ABSTRACT: A 76-year-old man with castration-resistant prostate cancer underwent Ga–prostate-specific membrane antigen (PSMA) PET/CT for restaging. A large PSMA-avid tumor with invasion to adjacent organs was noted causing gross hematuria and symptomatic anemia. Two cycles of Lu-PSMA were administered, and the patient showed significant reduction of hematuria as well as declining in PSA levels. Lu-PSMA therapy can be a good treatment option in patients with locally invasive tumors.