In the Philippines, prostate cancer is the third most common malignancy among men. Over time, it tends to recur and/or progress to metastatic castration-resistant prostate cancer, wherein conventional therapies no longer work. Taking advantage of the high expression of prostate-specific membrane antigen (PSMA) on prostate cancer cells, 68GA- and 177 Lu-PSMA theranostics provides a targeted approach to imaging and therapy. With it's availabity in our country, patients now have an appealing and accessible treatment option. In this paper, we present five cases of metastatic castration-resistant prostate cancer, who have undergone 68Ga-PSMA PET/CT scans and 177Lu-PSMA radioligand therapies in the Philippines, to showcase the usefulness of theranostics in the local setting.
Positron Emission Tomography Computed Tomography ; Precision Medicine ; Prostatic Neoplasms ; Philippines

A 43-year-old female with a surgically unresectable and non-secretory mediastinal small cell neuroendocrine carcinoma waws previously given the protein kinase inhibitor Everolimus with intolerable nausea and fatigue. High somatostatin receptor expression of the known tumor was seen on 68Ga-DOTATATE PET/CT scan. She was then given 6.4 GBq of 177 Lu-DOTATATE with no adverse events. A follow-up 68Ga-DOTATATE PET/CT scan three months post-treatment showerd stable DOTATATE affinity with no evidence of metastasis. this case presents an overview of peptide receptor radionuclide therapy (PRRT), especially for multidisciplinary teams in the Philippines, as 68Ga and 177 Lu theranostics is introduced in the country.
Precision Medicine ; Philippines ; Carcinoma, Neuroendocrine

Background: Parathyroid carcinoma is an uncommon, aggressive, endocrine malignant neoplasm and subsequent parathyroidectomy of such cases may lead to the life-threatening hypocalcemic condition called Hungry Bone Syndrome. We present a very rare case of parathyroid carcinoma with concomitant thyroid microcarcinoma with Hungry Bone Syndrome as its sequalae. Case Presentation: A 54/F initially presenting with hypogastric pain was showed to have nephrolithiasis. Subsequent Endocrinology referral revealed hypercalcemia and osteoporosis – and with a working impression of hypercalcemia secondary to a parathyroid adenoma. Sestamibi parathyroid scan showed persistently avid uptake in the left thyroid lobe highly suspicious for a parathyroid adenoma, but a concomitant thyroid nodule was not ruled out. Bone scan showed intense and diffuse tracer uptake in the skull and irregular tracer activity in the ribs, suggestive of metabolic bone disease, with no evidence of metastatic-looking bone lesions. She underwent left thyroid lobectomy with isthmusectomy and Sestamibi-guided left parathyroidectomy. Histopathology report showed a parathyroid gland carcinoma with papillary thyroid microcarcinoma. Two weeks post-surgery, hypocalcemic signs developed and ionized calcium was low. Hungry Bone Syndrome was considered and was treated with calcium gluconate and Zoledronic acid. Conclusion Nuclear imaging techniques and radioguided surgery are helpful in the diagnosis and management of both parathyroid and thyroid lesions – especially in difficult cases.
Parathyroid Neoplasms

Introduction: Prostate cancer is the third most common cancer among Filipino males. Ga-68 PSMA PET-CT and Lu-177 PRLT have been introduced in the Philippines for the diagnostics and therapy of prostate cancer. Objective: The aim of this study is to compare treatment outcomes of standard therapy plus Lu-177 PSMA radioligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-68 PET-CT as an outcome indicator. Methodology: This is an ambispective cohort study on Ga-68 PSMA PET-CT scans performed between January 1, 2018 and July 31, 2021. Serum PSA data taken within one month of the PET-CT scans were also collected when available. The PET-CT images were reviewed by a radiologist for RECIST response, and by a nuclear medicine physician for PERCIST response . Results: A total of 11 participants were included in the study. Six participants (55.5%) received standard therapy, while five participants (45.5%) received Lu-177 PSMA radioligand therapy plus standard therapy. There was no significant difference in the baseline and follow-up CT as shown by all p values > 0.05. A trend towards higher number of participants with non-complete/non-progressive RECIST response was noted in the control group than the treatment group, as well as higher number of participants with progressive or stable disease using the PERCIST response. Conclusion There were no significant differences noted in the clinical outcomes of participants who received Lu-177 PRLT and those with standard therapy alone. A trend towards decreasing serum PSA, CT and PET measurements were noted among patients given Lu-177 PRLT than those with standard therapy.
Prostatic Neoplasms