Lu-177-PSMA treatment for metastatic prostate cancer: case examples of major responses

Abstract

Prostate-specific membrane antigen (PSMA) is expressed in high-risk prostate cancer (PCa). PSMA has potential as a basis for new diagnostics and theragnostics. 177Lu-PSMA radioligand therapy is mainly used for patients with end-stage prostate cancer. This report describes seven PCa patients: one patient with extensive metastatic bone and bone marrow disease during the first visit, one patient with his fifth recurrence during 15 years, one patient with extensive metastatic disease in liver, one patient with multiple lung metastases, one patient with metastatic disease where 177Lu-PSMA was used as first-line treatment and one patient with extensive metastatic disease in the lymphatics and skeleton. All these patients were treated with 177Lu-PSMA radioligand therapy with major response, i.e. major (up to complete) response by imaging and substantial (> 90%) reduction of PSA. 177Lu-PSMA radioligand therapy gave only mild adverse effects. In conclusion, in patients with metastatic prostate cancer, 177Lu-PSMA radioligand therapy had an attractive therapeutic profile, showing efficacy in the prostate, in lymph nodes, in lungs, in the liver and also in bones. The therapy had to be adjusted according to the patients’ needs.