For a patient with PSMA+ mCRPC but relatively low SUV values, does that influence your decision to use 177Lu-PSMA or discussion with patient regarding potential benefit?

In general, the use of PSMA-lutetium is primarily utilized in patients with advanced metastatic castration resistant prostate cancer which has been heavily pre-treated with at least one novel anti-androgen (and often several) and one or two taxane based therapies.

No prospective trial has addressed this, but in retrospective subset analyses of the TheraP trials, (Buteau et al., GU ASCO 2022) SUV <10 vs SUV >10 did provide a significantly greater likelihood of decline of PSA >50% (91 vs 52% in those eligible for assessment).

However, given the lack of good alternatives other than the clinical trial option, it would be reasonable to offer this therapy until more robust data can be generated.