• Girish Kumar Parida, Raj Abhisek Panda, Komal Bishnoi, and Kanhaiyalal Agrawal.
• Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
• Med Princ Pract. 2023 Jan 1; 32 (3): 178191178-191.

BackgroundActinium-225 (Ac-225) labelled PSMA RLT has been tested recently in metastatic castration-resistant prostate cancer (mCRPC), with encouraging results. Ac-225, being an alpha emitter, is expected to have higher efficacy and fewer side effects compared to the beta-emitters such as Lutetium-177. We have performed a meta-analysis to assess the therapeutic responses, survival effects, and significant side effects of Ac-225 PSMA RLT in patients with mCRPC.MethodologySystematic literature search was carried out from five electronic databases PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Cochrane Library until March 2021. Eight studies were found to be eligible for this metanalysis.ResultsEight studies with 226 patients were analyzed in this metanalysis. 81% (95% CI 73-89) patients had a decline in PSA levels. 60% of the patients showed more than 50% PSA decline. Two studies assessed survival effects of radioligand naïve patients compared to patients who had received Lu-PSMA therapy previously and the pooled HR for radioligand naïve patients is 0.22. The most common toxicity reported was xerostomia in 167 patients out of 226 patients (73.9%, 95% CI 67.6-79.5%); however, most of them were confined to grade I and II levels. Other reported side effects include hematologic toxicity and nephrotoxicity.ConclusionAc-PSMA RLT is a safe and potentially effective treatment option for patients with mCRPC.© 2023 The Author(s). Published by S. Karger AG, Basel.

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