Abstract
The aim of this narrative review is to evaluate the current status of 177Lu-PSMA (prostate specific membrane antigen) therapy for metastatic castration-resistant prostate cancer (mCRPC) in the light of the current literature. We also addressed patient preparation, therapy administration and side effect profiles. 177Lu-PSMA therapy efficacy was assessed by using prospective trials, meta-analyses and major retrospective trials. Predictors of efficacy were also mentioned. Although there are some different approaches regarding the use of 177Lu-PSMA therapy in different countries, this type of therapy is generally safe, with a low toxicity profile. From the oncological point of view, a PSA (prostate specific antigen) decline of ≥50% was seen in 10.6–69% of patients with mCRPC; whereas progression-free survival (PFS) was reported to be 3–13.7 months in different studies. Consequently, 177Lu-PSMA therapy is a promising treatment in patients with mCRPC, with good clinical efficacy, even in heavily pretreated patients with multiple lines of systemic therapy. Currently, there are ongoing clinical trials in the United States, including a phase III multicenter FDA registration trial.
Highlights
Prostate cancer (PCa) is the most common cancer and the second cause of death related to cancer in the United States [1]
Depending on the relationship between serum PSA levels and applied treatment according to the location of the disease, the natural course of PCa might be evaluated in four distinct disease states
This review aims to summarize the theranostic benefits of 177 Lu-Prostate-specific membrane antigen (PSMA) in metastatic castrationresistant PCa (mCRPC)
Summary
Prostate cancer (PCa) is the most common cancer and the second cause of death related to cancer in the United States [1]. Despite appropriate ADT, if the disease progresses, it is defined as mCRPC [4] For this disease state, many agents given in conjunction with ADT are available with different survival benefits. The use of theranostic agents such as 177 Lu or 225 Ac-PSMA is an emerging therapy in patients with mCRPC, available for the clinical care of patients in many countries outside. As a further management strategy, it might be used as a theranostic radiotracer in combination with 177 Lu and 225 Ac to locate PCa cells and destroy them This approach, using some alpha or beta emitter agents, came into practice with favorable outcomes as a part of personalized medicine, which is highly convenient for decision-making and monitoring therapy
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