Use of 177Lu prostate-specific membrane antigen therapy in metastatic castration-resistant prostate cancer
Österreichische Gesellschaft für Nuklearmedizin und Theranostik (OGNMT); Österreichische Gesellschaft für Urologie und A · 2025 · Austria
Source and licence
- Authors
- Siroos Mirzaei, Gregor Schweighofer-Zwink, Heidemarie Ofner et al.
- Title
- Use of 177Lu prostate-specific membrane antigen therapy in metastatic castration-resistant prostate cancer
- Journal
- Wiener Klinische Wochenschrift, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12137475
Licence statement of the original publication
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Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Current guideline recommendations on 177Lu-PSMA-617 in PCa
- Offer 177Lu-PSMA-617 to pre-treated mCRPC patients with ≥1 highly PSMA expressing metastatic lesion
- 177Lu-PSMA-617 (with cancer expressing PSMA on PSMA-PET and without PSMA non-expressing lesions)
- 177Lu-PSMA-617 (≥ 1 PSMA-positive lesion and/or metastatic disease that is predominately PSMA-positive and with no dominant PSMA-negative metastatic lesions)
- 177Lu-PSMA-617 should be offered in patients with progressive mCRPC, previously treated with docetaxel and an ARTA, with a positive PSMA-PET imaging
- In mCRPC PSMA-positive patients, who progressed at least after an ARTA or alternative treatment options have been exhausted or are contraindicated on an individual patient basis
- 177Lutetium-PSMA-617 (177Lu vipivotide tetraxetan)
Possibility of rechallenge
- In all three studies the safety profile is favorable and comparable to the initial treatment cycles. Most adverse events are mild to moderate (grade 1–2) and no life-threatening (grade 4) events have been reported [45–47]. A slight increase in grade 3 hematological toxicities may occur but still remain manageable [45, 46].
Abstract
Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality in men. Over the past decades, the incidence has risen in all age groups. Prostate-specific membrane antigen (PSMA)-based theranostics, which involve the use of PSMA-targeting radiopharmaceuticals for both diagnostic imaging and therapeutic applications, have become integral in the management of patients with metastatic castration-resistant prostate cancer (mCRPC). The field has witnessed a substantial and continuously expanding body of scientific literature, encompassing case reports, original research, systematic reviews and also clinical guidelines. The objective of this joint statement is to enhance awareness of PSMA theranostics and underscore their critical role in contemporary precision oncology. We aim to provide a comprehensive yet practical perspective on the current landscape of PSMA-based diagnostic and therapeutic modalities, offering a consensus-driven approach to their clinical application.
Contents of the original publication
The section headings of the original.
- Aim
- Introduction
- Spectrum of disease and therapeutic implications
- PSMA expression, imaging and targeted therapy
- Radiopharmaceuticals for PSMA therapy
- Current guideline recommendations on 177Lu-PSMA-617 in PCa
- 177Lu-PSMA-RLT treatment evidence
- Alternative radiopharmaceuticals for PSMA-radioligand therapy
- Practical implementation of the PSMA-RLT and interdisciplinary procedure
- Treatment plan
- Predictive biomarkers and disease monitoring
- Possibility of rechallenge
- Radiation protection measures
- Outlook
- Conclusion
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