Liver enzyme elevation after 177Lu-PSMA radioligand therapy for metastasized castration-resistant prostate cancer.

177Lu-PSMA radioligand therapy (177Lu-PSMA-RLT) is a promising new therapeutic option for patients with metastasized castration-resistant prostate cancer (mCRPC). The spectrum of adverse events with this treatment has to be evaluated. Here, we describe the case of a mCRPC patient with M1c disease (mediastinum, lungs, bones and liver) who presented with elevated liver enzyme levels after 177Lu-PSMA-RLT administration. Pre-treatment 68Ga-PSMA PET/CT showed at least 4 liver lesions with low uptake. Overall, the liver uptake was inhomogeneous. Liver biopsy was performed subsequently.