8053 Background: Pleural mesothelioma (PM) is a rare malignancy associated with asbestos exposure and characterized by an aggressive clinical course and poor prognosis. Identifying clinical and biological prognostic markers is of significant clinical importance. Recently, computed tomography (CT) based body composition parameters have been investigated for their association with survival outcomes in cancer patients; however, their prognostic value in PM remains unclear. This study aimed to evaluate the impact of clinical characteristics and CT-derived body composition parameters on survival in patients with PM. Methods: This retrospective study included 73 patients diagnosed with pleural mesothelioma. CT images were used to calculate the subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), total abdominal adipose tissue index (TATI), skeletal muscle index (SMI), and psoas muscle index (PMI). Patients were classified as sarcopenic or non-sarcopenic based on SMI. Results: The median age was 60 years, and 57.5% of patients were male. Most patients had good performance status (ECOG 0–1), and the epithelioid subtype was the most common histology. Approximately one-third of patients had a history of smoking or prior surgery. In univariate analysis, age ≥60 years was significantly associated with increased mortality. In multivariate analysis, age ≥60 years (HR 2.45) and male sex (HR 2.13) were identified as independent poor prognostic factors. Non-sarcopenic patients had a significantly lower risk of mortality compared with sarcopenic patients (HR 0.37). Additionally, higher TATI values were associated with increased mortality risk (HR 2.26). Kaplan–Meier analysis demonstrated significantly shorter OS in patients aged ≥60 years (Table). Conclusions: In patients with pleural mesothelioma, advanced age and male sex are associated with poorer survival, whereas preserved skeletal muscle mass is associated with improved outcomes. Increased abdominal adiposity is linked to higher mortality risk. CT-based body composition parameters may provide useful prognostic information in patients with PM. Evaluation of the association between parameters and survival using univariate and multivariate analyses. Univariate analysis Multivariate analysis P value HR 95% CI P value HR 95% CI Age (<60y / ≥60y) 0.005 2.27 1.27-4.05 0.005 2.45 1.31-4.61 Gender (female*/male) 0.06 1.65 0.96-2.83 0.011 2.13 1.19-3.81 ECOG PS (0-1*/2-3) 0.35 1.43 0.66-3.07 Histological subtypes (epithelioid / non-epithelioid) 0.26 1.42 0.76-2.66 Stage (I-III*/IV) 0.43 1.26 0.70-2.27 SMI cm 2 /m 2 (sarcopenia*/normal) 0.21 0.70 0.41-1.21 0.007 0.37 0.18-0.76 TATI cm 2 /m 2 (low*/high) 0.30 1.36 0.75-2.48 0.04 2.26 1.03-4.97

68 Ga-Trivehexin PET/CT is an αvβ6 integrin-targeted imaging modality that has demonstrated promising potential in various malignancies. In addition, recent studies highlighted its high potential for detecting parathyroid pathologies. In this case report, we present the preoperative 68 Ga-Trivehexin PET/CT findings of a patient diagnosed with papillary thyroid carcinoma (PTC) and a parathyroid adenoma, emphasizing the potential role of this novel tracer in PTC imaging.

OBJECTIVE:The aim of this retrospective study is to evaluate the diagnostic accuracy of [ 68 Ga]Ga-Trivehexin PET/CT compared with [ 18 F]fluorodeoxyglucose (FDG) PET/computed tomography (CT) for nodal staging in various solid tumors. MATERIALS AND METHODS:Between 2024 and 2025, a total of 15 patients with histopathologically confirmed primary or recurrent cancer were enrolled in the study. All participants underwent both [ 18 F]FDG and [ 68 Ga]Ga-Trivehexin PET/CT imaging for oncologic staging. Imaging findings were compared with histopathological results and clinical/radiological follow-up. Primary tumors, lymph nodes, and metastases were visually assessed, and maximum standardized uptake values were calculated. RESULTS:The median age of the patients was 62 years. Diagnoses included colorectal, breast, pancreatic, lung, bladder, thyroid, and endometrial cancers. Both [ 18 F]FDG and [ 68 Ga]Ga-Trivehexin PET/CT demonstrated uptake in all primary tumors. While [ 18 F]FDG PET/CT showed uptake in all lymph nodes, [ 68 Ga]Ga-Trivehexin PET/CT demonstrated positive uptake only in metastatic lymph nodes. The positive predictive value of [ 68 Ga]Ga-Trivehexin PET/CT was calculated as 100%. In contrast, [ 18 F]FDG PET/CT exhibited lower specificity, with a positive predictive value of 26.3%. CONCLUSION:This study demonstrates that [ 68 Ga]Ga-Trivehexin PET/CT offers higher specificity than [ 18 F]FDG PET/CT, particularly in benign lymph node lesions, and is effective in accurately identifying metastatic lymph nodes. Compared to [ 18 F]FDG PET/CT, 68 Ga-Trivehexin PET/CT provides lower false-positive rates and higher diagnostic accuracy, potentially reducing the need for unnecessary invasive procedures.

Accurate assessment of inflammatory activity in inflammatory bowel diseases (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) remains a major clinical challenge. Positron emission tomography (PET) with fibroblast activation protein inhibitors (FAPI) has recently attracted considerable interest for its ability to visualize fibroblast-associated tissue remodeling and stromal activation in inflammatory conditions. In the study under evaluation, Debus et al. report a retrospective pilot study of [68Ga]Ga-FAPI-46 PET/CT for noninvasive characterization and activity assessment of CD and UC. Forty-three histologically confirmed IBD patients (20 CD and 23 UC) and 43 matched controls underwent dynamic abdominal (60 min) and whole-body [68Ga]Ga-FAPI-46 PET/CT to quantify FAPI uptake, kinetics, and lesion burden, with imaging findings compared with colonoscopy. They found significantly higher FAPI uptake in both FAPI-positive lesions and in many 'healthy-appearing' gut segments of IBD patients versus controls; uptake was greater in active versus inactive disease, and lesions displayed two characteristic kinetic patterns that can further stratify inflammatory disease. The study is an important, hypothesis-generating contribution that supports the feasibility and biological plausibility of FAPI PET for IBD, but its retrospective design, modest sample size, limited histologic lesion-level correlation and control selection temper conclusions about diagnostic performance and clinical utility.

68Ga-CXCR4 PET/CT was performed in a patient with acute myeloid leukemia (AML) and granulocytic sarcoma in the left cervical region, who had previously undergone 18F-FDG PET/CT. Compared with 18F-FDG PET/CT, 68Ga-CXCR4 PET/CT revealed a greater number of malignant lymph nodes with more intense uptake in both supradiaphragmatic and infradiaphragmatic regions. Furthermore, markedly increased radiotracer uptake was observed in the bone marrow and spleen compared with FDG. This case underscores the superior sensitivity of 68Ga-CXCR4 PET/CT in detecting AML infiltration and supports further investigation of CXCR4-targeted imaging and therapeutic approaches in high-risk AML.

This study compared the physiologic distribution of [68Ga]Ga-DOTATATE and [68Ga]Ga-NODAGA-LM3 PET/CT, assessed SUV and tumor-to-background ratio (TBR) measurements in primary and metastatic lesions, and evaluated lesion detection performance. Methods: Forty-one adult patients with well-differentiated (G1-G3) gastroenteropancreatic or lung neuroendocrine neoplasms, pheochromocytoma, medullary thyroid carcinoma, and well-differentiated thyroid carcinoma were included in this study. All patients underwent PET/CT imaging with both [68Ga]Ga-DOTATATE and [68Ga]Ga-NODAGA-LM3 within a 3-d interval. SUVmax and SUVmean were calculated for physiologic uptake regions, and SUVmax and TBR were determined for lesions. Paired data were analyzed using the paired-samples t test or Wilcoxon signed-rank test, with a P of less than 0.05 considered statistically significant. Results: The median patient age was 62 y (range, 27-90 y), and 63.4% were women. Analysis of uptake in normal organs revealed that [68Ga]Ga-DOTATATE PET/CT demonstrated significantly higher physiologic activity in the liver, spleen, pancreas, and jejunum, whereas [68Ga]Ga-NODAGA-LM3 showed significantly higher uptake in the parotid glands, mediastinal blood pool, lungs, breasts, kidneys, and uterus. Lesion-based analysis found that [68Ga]Ga-NODAGA-LM3 detected significantly more liver metastases than did [68Ga]Ga-DOTATATE (P < 0.05), with no significant differences observed in other regions. The TBR of liver metastases was significantly higher with [68Ga]Ga-NODAGA-LM3 (P = 0.006), although the SUVmax did not significantly differ between radiotracers. Conclusion: [68Ga]Ga-NODAGA-LM3 demonstrates a higher TBR and superior detection of liver metastases compared with [68Ga]Ga-DOTATATE. Although no significant differences were found in other regions, the 2 radiotracers exhibit distinct physiologic distribution patterns.

Background: Insulin resistance (IR) has been implicated in cardiovascular diseases, and a correlation between IR and the slow flow phenomenon (CSF)has been identified. The triglyceride–glucose index (TGI), a simple surrogate marker for IR, has recently emerged as a potential predictor of CSF, though data are limited. The aim of this study was to evaluate the association of TGI and other prognostic parameters in patients with CSF. Methods: This retrospective study included 693 patients who underwent diagnostic coronary angiography between January 2022 and December 2024. A total of 132 patients were diagnosed with CSF based on the corrected TIMI frame count (cTFC > 27 in at least one epicardial coronary artery), while 561 patients had normal coronary flow (NCF). Patients with confounding cardiovascular or systemic conditions were excluded. Clinical, demographic, and laboratory data were gathered, and TGI was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2].Results: Statistically significant distinctions were found between the CSF and NCF groups regarding TGI, age, glucose, HbA1c, creatinine, sodium, CRP, platelet count, heart rate, PR interval, and cQT interval (p < 0.05). Age, hypertension, diabetes mellitus, HbA1c, glucose, sodium, and cQT were identified as potential clinical and laboratory factors associated with CSF in univariate logistic regression analysis; however, no independent predictor was found in multivariate analysis. ROC analysis showed that a TGI cut-off value of ≥8.93 predicted CSF with 67.6% sensitivity and 66.7% specificity. Conclusions: Our study demonstrated that TGI was significantly greater in patients with CSF compared to those with NCF. Although TGI showed limited sensitivity and specificity in discriminating CSF, its possible value as a prognostic indicator warrants further validation in prospective, large-scale studies.

The aim of this study was to evaluate the diagnostic performance and lesion localization capability of [⁶⁸Ga]Ga-Trivehexin PET/CT for hyperfunctioning parathyroid tissue in primary hyperparathyroidism (P-HPT), through a retrospective analysis of data obtained from prospective studies conducted at two different centres, compared with the conventional preoperative imaging modalities [⁹⁹ᵐTc]Tc-MIBI scintigraphy and neck ultrasonography (US). A total of 44 patients diagnosed with P-HPT based on clinical and laboratory parameters, who subsequently underwent cervical ultrasonographic evaluation, were included in this study. For all patients, serum parathyroid hormone (PTH), calcium (Ca), phosphorus (P), 25-OH vitamin D, urea, creatinine, glomerular filtration rate (GFR), and 24-hour urinary calcium values were recorded. Following cervical US examination, all participants underwent [⁹⁹ᵐTc]Tc-MIBI scintigraphy as part of the routine preoperative work-up. Thereafter, to determine the diagnosis and localization of hyperfunctioning parathyroid tissue, [⁶⁸Ga]Ga-Trivehexin PET/CT imaging was performed. All [⁶⁸Ga]Ga-Trivehexin PET/CT data were visually assessed and quantitative measurements were obtained. [⁶⁸Ga]Ga-Trivehexin PET/CT findings were evaluated in conjunction with PTH wash-out results, postoperative biochemical response confirmation, and histopathological assessment. Forty-four patients with P-HPT (median age, 52 years; range, 24–73) were included. [⁶⁸Ga]Ga-Trivehexin PET/CT identified 37 hyperfunctioning parathyroid foci in 36 patients, corresponding to a patient-based detection rate of 81.8

BACKGROUND:Prostate-specific membrane antigen (PSMA)-PET usage in patients with prostate cancer is growing rapidly. Thus, novel risk-group definitions based on PSMA-PET are urgently needed for guidelines, clinical use, and trial study design. We report improved risk classification based on PSMA-PET Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE; PPP) nomograms (PPP3) to prognosticate 3-year, 5-year, and 7-year overall survival. METHODS:In this international, retrospective, registry-based cohort study, we collected data from the PROMISE PET registry with ongoing overall survival follow-up. Male patients (aged ≥18 years) with histological proven prostate cancer at any disease stage and any performance status, who underwent any PSMA-PET between Dec 6, 2012, and June 26, 2024, were included in the registry. Patients with neuroendocrine pattern or metastasised or disseminated malignancy other than prostate cancer were excluded. 35 investigator sites in Europe, Asia, Australia, North America, and South America were split pairwise (2:1) into development and validation cohorts. Entire investigator sites were split pairwise according to their site characteristics (ie, number of patients per disease group, country, follow-up). The primary study objective was overall survival. PPP3 nomograms were created based on Cox regression models with least absolute shrinkage and selection operator penalty to prognosticate 3-year, 5-year, and 7-year overall survival. Calibration curves and Harrell's c indices were applied and head-to-head comparison with clinical risk scores separated for each disease subgroup was conducted. Based on the visual PPP3 nomogram, a simplified risk-stratification table was created. FINDINGS:We analysed 11 154 patients and 7253 were included in the development cohort and 3901 in the validation cohort. Median follow-up to censoring or death was 4·9 years (IQR 3·5-6·6). Clinical disease group and PROMISE metrics were combined into visual and quantitative PPP3 nomograms, respectively. C indices were 0·83 (95% CI 0·82-0·84) for the visual nomogram and 0·84 (0·82-0·85) for the quantitative nomogram. Both nomograms and the simplified risk stratification table were accurate and equal or superior compared with established clinical risk scores (International Staging Collaboration for Cancer of the Prostate, European Association of Urology, a nomogram defined by Gafita and colleagues, and National Comprehensive Cancer Network). INTERPRETATION:We present new risk nomograms by PROMISE along with a simple table to prognosticate 3-year, 5-year, and 7-year overall survival in prostate cancer. PROMISE and PPP3 assessments are freely available online for global implementation. FUNDING:German Research Foundation, Prostate Cancer Foundation, Innovative Health Initiative Joint Undertaking, Novartis, AstraZeneca, and Amgen.

Incidental findings on 18F-FDG PET/CT may mimic pathologic processes, making recognition of imaging pitfalls essential. The eye-black sign, a rare finding characterized by bilateral symmetric FDG uptake in the lower eyelids, has mainly been reported in patients receiving systemic oncologic therapy. We present a 53-year-old woman with endometrial adenocarcinoma treated surgically and with adjuvant vaginal brachytherapy, without systemic therapy. Follow-up PET/CT 18 months later showed bilateral lower eyelid uptake (SUVmax: 9.7) without recurrence. Biopsy revealed chronic inflammatory changes. This case demonstrates that the eye-black sign can occur without systemic therapy and should be recognized as a benign imaging pitfall.

OBJECTIVE:This study aimed to determine the contribution of tubarial salivary glands to total salivary gland function using quantitative parameters obtained from 68 Ga-prostate-specific membrane antigen (PSMA) PET/computed tomography (PET/CT), including salivary gland volume (SV) and salivary gland function (SF). METHOD:This retrospectively designed study included 102 patients with prostate cancer (PCa) who had undergone 68 Ga-PSMA PET/CT for staging purposes between January 2022 and December 2023. Patients with missing data, those with tumors in the head and neck region, those who received radiotherapy to the head and neck region, those who underwent surgery in the head and neck region, those with any salivary gland-related disease, those previously treated with radioactive iodine, and those who received lutetium-177 ( 177 Lu) therapy were excluded from the study. RESULTS:All 102 patients included in the study were male and diagnosed with PCa. The mean age of the patients was calculated as 72.53 ± 7.58 years. Patients' tubarial SV% and tubarial SF% values were calculated as 7.76 ± 4.01 and 2.58 ± 1.34, respectively. The percentage volume of tubarial glands was found to be statistically significantly higher than that of sublingual glands ( P < 0.001, Wilcoxon signed-rank test). No statistical difference, however, was observed in their contributions to total function ( P = 0.506). CONCLUSION:When examining the volume ratios of salivary glands showing PSMA expression, it was found that the tubarial salivary glands had a higher volumetric ratio but a lower contribution to total function. We recommend considering these ratios when administering treatments that affect salivary gland functions.

A 57-year-old man diagnosed with a metastatic bladder tumor was initiated on pembrolizumab treatment. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging performed to evaluate treatment response showed numerical-dimensional and metabolic increase in the metastatic lesions. In the 18F-FDG PET/CT imaging performed 8 weeks later due to suspicion of pseudoprogression, a significant regression of the lesions was observed, and the patient was diagnosed with pseudoprogression. Pseudoprogression should be kept in mind when 18F-FDG PET/CT is performed after the use of immunotherapy, and evaluation with follow-up PET/CT is recommended to confirm that the patient has hyperprogression or pseudoprogression.

68 Ga-CXCR4 PET/CT was performed in a patient with acute myeloid leukemia (AML) and granulocytic sarcoma in the left cervical region, who had previously undergone 18 F-FDG PET/CT. Compared with 18 F-FDG PET/CT, 68 Ga-CXCR4 PET/CT revealed a greater number of malignant lymph nodes with more intense uptake in both supradiaphragmatic and infradiaphragmatic regions. Furthermore, markedly increased radiotracer uptake was observed in the bone marrow and spleen compared with FDG. This case underscores the superior sensitivity of 68 Ga-CXCR4 PET/CT in detecting AML infiltration and supports further investigation of CXCR4-targeted imaging and therapeutic approaches in high-risk AML.

Aim Multiple myeloma (MM) is a clonal plasma cell malignancy that infiltrates the bone marrow, bone, and sometimes extramedullary sites. Reliable staging and prognostic factors are essential for patient management. Imaging modalities, especially [18F]FDG PET/CT, are essential for the assessment of disease extent. This study evaluates a scoring system based on the IMPeTUs criteria for predicting progression-free survival (PFS) in MM. Materials and Methods This study included 35 newly diagnosed, treatment-naive MM patients (13 females, 22 males). Baseline [18F]FDG PET/CT scans were obtained within one month of diagnosis. Data on MM type, ISS stage, chemotherapy regimens and outcomes were collected. PET/CT scans were evaluated using the IMPeTUs criteria, focusing on the Deauville 5-point scoring system for bone marrow and lesions. Results The mean age of the cohort was 65 years. Ig G kappa was the most common MM type (37.1%). Diffuse bone marrow uptake and focal lesions were observed in 37.2% and 57.2% of patients, respectively, DS ≥ 4. The PET score cut-off of 6.5 predicted PFS with 61.5% sensitivity and 72.7% specificity (AUC 0.715). Median PFS was significantly different between patients with PET score < 6.5 and ≥ 6.5 (35 ± 4.1 months vs. 23.6 ± 4.03 months, p = 0.027). Conclusions The PET score cut-off value of 6.5 serves as a potential prognostic tool for MM, aiding in patient stratification and treatment decisions.

Purpose The present study aimed to predict the prognostic role of quantitative 18F-fluorodeoxyglucose PET/computed tomography parameters such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) obtained from primary tumor, lymph node metastases, and liver metastasis (LM) in patients with colorectal LM (CLM). Material and method The research was designed as a retrospective study and 66 patients with CLM were enrolled between January 2017 and December 2018. Primary tumor SUVmax (PSUVmax), liver SUVmax (LSUVmax), and lymph node SUVmax (LnSUVmax) values obtained from the primary tumor, liver, and lymph nodes were recorded. In addition, total MTV (TMTV) and total TLG (TTLG) values were obtained by summing the values obtained from the primary tumor (PMTV and PTLG), lymph nodes (LnMTV and LnTLG), and liver (LMTV and LTLG). Univariate and multivariate Cox regression analysis was used to measure the effects of prognostic variables on mortality and survival. Result In univariate Cox regression analysis, PMTV (P = 0.001), LnMTV (P = 0.008), LnTLG (P = 0.008), LnSUVmax (P = 0.047), and TTLG (P = 0.038) were identified as prognostic factors for overall survival. No statistically significant relationship was found between MTV and TLG values of LM and overall survival. In multivariate analysis, PMTV (P = 0.022) was identified as an independent prognostic factor. Conclusion In conclusion, our study demonstrated that the PMTV value used in evaluating treatment-naive patients diagnosed with CLM is an independent prognostic factor for survival. Our results need to be confirmed with more studies involving more patients.

OBJECTIVE:We aimed to determine whether TL-PSMA, PSMA-TV, and SUVpeak values measured in prostate adenocarcinoma patients who underwent imaging with Ga-68 PSMA PET/CT for primary staging have a role in predicting treatment response. MATERIALS AND METHODS:Images of 68 patients who underwent Ga-68 PSMA PET/CT for primary staging between March 25, 2019, and December 3, 2021, were analyzed retrospectively. Volumetric parameter data were obtained through manual delineation using a 40% threshold for the prostate gland, lymph nodes, bone, and visceral organ metastases. RESULTS:TL-PSMA(Bone) measurement differed statistically significantly between the treatment-responsive and unresponsive groups (p = 0.049). In addition, TL-PSMA and PSMA-TV parameters showed statistically significant differences between the treatment-responsive and unresponsive groups (p = 0.02 and p = 0.016). We could not find a significant relationship between other volumetric parameters and treatment response. CONCLUSION:It has been established that the volumetric parameters derived from Ga-68 PSMA PET/CT imaging conducted for primary staging may play a role in predicting treatment response in patients with prostate adenocarcinoma. However, further studies involving larger patient populations are necessary to clarify this issue.

In recent years, the increased incidence of differentiated thyroid cancers has largely been attributed to microcarcinomas. The aim of this study was to evaluate the impact of adjuvant radioactive iodine (RAI) therapy on recurrence in patients with multifocal papillary thyroid carcinoma (PTC) ≤ 1 cm. A total of 74 patients who were >18 years of age and diagnosed with multifocal PTC ≤ 1 cm at a tertiary referral center between July 2015 and December 2023 were retrospectively evaluated. Of the 74 patients, 78.4

To develop and validate the Istanbul [68Ga]Ga-PSMA PET/CT Criteria (IPPC), a standardized imaging framework designed to identify clinically significant prostate cancer (csPCa) and improve selection of candidates for active surveillance (AS). [68Ga]Ga-PSMA PET/CT scans and histopathology from 163 men with biopsy-proven International Society of Urological Pathology (ISUP) Grade Group (GG) 1–2 prostate cancer who underwent radical prostatectomy were retrospectively reviewed by a multidisciplinary panel of nuclear medicine physicians, radiologists, and urologists. Imaging characteristics—including uptake pattern, morphology, localization, and SUVmax—were iteratively analyzed to define three categories: IPPC-1 (indolent), IPPC-2 (indeterminate), and IPPC-3 (csPCa-suspected). Delayed pelvic acquisitions were used as the primary dataset to enhance lesion definition and interpretability. Reproducibility was evaluated in 56 GG1 patients using Cohen’s and Fleiss’ κ statistics. Correlations between PSA, SUVmax, and IPPC categories were assessed, and ROC curve analysis was performed to determine the optimal SUVmax threshold for csPCa detection. Pathological upgrading occurred in 40

PURPOSE:This study aimed to examine the role of computed tomography (CT)-derived myosteatosis, sarcopenia, and other body composition parameters on overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) scheduled to receive lutetium (Lu)-177 treatment. MATERIAL AND METHOD:Patients with mCRPC who underwent 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT imaging before [ 177 Lu]Lu-PSMA-617 treatment and received at least two cycles of Lu-177 PSMA treatment between March 2017 and March 2023 were retrospectively reviewed in this study. Body composition including psoas muscle, skeletal muscle, subcutaneous adipose tissue, and visceral adipose tissue were evaluated at the third lumbar spine vertebra on CT axial sections. RESULTS:Median age of the 76 patients enrolled in this study was 75 years (59-91 years), and the median Gleason score was 8 (6-10). All patients received two to six (median 4) cycles of 7.4 GBq Lu-177 PSMA treatment at 6-8 week intervals. Upon univariant Cox regression analysis, subcutaneous adipose tissue index, right psoas myosteatosis, left psoas myosteatosis, and skeletal muscle index were determined to be prognostic factors for OS ( P  = 0.03, P  = 0.02, P  < 0.001, and P  = 0.04, respectively). However, the left psoas myosteatosis value was an independent prognostic factor for OS as determined by multivariant Cox regression analysis ( P  < 0.001). CONCLUSION:Sarcopenia and myosteatosis before treatment were associated with shorter survival in mCRPC patients who were scheduled for Lu-177 PSMA treatment. Patients with left psoas myosteatosis value ≤26.85 HU had shorter OS, and we showed that OS is an independent prognostic factor.