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This is a case of a 63-year-old male with history

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of Gleason nine prostate cancer that was treated

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with prostatectomy develop, uh, metastasis.

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And, uh, he was treated with, uh, two lines of therapy,

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including hormonal therapy

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and a Taxol based chemotherapy.

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His PSA levels continue to rise and

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therefore PSMA PET was performed to evaluate

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for eligibility of the new PSMA therapy.

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One of the criteria for treatment

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with LUTETIUM 1 77 PSMA is,

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uh, to demonstrate that the patient has PSMA AVID disease.

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And so this is what we're gonna go through

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to see on this case.

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As you can see in this mid, there's extensive pality disease

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and as we will see in the axials

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and coronals, the disease is essentially oss.

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We always make sure that there is no noal disease.

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However, the advantage of this therapy compared

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to other therapies for metastatic prostate cancer, such

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as radium 2, 2 3, is that

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these therapy can treat O Cs in non OSCEs disease,

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whereas other alpha tracers such as radium, uh,

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would only be able to treat OS osteos metastatic disease.

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So let's take a look here.

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You can see that there are multiple sites of tracer uptake

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and they correlate to bone.

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But if you look at the ct,

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there is diffuses sclerosis in the bones of the pelvis,

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and this is true for the rest of the body.

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For instance, let's look at this vertebral body

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where you see that there are multiple areas of uptake,

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but the extent of the sclerosis is much larger.

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Combining these two imaging findings, these,

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uh, is showing us a combination of treated disease

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demonstrated by those areas that are sclerotic,

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but don't have PSMA uptake

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with active disease in those areas of the bone

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where there is tracer uptake.

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So remember, this patient was heavily treated

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and has failed multiple lines of treatment.

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So it is common to find a mix of active

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and treated disease in these patients.

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The majority of the lesions, if not all, showed intense

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or moderate degree

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of tracer uptake making this patient

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eligible for the therapy.

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Things to mention that are important are

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Lesions in the brain or skull base.

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This does not preclude treatment,

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but one

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of the recommendations is if there is extensive disease in

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the skull base or near the nervous system, being

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that in the brain

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or in the spine, steroids can be given prior

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to the therapy cycles.

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And I'm gonna scroll through

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so you can appreciate the entire exam

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and see where the extent of disease is in this patient.

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So to recap, this patient is a patient

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with frustration resistant metastatic disease

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that is mainly in the skeleton,

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has failed the therapies needed to consider

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these LUTETIUM 1 77 PSMA therapy.

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Uh, we can see that there is extensive disease

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and that the disease that is, uh, present shows a level

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of uptake that is enough for treatment in this patient.

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There are multiple sites of uptake in the skull base,

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so it will be recommended to give a steroids prior

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to the therapy.