Sudden Diffuse Hepatic Metastases After First 177Lu-PSMA Cycle in Bone Predominant mCRPC Patient.

Area of Science:

• Nuclear Medicine
• Oncology
• Radiopharmaceuticals

Background:

• Metastatic castration-resistant prostate cancer (mCRPC) is an advanced stage of prostate cancer.
• 177Lutetium-PSMA (177Lu-PSMA) therapy is a targeted radiopharmaceutical treatment for mCRPC.
• Distant metastases, including to the liver, are common in advanced mCRPC.

Purpose of the Study:

• To report an unexpected finding of new liver metastases during 177Lu-PSMA therapy in a patient with mCRPC.
• To discuss the clinical dilemma posed by these new findings.
• To highlight the importance of diagnostic confirmation for treatment adjustments.

Main Methods:

• Case presentation of a 63-year-old man with mCRPC.
• Administration of 177Lu-PSMA therapy.
• Post-treatment imaging (scans and SPECT/CT) to assess treatment response and disease progression.
• Liver Fine Needle Aspiration (FNA) for histopathological confirmation.

Main Results:

• Post-treatment scans revealed new, diffuse hepatic metastases not present in earlier scans.
• The unexpected liver metastases presented a clinical dilemma for the medical team.
• Liver FNA confirmed the presence of metastatic prostatic adenocarcinoma in the liver.

Conclusions:

• New hepatic metastases can emerge during 177Lu-PSMA therapy for mCRPC.
• Unexpected findings on post-treatment scans necessitate careful evaluation and confirmation.
• Accurate diagnosis is crucial for guiding subsequent treatment decisions in advanced prostate cancer.