Kidney Week

Abstract: SA-PO1238

Kidney Function Decline After Treatment for Metastatic Castration-Resistant Prostate Cancer

Session Information

• Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Chewcharat, Api, Brigham and Women's Hospital, Boston, Massachusetts, United States

Api Chewcharat, MD, MPH, FASN

• Tchitchkan, Elizabeth, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Elizabeth Tchitchkan

• James, Brady, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Brady James

• Lee, Megan, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Megan Lee

• Anumolu, Rajesh, Brigham and Women's Hospital, Boston, Massachusetts, United States

Rajesh Anumolu, MBBS

• Rider, Robert Stewart, Brigham and Women's Hospital, Boston, Massachusetts, United States

Robert Stewart Rider

• Ravi, Praful, Dana-Farber Cancer Institute, Boston, Massachusetts, United States

Praful Ravi, MD

• Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States

Shruti Gupta, MD, MPH

Background

The treatment landscape of metastatic castration-resistant prostate cancer (mCRPC) has been revolutionized by the introduction of Lutetium-177-PSMA-617 (¹⁷⁷Lu-PSMA-617), a radiopharmaceutical therapy targeting prostate-specific membrane antigen (PSMA). Despite its survival benefit, concerns remain regarding long-term nephrotoxicity due to PSMA expression in renal tissue and renal clearance of the radiotracer. We therefore compared eGFR slope decline between patients treated with standard-of-care docetaxel-based therapy and those receiving ¹⁷⁷Lu-PSMA-617.

Methods

We retrospectively examined patients with mCRPC treated at major academic cancer center between 2022-2025 who received docetaxel-based therapy or ¹⁷⁷Lu-PSMA-617 with at least 90 days follow-up. Longitudinal eGFR measurements were modeled using linear mixed-effects models with random intercepts and slopes to estimate individual slopes of kidney function over time, adjusting key characteristics.

Results

Of 353 patients with mCRPC, 213 (60%) received ¹⁷⁷Lu-PSMA-617 and 140 (40%) received docetaxel-based therapy. Median follow-up 335 days (Inter quartile range [IQR], 180- 577) among ¹⁷⁷Lu-PSMA-617 group and 326 days (IQR, 210-566) among docetaxel group. After adjusting for key characteristics, treatment with ¹⁷⁷Lu-PSMA-617 was associated with a significantly greater decline in eGFR compared to docetaxel-based therapy, with an adjusted difference in eGFR slope of 3.98 mL/min/1.73m2 per year (95% CI, [0.51, 7.45]; p = 0.02) (Figure 1)

Conclusion

In patients with mCRPC, treatment with ¹⁷⁷Lu-PSMA-617 was associated with a greater decline in eGFR compared to docetaxel-based therapy. Given that ¹⁷⁷Lu-PSMA-617 is now used earlier in the course of treatment for prostate cancer, patients receiving ¹⁷⁷Lu-PSMA-617 may warrant closer monitoring of their kidney function.