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Positive effect of Actinium 225-PSMA treatment on ECOG performance status: A case report on a patient with castration resistant stage IV prostate carcinoma6

Efecto positivo del tratamiento con Actinio 225-PSMA sobre el estado funcional ECOG: Informe del caso de un paciente con cáncer de próstata en estadio IV resistente a la castración

Fuad Novruzova,   Jamil A. Aliyevb,   Zeynəb Allahverdiyevac,   Elnur Mehdia, Francesco Giammariled,

a Department of Nuclear Medicine, National Centre of Oncology, Baku, Azerbaijan

b Department of General Surgery, National Centre of Oncology, Baku, Azerbaijan

c Department of Medical Oncology, Central Clinic Hospital, Baku, Azerbaijan

d International Atomic Energy Agency, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria

Prostate cancer is the third highest cause of cancer deaths and the most commonly found malignancy in males within economi- cally developed countries.1

Prostate-specific membrane antigen (PSMA) is a  unique  tar- get in metastatic castration resistant prostate carcinoma patients (mCRPC). PSMA is a good example of theranostic agent. Promising results obtained with Gallium-68 labelled PSMA Positron Emission Tomography/Computed Tomography (PET/CT) have been exten- sively studied for prostate cancer, particularly restaging in patients with biochemical relapse following treatment with curative intent. PSMA can also be used with therapy purposes. In particular, alpha-emitting radioisotope Actinium-225 is more effective than beta-emitting Lutetium-177, due to higher rates of double-strand DNA breaks in prostate cancer cells. It has less tissue penetration

and minimal surrounded effects in PSMA-negative cells.2

However, limited data are  available  on  the  clinical  efficacy and side effects of 225Ac-PSMA targeted radionuclide treatment in mCRPC patients.3

In our case, 225Ac-PSMA resulted in remarkable clinical and biochemical responses. It may be considered as a promising ther- apy and could improve the ECOG performance status of end-stage mCRPC patients.

However, the results obtained do not allow to reach any conclu- sion since, unfortunately, due to the short follow up of the patient, the increase in the ECOG level could not be confirmed in a long period of time (Figs. 1–3).

Fig. 1. 74 y patient with metastatic prostate carcinoma, diagnosed 4 years before and treated with Docetaxel and hormonal therapy. The figure shows bone scan prior to treatment.

6 Please cite  this  article  as:  Novruzov  F,  Aliyev  JA,  Allahverdiyeva  Z,  Mehdi E, Giammarile F. Efecto positivo del tratamiento con Actinio 225-PSMA sobre el estado funcional ECOG: Informe  del  caso  de  un  paciente  con  cáncer  de  próstata en estadio IV resistente a la castración. Rev Esp Med Nucl Imagen Mol. 2018. https://doi.org/10.1016/j.remn.2018.09.003

∗   Corresponding  author.

E-mail address: [email protected] (F. Giammarile).

2253-8089/© 2018 Sociedad Espan˜ola de Medicina Nuclear e Imagen Molecular. Published by Elsevier Espan˜a, S.L.U. All rights reserved.

Fig. 2. Due to progressive disease, the patient received 2 cycles of targeted treatment with 177 Lu-PSMA, for a total of about 15 GBq. The figure shows 68 Ga PSMA-11 PET/CT scan prior to treatment, MIP (A), axial PET (B), axial CT (C), and axial fusion (D) images indicate multiple intense pathologic uptakes in lymph nodes (simple arrow), liver (dashed arrow) and bone (arrowhead).

Fig. 3. After the second cycle of 177 Lu-PSMA, 68 Ga-PSMA PET/CT control scan showed no response in lymph node lesions. Only one liver lesion disappeared, while the bone lesion increased. The patient was considered in stable disease after the treatment. MIP (A), axial PET (B), axial CT (C), and axial fusion (D) images indicate multiple intense pathologic uptakes in lymph nodes (simple arrow), liver (dashed arrow) and bone (arrowhead). In comparison with pre-treatment images only the liver lesion disappeared (dashed arrow), while the bone lesion increased (arrowhead). When 225 Ac-PSMA treatment (8 MBq) was administered (about one month after the decision to treat), the patient was in ECOG stage IV, with a PSA level of 623.8 ng/mL. The thrombocyte count was 64,000 one day before treatment, after 5 days of the treatment the thrombocyte count has increased to 88,000. Fifteen days after the treatment, the PSA level got down to 476.3 ng/mL and ECOG performance status rise to more favourable stage III. No treatment-related toxicity occurred, but the patient passed away 45 days after treatment because of heart failure (that was diagnosed 2 years before).

Source of foundation

Science Development Foundation under the President of the Republic of Azerbaijan (Grant No. EIF-2014-9(24)-KETPL-14/13/3).


  1. Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J,  et  al. Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. Part II: Recom- mended approaches and details of specific care options. J Urol. 2018;199:990–7, http://dx.doi.org/10.1016/j.juro.2018.01.002.

  1. Arsenault  F,   Beauregard   JM,   Pouliot   F.   Prostate-specific   membrane   anti- gen  for prostate cancer  theranostics:   from   imaging   to   targeted   therapy. Curr Opin Support Palliat Care. 2018;12:359–65, http://dx.doi.org/10.1097/ SPC.0000000000000357.

  2. Zschaeck S, Lohaus F, Beck M, Habl G, Kroeze S, Zamboglou C, et al. PSMA-PET  based  radiotherapy:    a    review    of    initial    experiences,    survey on current practice and future perspectives. Radiat Oncol. 2018;13:90, http://dx.doi.org/10.1186/s13014-018-1047-5.

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