In terms of clinical course, prostate cancer is a relatively favorable condition. It can be treated even at the advanced stages. However, sooner or later the disease reaches that stage when chemotherapy is ineffective and various organs are affected by metastases. In such clinical situations, Lutetium-177 PSMA radionuclide therapy comes to the rescue. Being connected to the specific molecular carrier, Lutetium-177 reliably binds to malignant cells regardless of their localization. Local irradiation destroys metastatic foci and helps control the disease progression. Due to the unique mechanism of action, PSMA therapy with Lutetium-177 is effective in men who no longer respond to chemotherapy or hormonal therapy. During the last decades the procedure has become the therapy of choice in such patients regardless of their age.
This is a single intravenous infusion of Lutetium-177 solution. PSMA therapy with Lutetium-177 is indicated even if all other treatments have failed.
The radionuclide Lutetium-177 finds prostate cancer cells anywhere in the body and destroys them. This is especially important in bone metastases and metastases in internal organs. PSMA therapy with Lutetium-177 is performed at advanced cancer stages.
| Country | Average cost of treatment |
|---|
| Germany | 18,010 EUR |
| Turkey | 12,600 EUR |
| Austria | 12,000 EUR |
The best hospitals for metastatic prostate cancer therapy are:
- Helios Hospital Berlin-Buch
- University Hospital Rechts der Isar Munich
- University Hospital of Ludwig Maximilian University of Munich
- University Hospital Frankfurt-am-Main
- University Hospital Carl Gustav Carus Dresden
Content
- European treatment options for advanced prostate cancer
- What is Lutetium therapy in Europe?
- Who is eligible for 177-Lutetium therapy in Europe?
- How does Lutetium-177-PSMA therapy in Europe work?
- Effectiveness of Lutetium-177-PSMA therapy in Europe
- What is the cost of Lutetium treatment in European hospitals?
- Treatment in European hospitals with Booking Health
European treatment options for advanced prostate cancer
Symptom relief is the main goal of treatment for patients with metastatic prostate cancer because an already disseminated pathology is usually incurable. Hormone-targeted therapy and chemotherapy are forms of first-line treatment for advanced prostate cancer. Even with numerous metastases, some radiation treatments can reduce the disease's symptoms. For more advanced stages of the disease, a combination of targeted radiation therapy and medication therapy is also useful. The aforementioned techniques may result in positive outcomes for a long time, but eventually the therapy will no longer be effective. In such cases, radioactive medicine that penetrates the bone tissue is used as a second-line treatment. As long as the malignant cells are localized only in the bone tissue, this method is secure and effective.
More innovative methods of treating cancer emerge every year. Oncologists now favor using medications that directly attack cancer cells. This therapeutic strategy has won numerous awards for effectiveness and safety. Neuroendocrine tumors, thyroid cancer, various forms of brain tumors, and prostate cancer can all be cured with targeted therapy.
So, the main topic of discussion is radionuclide therapy, a cutting-edge method that combines targeted radiation exposure with the special properties of nuclear fusion. Regrettably, such medical services can only be obtained abroad, including in hospitals in Europe. The basic idea behind radionuclide cancer therapy is to administer unique drugs that contain radionuclides. The radiation is targeted since these medications reach the damaged areas immediately (not affecting the entire body, but affecting the cancer foci). The primary tumor or metastases accumulate the drug that is injected during the radionuclide treatment. The neoplasm is destroyed after being exposed to radiation. The body as a whole, healthy structures nearby, and surrounding tissues are only minimally impacted.
Lutetium-177 PSMA therapy is a novel radionuclide therapy approach used to treat men with prostate cancer. The top oncologists in the world believe that such a strategy can treat cancer patients who have given up on finding a cure.
Because metastatic prostate cancer frequently results in clinical problems and relapses after treatment, treating it is challenging overall. According to the most recent findings of randomized trials, Lutetium-177-PSMA therapy, which is typically considered an alternative to conventional techniques, combined with traditional treatment protocols is a very effective therapy in severe cases of advanced prostate cancer when compared to hormonal therapy and chemotherapy.
What is Lutetium therapy in Europe?
The treatment involves the use of Lutetium-177 (Lu-177) labeled prostate-specific membrane antigen (PSMA), 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 in bones and internal organs.
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, Lu-177 PSMA therapy destroys all cancer cells throughout the body. As a result, the size of the primary tumor lesion is significantly reduced and most metastases disappear.
Who is eligible for 177-Lutetium therapy in Europe?
Lutetium-177 PSMA 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 them, but systemic therapies can affect cancer cells regardless of their location.
PSMA therapy is an alternative to chemotherapy. It is prescribed in the following cases:
- Chemotherapy does not yield any result – the tumor does not respond to drug administration and continues to grow
- 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
Another 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 cellular 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 in Europe work?
Before the procedure the patient visits the doctor for clinical examination and review of the existing medical reports (e.g. PSMA PET CT). If a patient doesn’t have any medical reports, it is necessary to have a PSMA scan in Germany – this test reveals possible efficacy of the subsequent therapy. Blood tests are also carried out, so the doctor can be sure that the patient's liver and kidney functions are normal.
After this, the radiopharmaceutical is injected into the patient's vein slowly using a syringe. This is the whole procedure, actually. Additional drugs may be used to reduce the risk of complications and reduce side effects. The external cooling of the salivary glands with ice packs is carried out in order to prevent suppression of their work and xerostomia (dry mouth).
During the course of treatment, the man stays in a screened ward, as he is a source of beta-radiation for a while. Urine and stool become radioactive, so it is recommended to drink a lot of water and urinate frequently, flush the toilet 2-3 extra times, and wash the underclothes separately for up to 7 days. 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 the control scintigraphy. This is a follow-up examination, 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. The scintigraphy demonstrates the number of bone metastases and their size.
Several sessions of Lutetium-177 treatment are usually carried out in order to achieve the long-lasting result. On average, the patient undergoes three treatment cycles. The recommended intervals between them are 8 weeks. Medical monitoring is provided through PET-CT, PSA blood test, and general clinical studies. The doctors also control liver, kidney, and bone marrow function.
Effectiveness of Lutetium-177-PSMA therapy in Europe
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, symptomatic drugs are used to relieve them
Long-term benefit of Lutetium-177 on prostate cancer is still under investigation, but the current results are very promising. Treatment of the disease with Lutetium-177 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 and do not threaten life.
The complications may include liver or 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 constantly undergoes clinical and biochemical blood tests. These tests are conducted before starting prostate cancer treatment, as well as after each session.
As for the results of treatment, doctors notice significantly lower levels of PSA in the blood (which indicated lower disease activity), shrinkage of the primary tumor, control of metastases, including their disappearance. Having the full course of PSMA therapy with Lu-177 is connected with longer life expectancy and better quality of life.
What is the cost of Lutetium treatment in European hospitals?
It is always challenging to estimate the precise cost of treatment overseas, and therapy in Europe in particular, because preliminary calculations sometimes do not include costs for extra procedures or diagnostic tests that might be necessary later in the course of treatment. The pre-calculated cost of treatment will be modified up or down because, in actuality, the preliminary cost of treatment in Europe frequently differs from reality due to the peculiarities of the clinical case.
Hence, learning about the approximate costs of prostate cancer therapy in Europe in terms of specific treatments is the only option available. Please use the website's contact form if you would like to receive a customized offer with an estimated pricing.
Please do not hesitate to contact Booking Health if you have any questions. We'll schedule an appointment and provide you pricing advice for the entire course of therapy, including PSMA therapy with Lu-177 and other necessary options.
Treatment in European hospitals with Booking Health
The prostate cancer treatment with Lutetium is carried out in the best healthcare facilities 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 include:
- Organization of Lutetium-177-PSMA therapy in one of the best specialized clinics abroad
- Affordable treatment cost, which will be up to 50% lower due to the exclusion of extra charges for foreign patients
- Communication with the doctors of the clinic and its administration both prior to prostate cancer treatment start and after its completion
- Preparation of the preliminary treatment program
- Appointment at the dates convenient for the patient
- Assistance in purchasing and shipping of medicines for continuing treatment in the native country
- Control of invoices, treatment costs, return of unspent funds
- Organization of additional diagnostic or therapeutic procedures in the clinic, if necessary
Booking Health provides high quality organizational services for over 15 years. Compliance of the quality of the company's work with high international standards is confirmed by the prestigious ISO 9001: 2015 certificate. 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. An interpreter and personal medical coordinator will help you cope with medical issues and feel comfortable while communicating with doctors.
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!
Sources:
National Center for Biotechnology
Cancer Research Institute
Cancer Support Community
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