PSMA Radioligand Therapy in Advanced Age: Insights From an 85y+ mCRPC Patient Cohort.

Abstract

With increasing life expectancy, the number of older patients with metastatic castration-resistant prostate cancer (mCRPC) continues to rise, but this group is currently underrepresented in clinical trials. This study aims to assess the efficacy and safety of prostate-specific membrane antigen (PSMA) targeted radioligand therapy (RLT) in patients over 85 years old with mCRPC. A retrospective analysis was conducted on 21 mCRPC patients aged 85 years or older receiving PSMA-RLT (range: 85-96 y). The median number of treatment cycles was 4 (range: 1-13 cycles), with a mean cumulative administered activity of 26.9±17.3 GBq (range: 8.0-87.2  GBq) of [ 177 Lu]Lu-PSMA-617. Adverse events, including anemia, thrombocytopenia, leukopenia, renal impairment, fatigue, and xerostomia were classified according to CTCAE version 5.0. The mean best PSA response across the cohort was -37.6±73.3%, with 62% (13 of 21 patients) showing partial remission. Median progression-free survival and overall survival were 4.6 and 14.7 months, respectively. Severe adverse events were rare, occurring in 2 patients: 1 case of grade 3 anemia and 1 of grade 3 thrombocytopenia. The results demonstrate that PSMA-RLT is an effective and well-tolerated treatment for mCRPC patients over 85 years, with clinical outcomes and safety comparable to those observed in studies involving younger populations. This highlights its potential as a valuable therapeutic option for this aging patient group.