Lutetium-177-PSMA Therapy

In terms of clinical course, prostate cancer is a relatively favorable disease. It is well treatable even at the advanced stages. However, sooner or later the disease reaches that stage when chemotherapy is ineffective and various organs are affected by metastatic foci. In such situations, lutetium 177 PSMA radionuclide therapy comes to the rescue.

What is Lutetium therapy?

The treatment involves the use of Lutetium-177 (Lu 177) labeled prostate-specific membrane antigen, hence the name, PSMA therapy.

Radionuclide substance gives off radiation, but it is very short – only a few millimeters.  This substance should destroy not only the primary tumor, but also metastatic foci of prostate cancer.

A radiopharmaceutical is administered to the patient intravenously. It accumulates only in tumor cells, while the healthy ones get just a minimal amount, so they are almost not damaged. With its action, 177 Lutetium therapy destroys cancer cells. As a result, the size of the primary tumor lesion is significantly reduced and most metastases disappear.

Who is eligible for 177 Lutetium therapy?

PSMA Lutetium 177 therapy is the targeted treatment that is used in the combination therapeutic schemes for advanced prostate cancer. It is prescribed in the presence of multiple distant metastases. Indeed, the main advantage of the method is that it is not necessary to know the exact location of prostate cancer foci. It is impossible to detect them all and remove, but systemic therapies can affect cancer cells, regardless of their location.

PSMA therapy is an alternative to chemotherapy. It is prescribed in the following situations:

• Chemotherapy does not yield any result – the tumor does not respond to drug administration and continues to grow in size
• Cytostatics are contraindicated for the patient for health reasons – he may not tolerate another course
• The patient himself refuses to undergo chemotherapy because he no longer wants to endure side effects

Other field of Lu-177 application is treatment of the neuroendocrine tumors, particularly, gastro-, entero- and pancreatic ones (GEP tumors). GEP tumors have specific receptors for the somatostatin (somatostatin receptors, SSTR) on their cells membrane. Thus, during the Lutetium therapy for neuroendocrine carcinoma specific peptides that resemble somatostatin’s structure are labeled with Lutetium compounds (typically these are Lu dotatate and octreotate).

Due to the affinity between SSTR and Lu-labeled compounds, Lutetium dotatate treatment acts on the GEP tumors selectively. It decreases radiation burden on the healthy tissues. In addition, Lutetium dotatate therapy can be performed in patients with slightly impaired kidney function. Lutetium 177 octreotate therapy is another type of peptide receptor radionuclide therapy (PRRT).

How does Lutetium 177 PSMA therapy work?

The radiopharmaceutical is injected into the patient's vein slowly using a syringe. This is the whole procedure. Additional drugs may be used to reduce the risk of complications and reduce side effects.

During the course of treatment, the person is in a screened ward, as he is a source of beta radiation. The patient is allowed to take personal belongings to the ward. They will not become radioactive and can be used in the future.  

A day after the introduction of Lutetium-177 the patient will undergo scintigraphy. This is a follow-up study, which allows for the evaluation of the treatment results. 10 days later, the person will come to the clinic again and undergo a repeated study.

Several sessions of Lutetium 177 treatment are usually carried out. On average, the patient undergoes three treatment cycles. The intervals between them are 8 weeks. Monitoring is provided through PET, PSA blood test, general clinical studies. The doctors also control liver, kidney, bone marrow function.

Health effects

Lutetium 177 for cancer treatment is a relatively safe method. It does not cause irreversible complications. The doctors carefully monitor the condition of the patient and those for whom therapy can be harmful are not allowed to undergo it.  If prostate cancer is treated using this therapy, the doctors carefully monitor that the damage to healthy tissues was minimal. To this end, the following measures are taken:

• Patient examination prior to treatment to identify possible contraindications
• Cooling of the salivary glands in the course of therapy in order to prevent accumulation of the radiopharmaceutical in them
• In case of liver metastases, the patient may need bile duct stenting in order to prevent the development of obstructive jaundice due to edema and impaired bile outflow into the duodenum
• Intravenous infusion of crystalloid solutions serves to protect kidneys
• In case of side effects, there are used drugs to relieve them

Long term benefit of Lutetium 177 on prostate cancer is still under the investigation, but the current results are very promising. Treatment of the disease with Lutetium can cause side effects. The most frequent of them are nausea, swelling of the oral mucosa, impaired swallowing and difficulty speaking. All these side effects are temporary.

The complications may include liver, kidney dysfunction, as well as inhibition of the hematopoietic function of the red bone marrow. In order to timely identify the emerging complications, the patient is constantly undergoing clinical and biochemical blood tests. These tests are conducted before starting prostate cancer treatment, as well as after each session.

What is the cost of Lutetium treatment in Germany?

The prostate cancer treatment with Lutetium is provided in the best clinics abroad. Many patients go to Germany to get highly qualified and high-tech medical care for malignant tumors. Booking Health can arrange this for you. Our services and benefits:

• Organization of Lutetium 177 therapy in one of the best clinics abroad
• Affordable treatment cost, which will be up to 50% lower due to the lack of extra charges for foreign patients
• Communication with the doctors of the clinic and its administration both prior to prostate cancer treatment and after its completion
• Preparation of the program without previous examinations
• Appointment at the dates convenient for the patient
• Assistance in purchasing and transmission of medicines
• Control of invoices, treatment costs, return of unspent funds
• Organization of either additional examination or treatment of diseases in the clinic

Booking Health will provide high quality services. Our employees will book airline tickets for you, choose the hotel closest to the medical facility, meet you at the airport and take you to the clinic by car.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko