Does finding new lesions after lutetium-177 treatment mean my overall survival will be worse?
If you are being treated with lutetium-177 (Pluvicto) for metastatic castration-resistant prostate cancer (mCRPC), seeing new lesions on a scan after treatment can be concerning. Research shows that the appearance of new lesions is associated with a poorer outlook, but this does not mean treatment has failed completely. Your doctor will consider the full picture, including your symptoms and other test results, to guide next steps.
What the research says
A 2025 meta-analysis pooled data from 7 studies involving 648 patients with mCRPC who received lutetium-177 PSMA therapy. The analysis found that patients who developed new lesions on an interim SPECT/CT scan after treatment had a significantly higher risk of death. The hazard ratio for overall survival was 2.78, meaning their risk of dying was nearly three times higher compared to patients without new lesions 5. This finding was statistically significant and consistent across the studies reviewed. The meta-analysis also noted that an increase in total tumor volume on these scans signaled poor outcomes 5. Other research supports that imaging changes can predict survival. For example, a study on PSMA imaging agents found that patients with a decrease in PSMA-positive circulating tumor cells had longer progression-free survival 2. Additionally, a phase 3 trial of lutetium-177 showed it improved quality of life and delayed pain progression compared to other treatments 9. While new lesions are a concerning sign, they are just one piece of information. Your doctor will use them along with your overall health, PSA levels, and symptoms to decide if you should continue this therapy or try another option.
What to ask your doctor
- What do the new lesions on my scan mean for my treatment plan?
- Should we continue with lutetium-177 or consider switching to another therapy?
- Are there other tests, like a PSMA PET scan or blood markers, that can give us more information?
- What are my options if this treatment stops working?
- How will we monitor my condition going forward?
This question is drawn from common patient questions about Oncology and answered using cited medical research. We do not provide individualized advice.