Figure 4.

75-year-old male with known case of coronary artery disease, post-CABG and on cardiac remodeling agents, presented with multiple sites of skeletal pain, weakness and high serum PSA >500.0 ng/mL. Needle biopsy from prostate demonstrated acinar adenocarcinoma (Gleason score 4 + 3 = 7), underwent bilateral orchidectomy. ⁶⁸Ga-PSMA-11 PET-CT performed for high-serum PSA showed low-grade PSMA expression in relatively smaller prostate gland, with no significant PSMA-expressing or otherwise pelvic and retroperitoneal lymph nodes and PSMA-expressing sclerotic and marrow metastatic lesions involving entire visualised skeleton. In view of cardiac co-morbidity and post-CABG status, chemotherapy and anti-androgen therapies were not considered, and he was taken for ²²⁵Ac-PSMA-617 (alpha radionuclide) therapy. MIP images of ⁶⁸Ga-PSMA-11 PET-CT scans at baseline (a) and 3 months after second cycle of ²²⁵Ac-PSMA-617 (d), and first (b) and second (c) post alpha therapy planar gamma scans showed excellent scan response; PSA decreased to 0.405 ng/mL and patient became asymptomatic.