Combined [223Ra]Radiumdichloride and [177Lu]Lu-PSMA-617 Therapy in End-stage Metastatic Castration-resistant Prostate Cancer

We present an advanced mCRPC case treated with combined [177Lu]Lu-PSMA-617 and [223Ra]Radiumdichloride. The regimen was well tolerated, with mild xerostomia, fatigue (CTCAE 1), and moderate anemia (CTCAE 2). Initial imaging and serologic parameters demonstrated a favorable treatment response; however, subsequent evaluations showed progression driven by a dedifferentiated pelvic recurrence, increasingly FDG-avid osseous lesions, and new PSMA-negative lymph node metastases. Early biochemical improvement, including PSA and alkaline phosphatase decline, later transitioned to progression consistent with imaging. This case highlights the feasibility and safety of dual α/β- radionuclide therapy in heavily pretreated mCRPC.