Exceptional Response to Short-course 177Lu-PSMA Radioligand Therapy in a Patient With Metastatic Hormone-sensitive Prostate Cancer

We report a 69-year-old man with de novo high-volume metastatic hormone-sensitive prostate cancer (mHSPC) presenting with PSA 433.75 ng/mL and widespread skeletal and nodal metastases. Androgen-deprivation therapy with goserelin, abiraterone, and cyproterone acetate reduced PSA to 44.29 ng/mL. He subsequently received 3 cycles of 177Lu-PSMA radioligand therapy, achieving a near-complete biochemical response (PSA 0.15 ng/mL) and resolution of bone pain. Nine-month follow-up 99mTc-PSMA demonstrated complete regression of metastatic lesions. This case highlights the potential efficacy and safety of early 177Lu-PSMA therapy in high-volume mHSPC, suggesting a role for optimizing hormonal therapy outcomes.