177Lu-PSMA Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer

The majority of prostate cancer patients have an overexpressed prostate specific membrane antigen (PSMA) that is a target for radionuclide therapy. Our aim was to review the current evidence on clinical effectiveness and safety of 177 Lutetium (Lu) labelled PSMA for metastatic castration-resistant prostate cancer (mCRPC) patients. No controlled trials were found to answer the research questions on clinical effectiveness. Concerning safety, we identified five prospective before-after studies with the total of 141 patients. The serious adverse event of study related death or the adverse event of discontinuation rate did not occur in either study. Grade 3-4 toxicities that occured were nephrotoxicity, hematotoxicity, hepatotoxicity, and bone pain flare. The risk of bias ranged from low to high and the GRADE assessed quality of evidence was low to very low. At present, we do not recommend 177Lu-PSMA for mCRPC patients for inclusion in the Austrian catalogue of benefits and we suggest a reevaluation in 2021.