Exceptional Response to Short-course 177 Lu-PSMA Radioligand Therapy in a Patient With Metastatic Hormone-sensitive Prostate Cancer.
Nikoo Rezaei Borujerdi, Amin Saber Tanha, Haniye Elahifard et al.
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Case in brief
A 69-year-old man with de novo, high-volume metastatic hormone-sensitive prostate cancer presented with a PSA of 433.75 ng/mL and widespread skeletal and nodal metastases. Goserelin, abiraterone, and cyproterone acetate reduced PSA to 44.29 ng/mL. After three cycles of 177Lu-PSMA radioligand therapy, PSA fell to 0.15 ng/mL and bone pain resolved. At nine-month follow-up, 99mTc-PSMA imaging showed complete regression of metastatic lesions.
What made this case unusual
The marked biochemical and imaging response followed a short course of 177Lu-PSMA therapy in a patient with high-volume, hormone-sensitive disease, after an initial response to hormonal treatment.
Diagnostic / clinical pearl
In this case, PSA response and symptom improvement after 177Lu-PSMA therapy were accompanied by complete regression of metastatic lesions on follow-up PSMA imaging.
Why it matters
The report suggests potential efficacy and safety of early 177Lu-PSMA therapy in high-volume metastatic hormone-sensitive prostate cancer, but a single case cannot establish its role.