Treatment with 177Lu-PSMA-I&T Prior to Radical Prostatectomy in High-Risk Prostate Cancer

Preliminary results from a clinical trial, presented by lead author, Michael Frumer, at the 22nd Annual Meeting of the Society of Urologic Oncology, suggested that 177Lu-PSMA-I&T (LuPSMA) followed by radical prostatectomy (RP) with pelvic lymph node dissection (PLND) appeared safe in patients with high-risk prostate cancer (HRPCa).

The researchers administered two 7.5 GBq LuPSMA treatments six and eight weeks before RP with PLND to seven total patients with HRPCa with high prostate-specific membrane antigen (PSMA) avidity on 68Ga- PSMA PET/CT and recorded immediate outcomes. The participants’ median age was 66 years (IQR: 60–68). Four patients were Gleason grade group III and three were Gleason grade group V.

Frumer relayed that, after the LuPSMA treatments, patients’ median prostate-specific antigen (PSA) level dropped to 7.4 ng/dL (IQR: 2.8–20.9) from a baseline of 11.4 ng/dL (IQR: 7.6–27), a decrease of 35%. One case of fatigue was the only adverse event observed during treatment. Periprostatic adhesions were encountered during surgery in three patients without complications. One case of fever was the only post-surgery adverse event. Lastly, biochemical responses were observed in all patients, with a median PSA of 0.01 ng/dL (IQR: 0.01–0.03) after the operation.

“While longer oncological outcomes are pending, continence recovery seems to be unaffected by LuPSMA treatment,” concluded Frumer and his collaborators.