Targeted PSMA Therapy in an
85-Year-Old Male with mCRPC and BRCA Mutation

Patient Background

An 85-year-old male with a history of metastatic castration-resistant prostate cancer (mCRPC) presented with progressive disease despite standard therapies. The patient had con rmed bone metastases, a rising PSA, androgen-independent progression, and a known BRCA gene mutation.

Clinical Journey

The prostate cancer was  rst identi ed as low-grade prostatic intraepithelial neoplasm (PIN) on biopsy. He underwent annual surveillance, and  ve years later, he progressed to high-grade PIN with atypical cells. A subsequent biopsy con rmed Gleason 4+3 adenocarcinoma. He underwent robotic radical prostatectomy, which revealed Gleason 8 adenocarcinoma involving both lobes and positive surgical margins.

Two years post-surgery, salvage radiation therapy was initiated due to rising PSA. The patient also underwent melanoma resection with no residual malignancy two years later. Four years after that, another PSA rise
prompted a PSMA PET scan, which revealed metastases to the left posterior iliac bone and rib. These sites were treated with stereotactic body radiation therapy (SBRT).

He received antiresorptive therapy (Xgeva) and multiple courses of androgen deprivation therapy (Leuprolide, Casodex, Xtandi). However, three years later, the disease progressed again, as evidenced by di use osseous activity on PSMA PET imaging.

Advanced Targeted Therapy: Pluvicto (Lutetium-177 PSMA) Given his progressive, androgen-independent disease, the patient was referred for Pluvicto therapy. Following the  rst dose, a notable drop in PSA was observed within four weeks, suggesting early biochemical response. A follow-up PSMA PET scan is scheduled to assess imaging-based response.

Pluvicto (Lutetium-177 PSMA) – Expanded Indication
& Referral Guide for Physicians

FDA-Expanded Indication – March 28, 2025

Pluvicto is now approved for the treatment of patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) who have previously received an androgen receptor pathway inhibitor (ARPI) and are candidates to delay chemotherapy.

Clinical Evidence: Phase III PSMAfore Study Highlights

Pluvicto demonstrated signi cant e cacy over a change in ARPI in this pre-chemotherapy population:

  • Median rPFS: 12.0 months vs. 5.6 months
  • Risk Reduction: 51% reduction in risk of rPFS or death
  • Overall Response Rate (ORR): 49% (including 21% CR and 28% PR)
  • PSA Decline: 51% of patients had a PSA decline vs. 17% with ARPI
  • Favorable Safety Pro le: Lower rates of Grade  3 adverse events

Pluvicto o ers a proven option to delay chemotherapy while improving disease control.

Dr. Munir Ghesani, MD, FACNM, FACR, FSNMMI

Munir Ghesani, MD, FACNM, FACR, FSNMMI is the Medical Director of United Theranostics, Princeton and Chief Medical Officer of United Theranostics. Previously, he served as Systems Chief of Nuclear Medicine and Molecular Imaging at Mount Sinai Health, New York. Dr. Ghesani has been actively involved in clinical practice, research, clinical trials and education for more than 25 years, primarily focusing on nuclear medicine, molecular imaging and radiopharmaceutical therapy.

Dr. Ghesani has more than 200 publications in peer-reviewed journals and is the Editor-in-Chief of a three-part book on nuclear medicine and molecular imaging. He has given more than 150 presentations at regional, national, and international conferences.

Dr. Ghesani has served in leadership roles in various societies and colleges, including the Immediate Past President of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), Past-President of the Education and Research Foundation of Nuclear Medicine and Molecular Imaging, Past Chairman of the American Board of Nuclear Medicine, Past Chairman of the Government Relations Committee and the FDA Task Force of the SNMMI and Past Chairman of the Nuclear Medicine and PET Accreditation Committee of the American College of Radiology. In January 2020, he was awarded the ACNM Personal Best Mentor of the Year. He has been awarded as the Fellow of the American College of Nuclear Medicine (2006), the American College of Radiology (2018) and the Society of Nuclear Medicine and Molecular Imaging (2023).

Refer for Pluvicto Therapy

Refer patients who meet the following criteria:

  • mCRPC with progression after ARPI therapy (e.g., enzalutamide, abiraterone)
  • Confirmed PSMA-positive disease via PSMA PET imaging
  • Candidates to delay chemotherapy
  • Adequate organ function and performance status

 

How to Refer

Partner with United Theranostics

United Theranostics streamlines access and support for Pluvicto therapy. To initiate the referral process, please contact United Theranostics at one of the locations below.

Our team will provide step-by-step guidance on imaging, eligibility, and treatment coordination.