Lutetium-177 PSMA Therapy in Germany

Prostate cancer is a relatively non-aggressive tumor. It can be monitored for a long time, and in case of progression, the disease can be treated with surgery, radiation therapy or brachytherapy. Relapses are rare.

Nonetheless, in many patients, prostate cancer is diagnosed only beyond the stage one-three, after the spread of metastases. Such forms of the disease are subject to control throughout the patient's life. Doctors use hormone therapy and chemotherapy. In recent years, another method of systemic treatment has become widespread abroad: Lutetium PSMA therapy. Doctors inject radioactive substances into the patient's vein, which themselves find the tumor, and its metastases, accumulate in cancer cells, and destroy them with radiation. The cost of Lutetium-177 PSMA therapy for prostate cancer is between 22,700 EUR and 44,000 EUR.

Content

1. Essence of the method
2. In what cases can PSMA therapy be used
3. What is the process of treatment?
4. Benefits of the method
5. Why is it better to undergo cancer treatment in Germany?
6. Treatment in Germany at an affordable price

Essence of the method

After the spread of metastases, doctors cannot conduct radical prostate cancer treatment with surgery or radiation therapy. It is impossible to detect and destroy all metastases in the body. Such a surgical intervention would be too traumatic. In addition, it is simply impossible to detect all metastatic foci: most of them are minimal in size, but after a few months they will increase and cause symptoms.

Therefore, for patients with prostate cancer beyond the stage 1-3, doctors use systemic treatment methods. These are therapies that target all cancer cells in the body, no matter where they are. Examples of such therapy include chemotherapy, targeted therapy, immunotherapy, and hormone therapy. Medicines can be administered intravenously or taken orally. They are carried throughout the body with blood and also get into cancer cells.

Lutetium PSMA therapy is also among the systemic treatment options. The radiopharmaceutical agent is administered intravenously. The radioactive substance accumulates only in cancer cells and irradiates them without actually affecting normal tissues. How is this possible? How does the drug recognize where the tumor is and where are the normal cells?

The selectivity of action of the radiopharmaceutical agent is because it is directed to a molecular target. It can attach only to certain molecules that are present on cancer cells but are absent or are contained in minimal amounts on healthy cells. PSMA, a prostate-specific membrane antigen, is used as such a target. Cancer cells contain it hundreds of times more than normal ones.

The drug itself consists of two components. These are as follows:

• PSMA ligands – molecules that can bind to PSMA. 
• Radionuclide – in this case, it is lutetium 177, although other radioactive substances can also be used. 

Thus, lutetium itself does not know how to find a cancerous tumor. This is done by ligands, which deliver radioactive substances to the target.

Lutetium is the most popular radionuclide in the treatment of patients with metastatic prostate cancer. This is because it:

• Gives short beta radiation, spreading only 1 mm, which means that the normal tissues surrounding the cancerous tumor practically do not suffer from radiation. 
• It has an effective half-life of only 2 days, which means that the patient does not carry a radiation source in the body for too long, so he usually does not suffer from complications and is not dangerous to others.

In what cases can PSMA therapy be used 

Patients with advanced cancer are considered candidates for lutetium PSMA therapy if chemotherapy and hormonal treatment options do not work. The tumor must be PSMA positive, that is, it contains a sufficient number of receptors for the accumulation of the radiopharmaceutical agent.

With an aggressive form of prostate cancer and the absence of timely treatment, the tumor spreads metastases. They most often affect the lymph nodes and bones. The treatment involves the use of hormone therapy. Sooner or later, the patients develop hormone-resistant cancer: the tumor continues to grow despite hormonal treatment.

The next option is chemotherapy. In recent years, it has been increasingly prescribed even before the development of resistance to hormone therapy. Thus, hormone therapy is combined with cytostatics. In addition, methods of local control of the tumor are used: mainly radiation therapy or brachytherapy.

At some point, the patient stops responding to therapy with cytostatics. In addition, older people may have poor tolerance or suffer from severe side effects. PSMA therapy for prostate cancer is better tolerated and has fewer complications. Therefore, its use is possible in elderly patients, weakened by the disease or suffering from concomitant pathologies.

To test whether patients with metastatic prostate cancer are candidates for radionuclide treatment, PSMA PET is performed. A small amount of a radiopharmaceutical agent is injected into the body to check whether the tumor is capable of accumulating it. In the future, PSMA PET is performed at least after every second procedure to assess the results of therapy.

What is the process of treatment? 

This treatment option for prostate cancer does not take long and is well tolerated by patients.

One course consists of just one injection. The radiopharmaceutical agent is administered intravenously. The person must then spend three nights in the hospital, and on the fourth day they are discharged.

During the administration of the drug, a small amount of radioactive substance may accumulate in the kidneys and salivary glands. Occasionally, liver metastases may develop, which is why lutetium PSMA can cause jaundice in some patients.

Doctors carry out a careful diagnostic examination of patients. If there is a threat of jaundice, then bile duct stenting is performed before the procedure. The salivary glands are cooled to avoid dry mouth. To protect the kidneys, infusion solutions are administered intravenously. Prior to each course of treatment, the function of the internal organs is assessed.

The number of courses may vary. Patients treated with PSMA therapy can respond to treatment differently. In some patients, a complete response can be achieved – the disappearance of all tumor foci. In other cases, a partial response is established – a decrease in the diameter of the tumor and metastases by more than 30%. Some metastatic lesions may disappear completely. Even if the areas of cancer spread are not significantly reduced, they stabilize in size.

After each injection of the radiopharmaceutical agent, doctors assess the results of treatment by measuring PSA levels. Tumors and metastases are visualized with PET-CT. The treatment is repeated every 8 weeks. PSMA therapy for the patient continues as long as it works without causing unacceptable toxicity.

Benefits of the method 

Lutetium PSMA therapy is one of the best treatment options for patients with metastatic cancer. This is a real breakthrough in the fight against this pathology. When combined with other methods, lutetium treatment can increase the life expectancy of patients with advanced stages of cancer by several years, and significantly improve the quality of life.

PSMA therapy has been used in medicine relatively recently. However, in just a few years of application, it has already established itself as a procedure with a good balance of effectiveness and safety. The benefits of this treatment option for patients with metastatic prostate cancer are as follows:

• With the help of PSMA therapy, even the most advanced forms of cancer can be treated when chemotherapy and hormone therapy no longer work.
• Good treatment tolerance: patients are less likely to suffer from side effects than after chemotherapy.
• Serious complications are rare. Some doctors do not face them, even after treating dozens of patients with lutetium.
• PSA levels after a single injection of the radiopharmaceutical agent can decrease by 95% or more.
• It is possible to achieve a complete response to treatment: the disappearance of the primary tumor and all metastases according to the data of radiological diagnostics. 

If side effects occur, then, in most cases, these are toxic reactions of grade 1-2. The most common of them are dry mouth (68% of patients), nausea (48%), and fatigue (36%). Grade 3-4 toxic reactions occur very rarely. They are possible only in the presence of metastatic foci in the bones with the involvement of the bone marrow. In this case, radiation sources inhibit hematopoiesis, thrombocytopenia, and anemia (low platelet and erythrocyte levels) may develop. In Germany, doctors successfully correct these conditions through transfusions of blood and its components.

Why is it better to undergo cancer treatment in Germany? 

Germany is an economically prosperous country with developed medicine. Doctors in this country apply the very latest treatment options for prostate cancer. Patients in Germany can expect excellent results with minimal health risks.

There are several reasons for you to undergo treatment in one of the German hospitals: 

• Lutetium PSMA therapy can be used for metastatic cancer. In most countries all over the world, this method is not used at all or has limited application.
• Extensive experience – German doctors were among the first to treat patients with prostate cancer using radionuclide methods. 
• The departments of radiology and oncology are equipped with state-of-the-art medical technology. 
• A thorough diagnosis was conducted before the procedure. Doctors will examine you to see if radioligand therapy will be effective and whether it is appropriate to use it. During the treatment, you will be examined to evaluate the results and avoid damage to internal organs, primarily to protect the kidneys.
• Comfortable conditions in the hospitals. After the administration of the radiopharmaceutical agent, you will need to spend another 3 days in the hospital.
• A successful combination of several methods of treating prostate cancer – not only systemic (drug therapy), but also local (remote irradiation, brachytherapy).
• Other innovations in the treatment of prostate cancer are available: embolization of tumor vessels, robot-assisted operations, high-intensity focused ultrasound, and proton therapy.

Thanks to the high level of medicine, even advanced prostate cancer can be successfully treated in Germany. Despite the aggressive histological type of the tumor, and the development of distant metastases, provided with high-quality treatment, many patients can live for another 5-10 years or more after the diagnosis is made.

Treatment in Germany at an affordable price 

To undergo treatment for metastatic prostate cancer in the department of nuclear therapy in one of the German hospitals, please use the services of Booking Health. On our website, you can find out the cost of treatment in different nuclear medicine hospitals, compare prices, and book a medical care program at a favorable price. Treatment with lutetium in a German hospital will be easier and faster for you, and the cost of treatment will be lower.

Please leave your request on the Booking Health website. Our employee will contact you and advise you about treatment in Germany. Booking Health will take care of the organization of your trip to one of the nuclear medicine hospitals. We will provide the following benefits to you:

• We will select a hospital for treatment in Germany, whose doctors specialize in nuclear medicine.
• We will help you overcome the language barrier, and establish communication with your attending physician.
• We will reduce the waiting time for the start of the medical care program and book a doctor's appointment on the most suitable dates.
• We will reduce the price. The cost of treatment in German hospitals will be lower due to the lack of additional coefficients for foreign patients.
• We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreting services, etc.
• We will prepare a program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will provide communication with the hospital after cancer treatment in Germany.
• We will organize additional diagnostic examinations and treatment in a German hospital, if necessary.
• We will buy medicines abroad and forward them to your native country.
• We will help you keep in touch with the hospital and the doctor after treatment in Germany.

You will be treated by the best doctors in the world. Booking Health staff will help reduce the cost of treatment for metastatic cancer and solve all organizational issues, and you will only have to focus on restoring your health.

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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Sources:

National Library of Medicine

German Cancer Research Center

Cancer. Net