Liver Enzyme Elevation After ¹⁷⁷Lu-PSMA Radioligand Therapy for Metastasized Castration-Resistant Prostate Cancer

¹⁷⁷Lu-PSMA radioligand therapy is a promising new option for patients with metastasized castration-resistant prostate cancer, and the spectrum of adverse events with this treatment has to be evaluated. Here, we describe the case of a patient with M1c disease (metastasis to the mediastinum, lungs, bones, and liver) who presented with elevated liver enzyme levels after receiving ¹⁷⁷Lu-PSMA radioligand therapy for castration-resistant prostate cancer. Pretreatment ⁶⁸Ga-PSMA PET/CT showed at least 4 liver lesions with low uptake. Overall, the liver uptake was inhomogeneous. Liver biopsy was performed subsequently.