From the Guidelines
The life expectancy for a 79-year-old male with high-volume metastatic castration-sensitive prostate cancer (mCSPC) that is PSMA-positive, with a current PSA of 0.2 ng/mL, is approximately 15.3 months with Lu-177 PSMA therapy, based on the most recent and highest quality study available 1. This estimate is based on the results of the VISION trial, which demonstrated a significant improvement in overall survival (OS) with Lu-177 PSMA therapy compared to standard of care alone. The patient's good health status, lack of smoking history, and low PSA level are favorable factors that may contribute to a better prognosis. Some key points to consider in the management of this patient include:
- The patient's PSMA-positive status makes Lu-177 PSMA therapy a suitable option, as it has been shown to improve OS in patients with PSMA-positive metastatic lesions 1.
- Docetaxel is also a reasonable option, but the most recent and highest quality study available suggests that Lu-177 PSMA therapy may be a more effective treatment option for this patient population 1.
- Treatment selection should consider the patient's functional status, organ function (particularly renal and bone marrow function), and personal preferences regarding side effect profiles.
- Regular monitoring of PSA levels, imaging studies, and symptom assessment will be necessary to evaluate treatment efficacy and adjust the approach as needed.
- The patient's overall health status, comorbidities, treatment response, and disease biology will also impact their life expectancy, and individualized care should be provided to optimize outcomes.
From the Research
Life Expectancy with High-Volume Metastatic Castration-Sensitive Prostate Cancer
- The patient's condition is high-volume metastatic castration-sensitive prostate cancer (mCSPC) with a current Prostate-Specific Antigen (PSA) level of 0.2 ng/mL, and the cancer expresses Prostate-Specific Membrane Antigen (PSMA) 2, 3, 4, 5, 6.
- The patient is a candidate for either Docetaxel or Lutetium-177 (Lu-177) PSMA therapy, and their health can tolerate either treatment.
Treatment Options and Life Expectancy
- A study published in 2021 found that Lu-177 PSMA-617 significantly prolonged overall survival in patients with metastatic castration-resistant prostate cancer, with a median overall survival of 15.3 months compared to 11.3 months with standard care 2.
- Another study published in 2024 found that Lu-177 PSMA therapy was effective in real-world practice, with a median time to progression of 5 months and a median time until the start of a consecutive antineoplastic therapy of 8.5 months 3.
- A phase 2 trial published in 2025 found that Lu-177 PSMA-617 consolidation therapy after docetaxel in patients with synchronous high-volume metastatic hormone-sensitive prostate cancer demonstrated promising efficacy and safety outcomes, with a median radiographic progression-free survival of 18 months and a median PSA progression-free survival of 15 months 4.
- A prospective pilot study published in 2021 found that Lu-177 PSMA-617 was a feasible and safe treatment modality in patients with low-volume metastatic hormone-sensitive prostate cancer, with all patients showing altered PSA kinetics and half of the patients showing a PSA response of more than 50% 5.
- A systematic review and meta-analysis published in 2025 found that Lu-177 PSMA-617 resulted in significant reduction in PSA and improved progression-free survival, with tolerable side effects mainly including fatigue, constipation, thrombocytopenia, and leucopenia 6.
Life Expectancy Estimates
- Based on the studies, the life expectancy of a 79-year-old male with high-volume metastatic castration-sensitive prostate cancer who is a candidate for either Docetaxel or Lu-177 PSMA therapy can vary depending on the treatment chosen and the patient's response to treatment.
- However, with Lu-177 PSMA therapy, the median overall survival can range from 15.3 months to 18 months or more, depending on the study and the patient population 2, 4.