Real-World Outcomes of 177Lu-PSMA-617 Radioligand Therapy in Elderly Patients with Metastatic Castration-Resistant Prostate Cancer

Abstract

Objective: Among recently developed treatment strategies for advanced prostate cancer, 177Lu-PSMA-617–based radioligand therapy has shown considerable clinical potential in patients with metastatic castration-resistant disease. However, predictors of treatment response and survival outcomes remain incompletely defined. Methods: This retrospective analysis included 38 patients who received up to 6 cycles of 177Lu‑PSMA‑617 (4.0-6.8 GBq/cycle; mean 5.5 GBq) administered every 6-9 weeks. Clinical variables, laboratory findings, and prostate-specific membrane antigen–positron emission tomography/computed tomography metrics, including prostate-specific antigen (PSA), alkaline phosphatase (ALP), and maximum standardized uptake value (SUVmax), were evaluated for their association with treatment response, progression‑free survival (PFS), and overall survival (OS). Results: At the time of analysis, the median follow-up duration was 12.2 months (range: 1.1-65.8 months). Median PFS was 5.8 months, whereas median OS reached 12.3 months. Objective response to therapy was observed in 36.8% of the study population. Adverse events were common, occurring in 86.8% of patients overall, with grade 3-4 toxicities recorded in 57.9% of cases. Posttherapy SUVmax below 4 independently predicted prolonged PFS, whereas Eastern Cooperative Oncology Group (ECOG) performance status, ALP, PSA, and post‑treatment SUVmax independently influenced OS. Conclusion: 177Lu-PSMA-617 demonstrated meaningful clinical activity in this heavily pretreated cohort. However, the relatively high frequency of severe treatment-related toxicities highlights the importance of careful patient selection and close clinical monitoring. Functional imaging findings (post-treatment SUVmax), together with ECOG performance status and biochemical markers, may improve prognostic stratification in patients receiving this therapy.   Cite this article as: Karcı E, Atasever T,Ç.akır T, et al. Real-world outcomes of lu-PSMA-617 radioligand therapy in elderly patients with metastatic castration-resistant prostate cancer. Cerrahpaşa Med J. 2026, 50, 0082, doi: 10.5152/cjm.2026.26082.