Greater PSA decline from baseline in men with metastatic castration-resistant prostate cancer (mCRPC) treated with the radioligand therapy 177lutetium-PSMA-617 (177Lu-PSMA-617) predicts better outcomes, investigators reported at ESMO Congress 2022.

The finding is from a post hoc analysis of the phase 3 VISION trial, which previously demonstrated that men with PSMA-positive mCRPC treated with 177Lu-PSMA-617 had prolonged radiographic progression-free survival (rPFS) and overall survival (OS).

For the post hoc analysis, researchers classified patients into 4 subgroups by magnitude of confirmed best PSA decline from baseline: no decline; 50% or less; more than 50% and up to 90%; and more than 90%.

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Compared with patients who had no PSA decline, those with declines of 50% or less, greater than 50% and up to 90%, and more than 90% from baseline had a significant 60%, 80%, and 96% reduced risk for radiographic disease progression, respectively, and 42%, 58%, and 90% lower risk for death, respectively.

The median rPFS and OS were 3.0 and 8.4 months, respectively, for the patients who did not have a PSA decline. By comparison, the patients who had a PSA decline of 50% or less, more than 50% and up to 90%, and more than 90% had a median rPFS of 6.0, 8.8, and 19.7 months, respectively. Patients who had a PSA decline of 50% or less and more than 50% and up to 90% had a median OS of 12.0 and 15.0 months, respectively. The median OS was not estimable for those with a PSA decline greater than 90%.

In addition, study findings show that PSA declines delayed worsening of health-related quality of life, according to the investigators.

“These findings suggest that PSA decline is of prognostic importance for clinical outcomes during radioligand therapy with 177Lu-PSMA-617 in patients with PSMA-positive mCRPC,” the researchers reported.

Disclosures: This research was supported by Advanced Accelerator Applications, a Novartis company. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Armstrong AJ, Sartor O, Saad F, et al. Association between prostate-specific antigen decline and clinical outcomes in patients with metastatic castration-resistant prostate cancer in the VISION trial. Presented at ESMO 2022; September 9-13, 2022. Abstract 1372P.

This article originally appeared on Renal and Urology News