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Prostate Cancer Treatment with Lutetium-177 PSMA (program ID: 355871)

University Hospital of Ludwig Maximilian University of Munich

location_on Munich, Germany
10/10 from 40 Votes
Specialized hospital
Peter Bartenstein

Head Physician
Prof. Dr. med.

Peter Bartenstein

Specialized in: nuclear medicine

Department of Nuclear Medicine

The program includes:

  • Initial presentation in the clinic
  • history taking
  • general clinical examination
  • laboratory tests:
    • complete blood count
    • biochemical analysis of blood
    • urinalysis
    • TSH-basal, fT3, fT4
    • PSA blood test
    • tests for urogenital infections
    • indicators of inflammation
    • indicators of blood coagulation
  • ultrasound scan of the urogenital system
  • renal scintigraphy
  • PSMA PET-CT (if indicated)
  • PSMA treatment
  • full body scintigraphy after 24 hours
  • full body scintigraphy after 48 hours
  • symptomatic treatment
  • cost of essential medicines
  • nursing services
  • elaboration of further recommendations
  • stay in the hospital with full board 
  • accommodation in a room with 2 beds

How program is carried out

During the first visit, the doctor will carry out a general physical examination and go through the results of your previous laboratory and instrumental tests. After that, you will undergo any necessary additional tests, such as an assessment of your liver and kidney function, a scintigraphy of your skeleton and salivary glands, a PSMA PET/CT. This will allow the doctor to assess how effective PSMA therapy with Lutetium-177 will be for you, and how well you will tolerate it. The doctor will also calculate your individual dosage of the radionuclide.

PSMA therapy with Lutetium-177 is carried out via intravenous administration of a solution containing the radioactive isotope, Lutetium-177. The solution is injected through a catheter. This is a short procedure, as the infusion usually takes no more than 20 minutes.

During the procedure, you will need to apply cooling bags to your salivary glands, as Lutetium-177 partially accumulates in the salivary glands, affecting their function and causing a dry mouth. You will also receive intravenous saline solutions to protect your kidneys.

After the infusion of Lutetium-177, you will stay in a specially equipped (radiation-shielded) ward for 48 hours. The drug is quickly excreted by the kidneys, and after 48 hours you will no longer be dangerous to others. During these 48 hours, you can read, use a mobile phone, tablet or computer – none of these devices will be a source of radiation in the future.

Follow-up examinations include either a whole-body scintigraphy or a computed tomography in 24 hours, and then again 48 hours after the procedure. Based on the results of this examination, the doctor will determine whether one procedure is enough for you, or whether you will need to visit the hospital again. As a rule, 1-2 procedures are required for achieving a stable, positive result. Procedures are carried out with an interval of 8 weeks.

Required documents:

  • Medical records
  • MRI/CT scan (not older than 3 months)
  • Biopsy results (if available)
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About the department

The Department of Nuclear Medicine at the University Hospital of the Ludwig Maximilian University of Munich offers the full range of modern methods of radioisotope-based diagnostics and treatment. The department provides outpatient and inpatient medical care. In the field of diagnostics, special attention is paid to positron emission tomography (PET), including in combination with computed tomography (PET/CT), scintigraphy, single photon emission computed tomography (SPECT), and SPECT/CT. These examinations are most often performed for suspected cancers, neurological disorders, and heart disease. Radioisotope-based therapies can be used to treat benign and malignant thyroid diseases, benign joint lesions, prostate cancer, neuroendocrine tumors, primary and secondary liver tumors, and bone metastases. The department is the largest facility of this kind in Germany and is deservedly proud of its prestigious international ISO 9001:2015 certification.

The Head Physician of the department is Prof. Dr. med. Peter Bartenstein. The specialist has a worldwide reputation in the medical arena and has been diagnosing and treating patients using radionuclide methods for more than 35 years. The doctor attaches importance not only to clinical but also to research activities, which are focused on the study of positron emission tomography with receptor ligands and other radiopharmaceuticals for neurological and mental diseases, as well as endoradiotherapy for treating cancer, especially neuroendocrine tumors, prostate, and thyroid cancers. More than 460 scientific publications by Prof. Bartenstein are presented in Internet resources. From 2019 to 2021, the doctor served as a Board Member of the German Society of Nuclear Medicine.

An integral part of the department's clinical practice is high-precision diagnostic procedures such as scintigraphy, PET, PET/CT, SPECT, and SPECT/CT scans. The above-mentioned tests are of particular value in diagnosing patients with suspected malignant diseases of various localizations, assessing the state of the sentinel lymph nodes, brain, and spinal cord, as well as assessing the condition of the heart vessels and diagnosing a heart attack. Modern radioisotopes allow doctors not only to see the anatomical structure of the organ but also to assess its function, blood flow, and metabolic processes. Nuclear diagnostic methods often make it possible to detect pathology at an early stage when a patient does not experience any symptoms, which is not always possible with the help of laboratory and hardware diagnostic methods.

Since August 2013, the department has had a new center for the production of radiopharmaceuticals. The center is equipped with a cyclotron, which allows for the production of radioactive drugs based on the GMP standard in compliance with the current requirements for radiation protection and prescribing medicines. Thanks to this, the department receives the necessary high-quality and safe substances for diagnostics and radiopharmaceuticals for customized therapy in a shorter time. The doctors can thus provide patients with top-class treatment.

The team of the department's doctors also has perfect professional skills and exceptional experience in providing treatment with radiopharmaceuticals. Radioiodine therapy for benign and malignant thyroid diseases, pain management for skeletal metastases, radiosynoviorthesis for joint lesions, Lu-177-DOTATATE therapy for neuroendocrine tumors, Lu-177-PSMA therapy for prostate cancer, and selective internal radiation therapy (SIRT). These treatment programs are often elaborated in collaboration with doctors from other medical specialties (oncologists, endocrinologists, gynecologists, surgeons, orthopedists), for example, at the Comprehensive Cancer Center (CCC) or the Breast Center.

There are 16 beds available to accommodate inpatients in the department. The wards in the medical facility are different from those that patients are used to seeing in conventional clinics, since it is important for doctors to meet strict radiation protection rules. The duration of a hospital stay for radionuclide therapy is usually about one week. At the same time, the mandatory stay in a special room with radiation protection systems is 2-3 days. The indisputable advantages of radionuclide therapy are its high efficiency, painlessness, and absence of side effects.

The department's range of medical services includes:

  • Diagnostic options
    • Scintigraphy
      • Detection of the source of bleeding
      • Scintigraphy to detect inflammatory processes
      • Brain scintigraphy
      • Testicular scintigraphy
      • Bone marrow scintigraphy
      • Liver scintigraphy
    • Positron emission tomography (PET)
      • PET/CT for suspected cancer
      • PET for suspected neurological/neurooncological pathologies
      • PET and PET/CT for other diagnostic tasks (for example, in cardiology, etc.)
    • SPECT and SPECT/CT
  • Therapeutic options
    • Radioiodine therapy for benign and malignant thyroid diseases
    • Lu-177-PSMA-DKFZ-617 therapy for prostate cancer
    • Xofigo® (Ra-223) therapy for bone metastases
    • Peptide receptor radionuclide therapy for neuroendocrine tumors: Lu-177-DOTATATE therapy and 90Y-DOTATATE therapy
    • Metaiodobenzylguanidine treatment (MIBG therapy) for pheochromocytomas and other tumors
    • Selective internal radiation therapy (SIRT) for primary and metastatic liver tumors
    • Radiosynoviorthesis (RSO) for pathological joint lesions
  • Other diagnostic and treatment methods

Curriculum vitae

Higher Education and Professional Career

  • 1978 - 1984 Medical Studies, Universities of Bochum and Bonn.
  • 1981 - 1984 Research work in the Department of Hematology and Oncology, University Hospital Bonn.
  • 1984 - 1985 Clinical Internship in the Departments of Radiology, Internal Medicine and Surgery at the District Hospital Waldbröl.
  • 1985 State Medical Examination, graded "very good".
  • 1985 - 1986 Military Service as a Medical Officer in Andernach.
  • 1985 Doctorate, University of Bonn, magna cum laude.
  • 1986 - 1990 Assistant Physician in the Department of Nuclear Medicine, University Hospital Muenster.
  • 1990 Board certification in Nuclear Medicine.
  • 1990 - 1991 Research Fellowship, German Research Foundation), PET Group of the Medical Research Council, Hammersmith Hospital London.
  • 1991 - 1994 Senior Physician in the Department of Nuclear Medicine, University of Muenster.
  • 1994 Habilitation.
  • 1994 - 1999 Senior Physician in the Department of Nuclear Medicine, University Hospital Rechts der Isar Munich, and Head of the Group on Neuroimaging.
  • 1999 - 2006 Chairman of the Department of Nuclear Medicine, Johannes Gutenberg University Mainz.
  • 2002 - 2006 Head of the University Neuroscience Center.
  • Since 2006 Head Physician of the Department of Nuclear Medicine at the University Hospital of Ludwig Maximilian University of Munich.

Photo of the doctor: (c) LMU Klinikum

Sources:

Bundesärztekammer

Wikipedia

PubMed, National Library of Medicine


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