Lutetium 177-PSMA: a new generation drug for prostate cancer treatment
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Prostate cancer is a widespread oncological disease experienced by older men. Malignant tumors of the prostate can be successfully treated at the early stages. When distant metastases are detected, life prognosis becomes more unfavorable. However, the development of medicine gives patients and healthcare professionals more options. A new drug called Lutetium-177 PSMA was introduced into the medical practice to treat prostate cancer that has spread beyond the stage 1-3. Targeted radionuclide therapy with Lutetium-177 helps to prolong a patient’s life considerably. Carefully performed in specialized healthcare facilities, it is effective even in men with numerous distant metastases, in whom hormonal therapy and chemotherapy have failed.
Content
- The principle of the technique treatment with Lutetium-177
- Goals of treating prostate cancer with Lu-177
- Preparation for PSMA therapy
- How does the procedure work?
- Efficiency control
- Benefits of prostate cancer treatment with Lutetium-177
- Where is it best to undergo a PSMA therapy course?
- Arrangement of prostate cancer treatment in Germany
Prostate cancer treatment with Lutetium 177
The principle of the technique treatment with Lutetium-177
Lu-177-PSMA-therapy stands for Lutetium-177 prostate‐specific membrane antigen radionuclide therapy. Thus, the membrane antigen selectively binds with cancer cells. Lutetium-177 (Lu-177) radionuclide is attached to this substance which is a beta emitter.
After introducing radiolucent labeled PSMA into the human body, it binds only with the prostate gland neoplastic cells. Since beta radiation extends a short distance (several millimeters), healthy tissues are not irradiated. After PSMA therapy, cancer cells die, and the tumor size is significantly reduced.
The key point of this technique is that the drug kills not only the primary tumor in the prostate gland but also daughter tumors thanks to the selective binding.
Goals of treating prostate cancer with Lu-177
In the treatment of prostate cancer, the synergy of therapeutic advances not only improves survival rates, but also significantly increases success rates, ultimately leading to a tangible increase in life expectancy for those affected by the disease. The technique, using nucleotides labeled PSMA, is used to diagnose and treat men’s prostate cancer. Diagnosis involves the use of scintigraphy, which includes scanning the body and recording the beta radiation of the tumor formation region.
Also, the technique is used for a therapeutic purpose when the death of cancer cells occurs after a course of therapy with a radiopharmaceutical.
Preparation for PSMA therapy
PSMA, labeled with a radionuclide, is a compound that can develop an allergic reaction. Therefore, a test for hypersensitivity is mandatory before its intravenous administration during the main course of therapy or during diagnostic scintigraphy.
Also, preparatory measures include visualizing the tumor, including scintigraphy, computer, magnetic resonance imaging, and ultrasound. These methods determine the size, location of malignant neoplasm and its metastases.
The radiopharmaceutical used to perform PSMA therapy is excreted by the liver and kidneys, therefore, general clinical studies are carried out before its use, including a clinical analysis of urine, blood, and a biochemical blood test. Clinical studies help a doctor assess the degree of possible risk associated with the influence of the radiopharmaceutical on the liver and kidneys. During the treatment course, these studies can be administered to the patient several times to monitor the functional state of the organism.
A diet is prescribed with the exception of fatty, fried foods and alcohol a few days before the start of the treatment course.
How does the procedure work?
The specialist intravenously introduces a radiopharmaceutical on an inpatient basis after all the preparatory measures. The drug flows through the body and binds with the malignant neoplastic cells and their sites of metastases within a certain period, providing the necessary therapeutic effect.
The procedure is usually carried out several times. A patient is under the supervision of the attending physician at all times. Kidneys and salivary glands are cooled down before each procedure for their safety. Side effects, if any, are blocked with the medication.
The duration of PSMA therapy may vary, depending on the stage of prostate cancer. The end of treatment is determined by the control study results, including scintigraphy with the labeled radionuclide PSMA. The average length of stay in a medical hospital is 3-4 days.
Efficiency control
The attending physician prescribes a follow-up study after the course of PSMA therapy, which necessarily includes scintigraphy. Based on his results, he decides on the completion of treatment and the possibility of discharging the patient from a hospital.
A positive result, indicated by the effectiveness of the PSMA-therapy, is the absence of malignant neoplasm foci in the prostate gland and other areas of the body where metastases may develop.
Benefits of prostate cancer treatment with Lutetium-177
PSMA therapy have many advantages over other metastatic prostate cancer treatment techniques, primarily over chemotherapy and hormonal therapy. PSMA therapy is usually used when hormonal therapy and chemotherapy fail to give the desired results or if the patient refuses them because of poor tolerance.
The most important advantages are
- Selective action on malignant cells. Healthy tissues are not irradiated, which is especially important during the treatment of bone metastases located close to the bone marrow.
- The possibility of destruction of metastases in any part of the body, including Liver and bone metastases that are resistant to other treatments.
- Good tolerance of therapy and absence of irreversible side effects. PSMA therapy is suitable for debilitated men with advanced cancer.
- Adjustable therapeutic courses. If one procedure is not enough for controlling the malignant process, it can be safely repeated.
- High effectiveness. Over 95% of men respond to radionuclide therapy well.
Depending on the clinical situation, your physician may recommend PSMA therapy with Lutetium-177 or Actinium-225. The separate article is devoted to the comparison of the effectiveness of various radionuclides for the treatment of metastatic prostate cancer.
Where is it best to undergo a PSMA therapy course?
Treatment of metastatic prostate cancer with Lutetium-177 PSMA therapy is carried out at the Departments of Nuclear Medicine of large German University Hospitals or at the specialized Nuclear Medicine centers.
Here are the most successful healthcare facilities that provide such medical services:
- Helios Hospital Berlin-Buch, Department of Nuclear Medicine. The department's medical team is headed by Prof. Dr. med. Stefan Dresel. He has devoted more than 22 years of his life to nuclear medicine and specializes in Lu-177-DOTATOC therapy for prostate neuroendocrine tumors and Lu-177 PSMA therapy for prostate cancer.
- University Hospital Rechts der Isar Munich, Department of Nuclear Medicine. The department is headed by Prof. Dr. med. Wolfgang Weber, whose specialization includes radionuclide cancer therapy. Based on the results of his work, the professor has published more than 250 articles in leading scientific journals, including the Journal of Clinical Oncology.
- University Hospital of Ludwig Maximilian University of Munich, Department of Nuclear Medicine. The department is headed by Prof. Dr. med. Peter Bartenstein. The professor has more than 35 years of practical experience in the field of administration of radionuclide methods, he is also engaged in research activities. The number of scientific publications of professor Bartenstein exceeds 450 articles, book chapters, etc.
- University Hospital Frankfurt-am-Main, Department of Nuclear Medicine. The department is headed by Prof. Dr. med. Frank Grunwald. With over 30 years of experience in the treatment of patients with radionuclide methods, the professor is recognized as one of the best specialists in Germany.
- University Hospital Carl Gustav Carus Dresden, Department of Nuclear Medicine. The department is headed by Prof. Dr. med. Jörg Kotzerke, who has over 30 years of experience in radioisotope diagnostics and treatment. The professor is a board member of the German Society for Nuclear Medicine (DGN).
The cost of Lutetium-177 PSMA therapy in German specialized healthcare facilities can be obtained on request.
Arrangement of prostate cancer treatment in Germany
Patients wishing to benefit from the latest medical advances and receive quality treatment for prostate cancer using Lutetium-177 can find a suitable clinic using Booking Health’s service. On this website, you can see all therapeutic programs for cancer at the stage one-three or for the advanced cancer stages with their current prices: robotic surgery, cryoablation, external beam or intensity modulated radiation therapy, irreversible electroporation, etc.
When organizing treatment in Germany with the help of Booking Health you get a number of advantages, namely:
- Coverage against unforeseen medical events. Initially, the agreed cost of treatment is guaranteed not to increase, even in the case of complications should you require emergency medical care.
- Complete service package. We are fully responsible for arranging your treatment in Germany. We will liaise with the hospital authorities, help obtain a visa, book hotel and flight tickets. Our agent will meet you at the airport and take you to the medical facility where you will have therapy.
- Saving funds. You will not need to buy additional insurance. Look for an interpreter and pay for his services. We will help with choosing a treatment course at the best price. That is why BookingHealth’s clients save up to 70% of the general program cost.
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Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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