate 2025;85:833–40.

Urabe F, Hatakeyama S, Yanagisawa T, Narita S, Muramoto K, Katsumi K, et al. Clinical significance of PSA dynamics in castration-sensitive prostate cancer treated with ARSI doublet therapy: A multicenter study. Urol Oncol. 2025;43:271.e279–271.e218. DOI

Sadaghiani MS, Sheikhbahaei S, Werner RA, Pienta KJ, Pomper MG, Gorin MA, et al. 177) Lu-PSMA radioligand therapy effectiveness in metastatic castration-resistant prostate cancer: An updated systematic review and meta-analysis. Prostate. 2022;82:826–35. PubMed DOI PMC

Kratochwil C, Giesel FL, Heussel CP, Kazdal D, Endris V, Nientiedt C, et al. Patients Resistant Against PSMA-Targeting α-Radiation Therapy Often Harbor Mutations in DNA Damage-Repair-Associated Genes. J Nucl Med. 2020;61:683–8. PubMed DOI

Fazekas T, Széles ÁD, Teutsch B, Csizmarik A, Vékony B, Kói T, et al. Poly (ADP-ribose) Polymerase Inhibitors Have Comparable Efficacy with Platinum Chemotherapy in Patients with BRCA-positive Metastatic Castration-resistant Prostate Cancer. A Systematic Review and Meta-analysis. European Urol Oncol. 2024;7:365–75. DOI

Crumbaker M, Goldstein LD, Murray DH, Tao J, Pathmanandavel S, Boulter N, et al. Circulating Tumour DNA Biomarkers Associated with Outcomes in Metastatic Prostate Cancer Treated with Lutetium-177-PSMA-617. Eur Urol Open Sci. 2023;57:30–36. PubMed DOI PMC