First-Line [177Lu]Lu-PSMA-617 Therapy Without ADT, Chemotherapy, or Local Therapy for Metastatic Hormone-Sensitive Prostate Cancer.

The treatment of metastatic prostate cancer relies on the use of androgen deprivation therapy, which is associated with many side effects, including adverse cardiovascular outcomes. 177Lu-vipivotide tetraxetan ([177Lu]Lu-PSMA-617) is used in the treatment of prostate-specific membrane antigen-expressing metastatic castration-resistant prostate adenocarcinoma. We present the case of a patient with prostate cancer with numerous metastatic lesions who declined androgen deprivation therapy, chemotherapy, and local therapy to the prostate gland and instead received first-line systemic [177Lu]Lu-PSMA-617. He exhibited a significant response in both the primary cancer and its metastatic foci after 2 doses of the treatment.