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

We present a 63-year-old man with a history of prostate adenocarcinoma (mCRPC), widespread skeletal and multiple lymph node metastases, who was referred for 177Lu-PSMA therapy. In second course of therapy, posttreatment scan showed multiple foci of increased activity throughout the liver, compatible with diffuse hepatic metastases, which were not seen in the diagnostic and the first posttreatment scans and SPECT/CT images. This unexpected finding turned the case into a clinical dilemma, leaving the medical team uncertain about how best to proceed to ensure the most appropriate care. Eventually, a liver FNA confirmed the presence of metastatic prostatic adenocarcinoma.