Dean Pepol is no stranger to prostate cancer.
Prostate cancer is the second-leading type of cancer death in American men, and Pepol has experienced multiple family members being diagnosed with the disease during his lifetime, including his own father. This heightened awareness of the disease led Pepol to get regular physicals and tests for prostate-specific antigen, or PSA — high levels of which could signal prostate cancer.
In the spring of 2006, Pepol's PSA levels came back, as he says, "slightly wonky." A biopsy and further testing revealed Pepol had developed an aggressive form of prostate cancer. He soon had an invasive prostatectomy surgery to remove his prostate in his home city of Chicago. Pepol also pursued a breakthrough treatment at the time, a type of precise, targeted radiation called intensity-modulated radiation therapy, which also helped keep his cancer at bay for eight years.
Then, in 2014, Pepol received devastating news: His treatment was no longer working; his cancer had developed into Stage 4, and his PSA levels were again skyrocketing. Ever the fighter, Pepol, his wife and his daughter moved to Arizona to seek treatment there. After three years, Pepol's PSA levels rose again, and he enrolled in a clinical trial in San Francisco in 2017, taking flights between Phoenix and San Francisco every Monday for two years to participate.
"I came to learn that prostate cancer is like a river, it keeps moving," says Pepol. "I try new treatments that dam up the river for a while until having to try something else. At this time, my little girl was in eighth grade — I knew I had to just keep battling."
Following years of rotating treatments, Pepol and his family moved once more, this time to Virginia, to be close to their now college-aged daughter and so Pepol could seek treatment at Johns Hopkins Medicine.
He received radiation therapy and surgery at Sibley Memorial Hospital to treat bone metastases in his spine and hip, before being introduced to providers at the Johns Hopkins Theranostics Center (JHTC) in the Russell H. Morgan Department of Radiology and Radiological Science. Theranostics, also known as radiotheranostics, is a unique combination of imaging and molecular radiotherapy that uses radiopharmaceutical drugs to image, treat and eliminate specific cancer tissue.
Pepol was set to begin a clinical trial for a new radiopharmaceutical drug at JHTC in 2022, but the treatment, called lutetium Lu 177 vipivotide tetraxetan (brand name Pluvicto), was approved as a prostate cancer therapy by the Food and Drug Administration around the same time. The trial was canceled, but Pepol became the first patient to receive the drug with FDA approval at Johns Hopkins Medicine.
"We were able to determine that Mr. Pepol was a great candidate for imaging and therapy that targeted PSMA, or prostate-specific membrane antigen, which is overexpressed in prostate cancer," says Andrei Gafita, M.D., an expert on PSMA theranostics at the center. "His response to the treatment was dramatic — his PSA cancer biomarker was drastically reduced. Such trials and research that led to these drugs, especially studies with funding channeled from the National Institutes of Health (NIH) and the Prostate Cancer Foundation, have been a game changer in prostate cancer."
Collaborative, cross-divisional clinical trials and federally funded research on prostate cancer have long occurred at Johns Hopkins Medicine. Researchers have uncovered groundbreaking ways of imaging prostate cancer, including the development of molecular agents that home in on PSMA to provide detailed PET scans of the disease. Many of these studies and trials were funded through the NIH, and helped lead to the development and approval of lutetium Lu 177 vipivotide tetraxetan.
"Innovation happens at academic centers, and NIH funding enables ideas to be investigated," says Lilja Solnes, M.D., M.B.A., director of nuclear medicine and molecular imaging and associate professor of radiology and radiological science at the Johns Hopkins University School of Medicine. She helped create JHTC a decade ago. "Successful treatments from such research have shown exceptional responses in patients, and helped them retain or improve their quality of life."
Pepol continued treatment at JHTC, receiving six initial doses of lutetium Lu 177 vipivotide tetraxetan. For a time, this treatment maintained Pepol's cancer and quality of life, but he was ineligible for additional doses of the drug.
During this time, Pepol enrolled in a separate, ongoing clinical trial at Johns Hopkins Medicine to try and manage the cancer. Despite his participation, his cancer spread further, this time into his skull. Pepol had multiple, intense surgeries to eliminate this spread, and in October of 2024, was finally on the mend thanks to his care team and supportive wife and daughter.
"I was thinking this was it," says Pepol. "But out of nowhere, the Theranostics Center calls me, and Jeff, the clinic's theranostics manager, tells me that they're working on something for me so I could get more treatment."
The theranostics staff had managed to enroll Pepol in a voucher program that afforded him an additional three treatments. After his most recent treatment in May 2025, his PSA levels have fallen, and he plans to have another treatment at the end of August 2025. Pepol credits the center and his care team at Johns Hopkins with extending his life.
"There's a whole team behind me at Hopkins — all of my clinicians, they care, they're with me," says Pepol. "Nobody wants to be on this journey, but my doctors and the staff at the center have been marvelous and comforting. They empathize. They help get me through."
