Prostate cancer is one of the most common types of malignant tumours. It is often treated by surgery, radiation and chemotherapy. However, on condition of big amount of metastases the only thing that remains is to oppress the growth of numerous daughter tumours in the body with drugs. Unfortunately, sooner or later the drugs stop working.
Such patients can try the latest and advanced method of metastatic prostate cancer treatment. This technique is called LU-177-PSMA-therapy (Lutetium 177 prostate specific membrane antigenradionuclide therapy). LU-177-PSMA-therapy is used only in Germany, basically in the university hospitals.
LU-177-PSMA-therapy presupposes the introduction of Lutetium 177 radioactive substance into the patient’s body. Then, it selectively connects to the prostate‐specific membrane antigen (PSMA) that is present on the cancer cell’s surface. Besides, it doesn’t even matter what part of the body these cells are located at. Lutetium 177 penetrates through the blood flow as it is administered intravenously.
Both regional and distant tumours’ or metastases’ growth is inhibited as a result of this treatment. Meanwhile, healthy tissues don’t experience any impact, as Lutetium 177 spreads short-distant irradiation for several millimetres.
A patient undergoes a thorough exam before the start of treatment with LU-177-PSMA-therapy. Scintigraphy and positron emission tomography are necessary to evaluate the feasibility of using this treatment method.
Indications for LU-177-PSMA-therapy
LU-177-PSMA-therapy is prescribed after all the other techniques have been tried and tested to cure the prostate cancer. If they became ineffective, or it’s further administration is contraindicated to the patient, then LU-177-PSMA-therapy steps in. Otherwise, the therapy can be done when a patient refuses to receive chemotherapy because of side effects.
Benefits of LU-177-PSMA-therapy are:
- Damages cancer cells in different parts of the body
- The radioactive substance has no pronounced negative effect on healthy tissues, since it binds to receptors on the surface of only cancer cells
- It is well tolerated by most patients
- Does not cause irreversible side effects
Safety of the procedure
LU-177-PSMA therapy can however, still cause side effects, but they are completely reversible. In addition, German hospitals take all necessary measures to minimise risks.
Possible adverse phenomena are:
- Diminished taste senses
- Edema of the oral mucosa, difficulty speaking and swallowing
- Decreased kidney function
- Metastases in the liver may trigger edema with a violation of bile secretion, which will require endoscopic stenting
- Oppression of the hematopoietic function of the red bone marrow with a decrease in the formation of uniform elements
Salivary glands and kidneys are at the greatest risk of damage while performing the LU-177-PSMA therapy. Nonetheless, doctors do everything possible and necessary to prevent the risks and by following these measures:
- They carry out a thorough examination of the patient before the treatment, including assessment of kidney function
- Cool the salivary glands during treatment to reduce blood flow to the glans and minimise the accumulation of radioactive material
- Crystalloid solutions are injected intravenously to protect the kidney from exposure to Lutetium 177
- If side effects occur, the patient is additionally injected other drugs to eliminate them
How does the procedure work?
LU-177-PSMA-therapy involves the intravenous injection of the drug. It is injected slowly with a syringe, for 10-15 seconds. Also, additional medications and non-medicated measures are used to minimise the risk of harm caused to internal organs.
The necessary time of inpatient stay is 4 days. All this time the patient stays in a screened ward. He is not allowed contact with anyone, but personal things, including a phone or a laptop, can be taken to the ward. These items will not become radioactive and they can be used in the future.
Scintigraphy is performed 1-2 days after LU-177-PSMA-therapy and also on the day of release from the hospital. Then the patient should return to the clinic again, 7-10 days after the treatment.
LU-177-PSMA therapy usually involves three cycles at the 8 week intervals. Monitoring of the patient's condition and evaluation of the effectiveness of treatment is carried out using PET and laboratory tests (PSA blood level test). It is also necessary to monitor the function of the liver, kidneys and bone marrow.
LU-177-PSMA-therapy increases the duration and quality of patients’ lives suffering from the metastatic prostate cancer. This is an innovative, effective and relatively safe method of treatment, which is already available in German hospitals.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova