Wang Ziye, Tang Wen, Liu Mingwen, Xie Zhifei, Li Yi, Du Jiang, Wu Tao
Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Department of Urology, Kaiyang County People's Hospital, Guiyang, Guizhou, China.
Front Med (Lausanne). 2025 Jul 16;12:1569143. doi: 10.3389/fmed.2025.1569143. eCollection 2025.
Advanced prostate cancer (PCa) is still an incurable disease. Still, the field of PSMA-targeted radioligand therapy is developing rapidly and is playing an increasingly important role in the treatment of advanced Pca in the future. As an α -particle emitter, Ac-225 shows a potent killing ability for tumor cells due to its short range and high energy deposition in the tumor micrometastasis focus. However, the secondary myelofibrosis (SMF) associated with Ac-225-PSMA-617 treatment is a significant concern. We present a case of metastatic castration-resistant prostate cancer (mCRPC) who developed pancytopenia following the Ac-225-PSMA-617 treatment period, a bone marrow biopsy confirmed SMF and remained uncorrected after multiple component transfusions and symptomatic supportive therapy. Ac-225-PSMA-617 has demonstrated promising therapeutic efficacy in the management of advanced PCa; however, the potential risks associated with SMF necessitate careful consideration. Through comprehensive analysis of this clinical case and comparative evaluation with the existing literature, this study highlights the need to balance clinical benefit with increased vigilance for treatment-related adverse events.
晚期前列腺癌（PCa）仍然是一种无法治愈的疾病。尽管如此，靶向前列腺特异性膜抗原（PSMA）的放射性配体疗法领域正在迅速发展，并在未来晚期PCa的治疗中发挥着越来越重要的作用。作为一种α粒子发射体，Ac-225由于其射程短且在肿瘤微转移灶中的能量沉积高，对肿瘤细胞显示出强大的杀伤能力。然而，与Ac-225-PSMA-617治疗相关的继发性骨髓纤维化（SMF）是一个重大问题。我们报告一例转移性去势抵抗性前列腺癌（mCRPC）患者，在接受Ac-225-PSMA-617治疗后出现全血细胞减少，骨髓活检证实为SMF，在多次成分输血和对症支持治疗后仍未纠正。Ac-225-PSMA-617在晚期PCa的治疗中已显示出有前景的治疗效果；然而，与SMF相关的潜在风险需要仔细考虑。通过对该临床病例的综合分析以及与现有文献的比较评估，本研究强调了在临床获益与提高对治疗相关不良事件的警惕性之间取得平衡的必要性。
