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Excellent Response to 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy in a Patient with Treatment-Related
Ryusei Yasukawa1, Bunya Kawamoto1, Kuniyasu Muraoka1
1Department of Urology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan.
Abstract:
Treatment-related neuroendocrine prostate cancer (tNEPC) occurs after androgen deprivation therapy and has a poor prognosis; however, there are few effective treatments for tNEPC. Therefore, tNEPC management is often challenging. This is a case of a 65-year-old Asian male patient with prostate adenocarcinoma who had metastases at initial presentation. After prostate biopsy revealed neuroendocrine prostate cancer (NEPC), he was treated with platinum-based systemic chemotherapy followed by pembrolizumab treatment. The primary tumor regions temporarily regressed, but progression of the primary tumor resulted in urinary retention and rectal obstruction; therefore, a transverse colostomy was performed, and a urethral catheter was inserted. Following somatostatin receptor scintigraphy (SRS), it was determined that the primary tumor expressed somatostatin receptors. Based on these results, treatment with 177Lu-DODATATE peptide receptor radionuclide therapy was prescribed. Subsequently, the primary tumor regressed remarkably, and the urethral catheter was removed. 177Lu-DOTATATE peptide receptor radionuclide therapy may be an effective option for tNEPC, which has few effective treatment options.
Insights
Treatment-related neuroendocrine prostate cancer (tNEPC) has limited treatment options. Peptide receptor radionuclide therapy with 177Lu-DOTATATE showed remarkable regression in a patient with advanced tNEPC.
Area of Science:
- Oncology
- Nuclear Medicine
- Urology
Background:
- Treatment-related neuroendocrine prostate cancer (tNEPC) is an aggressive complication of androgen deprivation therapy with a poor prognosis.
- Effective therapeutic strategies for tNEPC remain limited, posing significant clinical challenges.
- This case highlights the management difficulties associated with advanced tNEPC.
Observation:
- A 65-year-old male with metastatic prostate adenocarcinoma developed tNEPC.
- Initial treatment with chemotherapy and pembrolizumab resulted in temporary tumor regression but eventual progression.
- Symptomatic progression led to urinary retention and rectal obstruction, necessitating a colostomy and urethral catheterization.
Findings:
- Somatostatin receptor scintigraphy (SRS) confirmed somatostatin receptor expression in the primary tNEPC.
- Subsequent treatment with 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) led to significant primary tumor regression.
- The patient experienced clinical improvement, allowing for the removal of the urethral catheter.
Implications:
- 177Lu-DOTATATE PRRT demonstrates potential as an effective treatment for advanced tNEPC.
- This therapy offers a promising new avenue for patients with limited therapeutic options.
- Targeted radionuclide therapy may improve outcomes in refractory neuroendocrine prostate cancer.
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