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Journal of Case Reports
Excellent and Durable Response to Lutetium177 PSMA Therapy in a Metastatic Prostate Cancer Patient Refractory to Docetaxel Therapy: An Illustrative Case Report
Smriti Srivastava, Ajeet Kumar Gandhi, Madhup Rastogi, Rohini Khurana, Avinash Poojari, Vachaspati Kumar Mishra
Department of Radiation Oncology, RML Institute of Medical Science, Lucknow, Uttar Pradesh, India.
Corresponding Author:
Dr Smriti Srivastava
Email: drsmritisrivastava2017@gmail.com
Received: 19-OCT-2021 Accepted: 28-SEP-2022 Published Online: 15-OCT-2022
DOI: http://dx.doi.org/10.17659/01.2022.0027
Background: Prostate specific membrane antigen (PSMA) is a membrane-bound protease largely overexpressed in all prostate cancers. Differential expression of PSMA in tumor and non-tumor tissue has led to evolution of several targeted therapeutic interventions in metastatic castration resistant prostate cancer (mCRPC). Case Report: Here we present the case of 66-year-old male of advanced carcinoma prostate with multiple skeletal metastasis. He underwent bilateral orchidectomy and started on abiraterone followed by enzalutamide. Being unresponsive to both these treatments, he received 6 cycles of chemotherapy with docetaxel but had continuously rising PSA. His genomic analysis did not reveal any DNA repair defects. After performing 68Ga-PSMA-PETCT scan, he was started on 177-Lu-PSMA therapy. On receiving three cycles of Lu-177 DKFZ-PSMA-617, good clinical and biochemical response was obtained. However, on further PSA rise he was started on actinium 225-PSMA therapy. Till date three cycles of Actinium-225 PSMA therapy has been given and 68Ga-PSMA-PETCT scan demonstrated good partial response at metastatic sites with corresponding decrease in sPSA levels. The patient is now on follow up and receiving zoledronic acid at 3 months interval and is presently asymptomatic at the time of last follow up. Conclusion: PSMA directed radionuclide therapy is a promising treatment option in patients of mCRPC refractory to docetaxel therapy yielding excellent and durable biochemical control.
Keywords : Metastasis, Prostate Cancer, Prostate Specific Antigen, Radionuclide Therapy, Targeted Therapy.
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