Tarık ŞENGÖZ, Onur Cumhur ÇİMEN, Ali ÇELİK, Aziz GÜLTEKİN, Fikri Selçuk ŞİMŞEK
Anatolian Current Medical Journal - 2026;8(3):473-478
Aims: Lutetium-177 (Lu-177) PSMA radioligand therapy (PRLT) is an effective treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Treatment-related nephrotoxicity and hematotoxicity can occur. In our study, we investigated the development of nephrotoxicity and hematotoxicity after Lu-177 PRLT applied to mCRPC patients in our department. Methods: All patients diagnosed with mCRPC who applied to our department between March 2018 and May 2025 and received at least 3 courses of Lu-177 PRLT were included in the study. The study was designed retrospectively. Patient information was obtained from patient treatment files and the hospital system. Patients were divided into two groups: those who received 3 courses of Lu-177 PRLT (group 1) and those who received >=4 courses of Lu-177 PRLT (group 2). For the evaluation of hematotoxicity and nephrotoxicity, blood values were used in group 1 patients before treatment (on the day of the first cycle) and at the end of treatment (1 month after the third and final cycle); and in group 2 patients before treatment (on the day of the first cycle), interim (1 month after the third cycle), and at the end of treatment (1 month after the final cycle). Hematological and renal toxicity were determined according to the "Common Terminology Criteria for Adverse Events (CTCAE v5.0)" . Results: The study included 43 male patients (16 (37.3%) in group 1, 27 (62.7%) in group 2). The mean age was 69.74+/-7.86 years. In group 1 patients, post-treatment glomerular filtration rate (eGFR), red blood cells (RBC), hemoglobin (Hb), hematocrit (Htc), platelets (PLT), white blood cell count (WBC), and lymphocyte values were statistically significantly lower than pre-treatment values, while creatinine values were higher. In Group 2 patients, post-treatment and interim eGFR, RBC, Hb, Htc, mean corpuscular hemoglobin volume (MCV), mean corpuscular hemoglobin (MCH), PLT, WBC, and lymphocyte values were statistically significantly lower than pre-treatment values, while creatinine levels were higher. When toxicity was assessed according to CTCAE v5.0, nephrotoxicity was detected in 2 patients (grade 2 and 3) (4.7%) and hematotoxicity in 3 patients (grade 2, 3 and 4) (7%) after treatment. No significant differences were found between the groups that received/did not receive chemotherapy before Lu-177 PRLT, and between pre- and post-treatment blood parameters. Conclusion: Although post-treatment deterioration in blood parameters indicating hematological and nephrological side effects was observed in patients diagnosed with mCRPC following Lu-177 PRLT, toxicity assessment according to CTCAE v5.0 revealed low levels of hematotoxicity and nephrotoxicity. Lu-177 PRLT is a safe treatment that can be applied with appropriate patient selection and monitoring.
