转移性前列腺癌 (mPCa) 的治疗面临着重大挑战。在本系统综述、荟萃分析和荟萃回归中，利用镥-177（[177Lu ]Lu-PSMA) 和锕-225 ([225Ac]Ac-PSMA) 进行了评估。对 PubMed/Medline、EMBASE、Web of Science、Scopus 和 Cochrane 图书馆进行了详细的文献检索，最终纳入了 100 项研究涉及8711名患者。分析了前列腺特异性抗原（PSA）反应、毒性特征、生活质量和生存结果的数据。进行了比例荟萃分析和荟萃回归分析。在 mPCa（尤其是转移性去势抵抗性前列腺）中，[177Lu]Lu-PSMA 中 PSA 下降≥50% 的患者估计比例为 0.49，[225Ac]Ac-PSMA 为 0.60癌症。荟萃回归分析表明，累计给药量与 PSA 下降≥50% 的比例之间存在关联。两种疗法均观察到积极的 PSA 反应以及总生存期的改善。我们的分析还确定了与 PSA 反应和生存结果相关的关键因素，包括基线血红蛋白水平和内脏转移的存在。虽然使用[177Lu]Lu-PSMA时经常观察到贫血，但严重的毒性并不常见。 [177Lu]Lu-PSMA 治疗后观察到生活质量改善，而在 [225Ac]Ac-PSMA 治疗第二周期后保持稳定。 PSA 反应和毒性特征研究之间的异质性是一个限制。我们的研究结果表明 PRLT 与 PSA 水平降低之间存在关联，以及与 mPCa 生存结果增强之间存在关联。此外，我们的分析显示与这种治疗相关的严重毒性发生率较低。这些观察强调了 PRLT 在 mPCa 管理中的重要作用。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Management of metastatic prostate cancer (mPCa) presents significant challenges. In this systematic review, meta-analysis, and meta-regression, the efficacy, safety, and quality of life (QoL) outcomes of prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PRLT) utilising lutetium-177 ([177Lu]Lu-PSMA) and actinium-225 ([225Ac]Ac-PSMA) were assessed.A detailed literature search across PubMed/Medline, EMBASE, Web of Science, Scopus, and Cochrane Library was conducted, culminating in the inclusion of 100 studies involving 8711 patients. Data on prostate-specific antigen (PSA) responses, toxicity profiles, and QoL and survival outcomes were analysed. Proportional meta-analyses and meta-regression analyses were performed.The estimated proportion of patients with PSA decline ≥50% was 0.49 for [177Lu]Lu-PSMA and 0.60 for [225Ac]Ac-PSMA in mPCa, particularly metastatic castration-resistant prostate cancer. A meta-regression analysis indicated an association between the cumulative amount of administered activity and the proportion of PSA ≥50% decline. Positive PSA responses were observed alongside improved overall survival across both therapies. Our analyses also identified the key factors associated with PSA responses and survival outcomes, including baseline haemoglobin level, and the presence of visceral metastases. Although anaemia was commonly observed, with [177Lu]Lu-PSMA, severe toxicities were infrequent. Improved QoL was observed following [177Lu]Lu-PSMA therapy, whereas it remained stable following the second cycle of [225Ac]Ac-PSMA treatment. Heterogeneity across studies for PSA responses and toxicity profiles is a limitation.Our findings suggest an association between PRLT and reductions in PSA levels, as well as associations with enhanced survival outcomes in mPCa. Furthermore, our analysis shows a low incidence of severe toxicity associated with this treatment. These observations highlight the important role of PRLT in the management of mPCa.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.