Skeletal muscle radiodensity as an automated survival predictor in men with metastatic castration-resistant…

Cohort studyEuropean journal of nuclear medicine and molecular imaging· Jul 2026

Skeletal muscle radiodensity as an automated survival predictor in men with metastatic castration-resistant prostate cancer undergoing PSMA-targeted radioligand therapy.

Christian Immanuel, Thomas Büttner, Alois M Sprinkart … Milka Marinova

TheranosticsCohort studyPrognosisQ1IF 5.8

Lower skeletal muscle radiodensity is associated with reduced overall survival in metastatic prostate cancer.

Skeletal muscle radiodensity as an automated survival predictor in men with metastatic castration-resistant prostate cancer undergoing PSMA-targeted radioligand therapy.

Christian Immanuel … Milka Marinova

European journal of nuclear medicine and molecular imaging · Jul 2026 · Q1 in General Medicine

Background

Skeletal muscle radiodensity (SMD) is an emerging imaging-derived marker of muscle quality.

Purpose

This study aims to investigate the prognostic value of SMD derived from routine pretherapeutic PET/CT imaging in a large real-world mCRPC cohort treated with [¹⁷⁷Lu]Lu-PSMA-617.

Methods

In this single-center study, the largest to date cohort comprising 410 mCRPC patients was analyzed.

n = 410 mCRPC patients

Results

HR 1.87

lower muscle quality means nearly twice the risk of dying from advanced prostate cancer

n = 410 mCRPC patients

More results

This prognostic stratification was seen in both, patients with or without PSA50 or PSA90 response, respectively.

SMD correlated with age, albumin, and PSA, but not with BMI.

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Conclusion · 1 of 2

SMD assessed from routine pretherapeutic PET/CT is a non-invasive prognostic biomarker in patients undergoing PSMA-targeted radioligand therapy.

Conclusion · 2 of 2

Integration of host-derived imaging biomarkers such as SMD with tumor-specific parameters may improve risk stratification, prehabilitation and support future individualized treatment strategies in advanced prostate cancer.

Skeletal muscle radiodensity as an automated survival predictor in men with metastatic castration-resistant prostate cancer undergoing PSMA-targeted radioligand therapy.

Skeletal muscle radiodensity as an automated survival predictor in men with metastatic castration-resistant prostate cancer undergoing PSMA-targeted radioligand therapy.

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