Upfront 177Lu-PSMA Radioligand Therapy With Concurrent Androgen-deprivation Therapy Producing Dramatic Clinical and Biochemical Response

A 72-year-old man presented with severe weight loss, anemia, and a PSA level of 73 ng/mL. Bone scintigraphy and 99mTc-PSMA imaging revealed extensive skeletal metastases. As part of a clinical trial, he received upfront 177Lu-PSMA radioligand therapy combined with androgen-deprivation therapy (ADT). The second cycle of 177Lu-PSMA resulted in complete resolution of all PSMA-avid lesions and a 99% decline in PSA to <0.4 ng/mL. Radioligand therapy was discontinued after achieving complete molecular and biochemical response. At 8 months of follow-up, the patient remains disease-controlled, supporting the potential value of early 177Lu-PSMA integration in hormone-sensitive metastatic prostate cancer.