PMC10175697_01
Clinical timeline.
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The patient began ADT with degarelix to quickly lower testosterone and PSA levels ( Figure 1 ). While continuing with abiraterone, the patient completed four cycles of 177Lu-PSMA-617 therapy over the course of 10 months (due to the patient's robust response, the interval between the 3rd and 4th cycles was extended) and tolerated treatment well without any adverse effects ( Figure 1 ).
PSMA imaging before and after targeted radioligand therapy with 177Lu-PSMA-617. A 73-year-old male with mCRPC in 2017 with multiple bone and lymph node metastases with increased PSMA expression. (A) Imaging on March 14, 2017, just before the first dose of [177Lu]-PSMA-617 therapy; the baseline coronal PET [68Ga]-PSMA-11 PET maximum intensity projection (MIP) image shows bone metastases with significantly higher PSMA expression as well as the normal biodistribution of the tracer. (B) Imaging on July 24, 2017, just before the third dose of Lu-177 PSMA radioligand therapy, showed intense but decreasing uptake with an excellent target-to-background ratio, corresponding with molecular response to RLT therapy. Imaging four months (May 15, 2018) (C) and just over one year (February 11, 2019) (D) after the fourth dose of [177Lu]-PSMA-617, the [68Ga]-PSMA-11 PET MIP image shows multiple decreased or disappeared metastases. No evidence of PSMA-positive lymph nodes or new metastases and very mild uptake was noted in the central skeleton and sternum. Overall, no new and no intense PSMA-avid lesions were noted.
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