Treatment of Prostate Cancer With Metastasis by Lutetium 177-PSMA (LU-177) in Germany

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University Hospital of Ludwig Maximilian University of Munich

location_onGermany, Munich

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of diagnostic and therapeutic services in modern nuclear medicine for both outpatients and inpatients. The focus is on the detection and treatment of oncological, neurological and cardiac diseases. The department is the largest institution of this kind in Germany. The international recognition is approved by ISO 9001: 2015 certification.

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Hospital directly21305
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University Hospital Rechts der Isar Munich

location_onGermany, Munich

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of services in this field. The key clinical focuses include the diagnostics and treatment of tumors, thyroid, kidney, brain and heart diseases. To do this, doctors have at their disposal all the necessary medical equipment of the latest generation, for example, devices for PET-CT, SPECT/CT, MRI, etc.

Helios Hospital Berlin-Buch

location_onGermany, Berlin

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of diagnostic and therapeutic procedures using modern radioactive substances. The diagnostic options include scintigraphic studies of the lungs, heart, brain, kidneys, lymph nodes, bones, including in small patients. In the field of therapy, one of the priority focuses is the use of radioiodine therapy for thyroid pathologies. Medical care and patient care are provided by highly qualified doctors and nursing staff who believe that the health and wellbeing of their patients is a top priority.

Hospital directly20031
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University Hospital Frankfurt am Main

location_onGermany, Frankfurt am Main

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of modern diagnostics and therapy using various radioisotopes. The department is equipped with the advanced systems for carrying out such high-precision and informative examinations as SPECT, PET, etc. The department carries out more than 8,000 outpatient examinations annually. The key focus in the field of diagnostics is on the detection of neurological, cardiac and oncological diseases. The department's therapeutic options include the treatment of benign and malignant diseases of the thyroid gland, pain therapy in bone metastases, treatment of malignant tumors in children (for example, neuroblastomas). The spectrum is also complemented by such innovative techniques as radiosynoviorthesis, selective internal radiation therapy and radioimmunotherapy.

University Hospital Carl Gustav Carus Dresden

location_onGermany, Dresden

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of diagnostics and treatment with therapeutic radionuclides. The department has been successful in conducting clinical activities for more than 60 years, and therefore has an extensive experience and outstanding achievements. The department is equipped with the state-of-the-art medical equipment, which allows its specialists to provide the optimal medical services in accordance with the highest international standards. Special focus is on treatment of benign and malignant thyroid diseases.

University Hospital Erlangen

location_onGermany, Erlangen

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of diagnostic and therapeutic services in its specialization. Of particular interest are PET/CT, SPECT/CT, as well as innovative therapeutic methods of nuclear medicine, such as peptide radioreceptor therapy for neuroendocrine tumors, radioembolization of liver tumors and treatment of prostate cancer with radioligands targeting a prostate specific membrane antigen (PSMA therapy). The highly qualified world-renowned doctors take care of the patients.

University Hospital Bonn

location_onGermany, Bonn

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of radioisotope diagnostics and treatment of various diseases. The department began its work in 1951 and today it is one of the leading and most reputable medical facilities of this kind in Germany. The clinical activities mainly focus on detection and treatment of pathologies of the thyroid gland, heart, lung cancer, breast cancer, prostate gland, liver cancer and metastases, neuroendocrine tumors, malignant melanoma, and brain tumors. The doctors use only reliable, the most effective innovative methods of examination and therapy, which guarantee an optimal result.

University Hospital Duesseldorf

location_onGermany, Duesseldorf

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of diagnostics and treatment with radioactive substances. It conducts many scintigraphic examinations, ranging from the diagnostics of the thyroid gland and skeleton to amino acid metabolism studies in brain tumors and metabolic studies in other malignant tumors. The department has at its disposal a specialized outpatient clinic for the diagnostics and treatment of thyroid diseases.

University Hospital Halle (Saale)

location_onGermany, Halle

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of services in this ​​medical field. It carries out all common and proven types of scintigraphic diagnostics and treatment. A unique offer of the department is SPECT-CT and PET-CT using various tracers and modern targeted radiopharmaceuticals. The department has an in-house Section of Radiochemistry, in which all the necessary radiopharmaceuticals for the diagnostics and therapy are synthesized. Thus, the department has all the resources to provide excellent medical service.

University Hospital Jena

location_onGermany, Jena

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of radioisotope diagnostics and treatment using the state-of-art gamma cameras and PET-CT systems. The main therapeutic facilities of the department include radioiodine therapy, selective internal radiotherapy, peptide-receptor radionuclide therapy. All medical services comply with the guidelines of national and international professional societies, which ensures an accurate diagnostics and optimal treatment outcome.

University Hospital Würzburg

location_onGermany, Würzburg

Department of Nuclear Medicine

The Department of Nuclear Medicine offers all modern diagnostic and therapeutic procedures using radioactive substances. In addition to the classical methods of nuclear diagnostics, for example, thyroid scintigraphy, special attention is paid to the functional and molecular imaging using the state-of-art PET-CT and SPECT-CT techniques. A special feature of the department is also the Section of Radiochemistry, which produces its own radiopharmaceutical medicines for the targeted therapy of oncopathology (including prostate cancer, neuroendocrine tumors or lymphomas), diseases of the cardiovascular system, and neurological disorders.

University Hospital Muenster

location_onGermany, Muenster

Department of Adult and Pediatric Nuclear Medicine

The Department of Adult and Pediatric Nuclear Medicine offers the full range of radioisotope diagnostics and therapy at the highest technical level. The department specializes in the detection and treatment of benign and malignant thyroid diseases, oncopathology of other organs and anatomical structures of the human body. The department's feature is the radioisotope examinations in children, for example, PET-CT, PET-MRI, kidney, bone scintigraphy, etc. The high-quality medical care is provided thanks to the availability of advanced medical technologies and experienced medical personnel who regularly undergo advanced training courses to keep abreast of medical innovations.

University Hospital Tuebingen

location_onGermany, Tuebingen

Department of Nuclear Medicine and Clinical Imaging Diagnostics

The Department of Nuclear Medicine and Clinical Imaging Diagnostics offers the full range of radioisotope diagnostics and treatment of various diseases. Both classical diagnostic methods, for example, scintigraphy, SPECT and innovative hybrid techniques, for example, PET-CT, PET-MRT, SPECT-CT are available in the department, which allow to detect metabolic changes at the early stages of various diseases, as well as their localization in the human body. In addition, the department's doctors specialize in radiotherapy for the treatment of oncopathologies.

University Hospital Heidelberg

location_onGermany, Heidelberg

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of radioisotope diagnostics and treatment of various diseases. The department is equipped with the advanced medical equipment, which provides the most accurate scanning of all anatomical structures and organs of the human body. In the field of treatment, the focus is on oncological, cardiological and neurological diseases. The department's doctors work in accordance with the international standards, therefore, each patient receives high-quality, individualized medical care.

University Hospital Essen

location_onGermany, Essen

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range of radioisotope diagnostics and treatment. Of particular interest is the detection and treatment of thyroid diseases, endocrine tumors. The department also specializes in radioiodine therapy for the treatment of thyroid diseases, radionuclide therapy for bone metastases, MIBG therapy for the treatment of neuroblastomas, malignant pheochromocytes and many other therapies. In addition, the department operates its own Radiopharmaceutical Section, which produces radiopharmaceuticals for two positron emission tomography (PET) scanners.

HELIOS University Hospital Wuppertal

location_onGermany, Wuppertal

Department of Nuclear Medicine

The Department of Nuclear Medicine offers the full range in this medical focus. The main activities of the department include PET-CT diagnostics of oncological diseases, neurological and cardiological diseases, scintigraphy of bones, thyroid gland, kidneys, myocardium, radioimmunotherapy, pain therapy and radioiodine therapy.

The scientists of the German Cancer Research Center have developed a biologically active substance PSMA-617, targeted to bind to prostate cancer cells. The biologically active substance is labeled by various radioactive substances. Binding to a weakly emitting diagnostic radionuclide, it will expose prostate tumors and their metastases in PET. Being labeled by a strongly emitting therapeutic radionuclide, PSMA-617 can destroy the cancer cells in a targeted manner. The first clinical use of the radiopharmaceutical was promising.

Prostate carcinoma is the most common cancer among men. After local therapy (surgery and/or radiation) for advanced prostate cancer, an additional anti-hormonal treatment is often prescribed. After a prolonged anti-hormonal therapy, the cancer cells frequently become resistant to these medicines, so later, upon tumor progression, chemotherapy often remains the only option. A further treatment options for patients with prostate cancer can be a PSMA-therapy. PSMA (prostate-specific membrane antigen) is a protein propagating on the surface of the prostate cancer cells. This allows using the same in radiation diagnostics and therapy of these tumors by combining the substance associated with PSMA with a radioactive nuclide (177 Lu, ß-emitter). For PSMA therapy, the radioactive emission (beta radiation) may exercise a direct therapeutic effect on tumor cells. Being associated with a weakly emitted specific diagnostic radionuclide, PSMA-617 can detect very small aggregates of prostate cancer cells in PET (positron emission tomography) studies.

Upon PSMA radionuclide therapy, the radioactive emission (ß-radiation) may exercise a therapeutic effect directly on the tumor cells while sparing the healthy surrounding tissues.

The treatment goal is inhibition / delay of the tumor cell growth, while covering the metastases (in bones, soft tissues, and the like).


Metastatic prostatic carcinoma cells bear on their surface a so-called high-density prostate-specific membrane antigen (PSMA). The ligands binding to PSMA can be radioactively labeled, and including by radionuclides used for therapeutic purposes, such as 177-lutetium. This type of therapy is feasible for patients with metastatic prostate cancer, which are no longer affected by the prior conventional systemic therapy, i.e. chemotherapy. In agreement with the attending urologists/oncologists, especially considering the exclusion of subsequent treatments, such as the second and third cycle of chemotherapy due to the possible low effectiveness, side effects and comorbidities, as well as at the patient's request, the chemotherapy with a high degree of side effects should be avoided.

Treatment methods and procedure:

Preparation for treatment:

in the course of preparation and planning of this treatment, various studies are carried out: blood tests, including a differential blood count, liver and kidney function tests, as well as PSA.

This allows assessing the risks and side effects to the other organs (e.g., hematopoietic spinal cord) and monitoring the same since an early treatment stage.

During the preparation for treatment, it is required to conduct a PSMA scintigraphy or PSMA-PET-CT to assess whether the PSMA-therapy is feasible and promising. Besides, it is required to conduct a preliminary bone and salivary gland scintigraphy. In order to determine the indications for PSMA, the findings of the other studies, as well as pictures of the previous surveys, e.g., diagnostic computed tomography (CT) or Choline-PET-CT, are useful.

Treatment process:

Lutetium-177-PSMA ligands bind PSMA to cells carrying the prostate cancer on their cell membranes. Due to radioactive rays with a short exposure, the cell growth is prevented at a depth of a few millimeters only; they are damaged or destroyed.

PSMA treatment is carried out after conversation with a clinic department physician on the day for which the treatment is scheduled. The salivary gland scintigraphy is performed, unless it was conducted on the day before. It is also required to conduct a preliminary renal scintigraphy to determine their functions and the kidney outflow ratio.

On the treatment day, you must be sober. The department physician will introduce venous catheters into both of your hands. About 2 hours before the treatment start, we will apply an ice pack to your lower jaw to protect your salivary glands so that they were cooled and thus bled to a lesser extent. This implies a lesser accumulation of radioactive substances in the salivary glands. Before treatment, an injection of saline solution will be administered to protect your kidneys. Following this, a healing radioactive substance is injected. It is introduced with a syringe for about 10-15 seconds. If you have any side effect during or after treatment (e.g., nausea), please, inform the department staff to receive the appropriate drugs suppressing the side effects.

About 15-30 minutes and 2-4 hours after the healing injection, we conduct a general scintigraphy to monitor the activity distribution and measure the radiation load on the kidneys, respectively; simultaneously, a tube of blood is taken to evaluate the radioactive dose in the blood and bone marrow at each sampling. During the hospital stay, the radiation dose rate is determined, and the necessary blood sample is taken.

On the day of discharge, a repeated general scintigraphy of the whole body is carried out to visualize the PSMA distribution (the scintigraphy is performed 24 and 48 hours later, when required, depending on the used nuclide). Once the radioactive radiation emitted by the patient's body is below the regulatory threshold, the patient can be discharged.

In accordance with the Regulations on Radiation Protection, the treatment can be carried out in a hospital setting only, and the patient must stay in the radiotherapy department for four days.

Typically, the hospital stay takes 3 to 4 days. 

To estimate the radiation dose received, we appoint your next visit to us for scintigraphy of the whole body, and for blood sampling 6 to 9 days after treatment. The final scintigraphy is performed about 7 to 10 days after treatment.

The total permitted amount of therapeutic radioactivity is not introduced within a single session. In most cases, the treatment is carried out in several separate cycles, during which you will stay in our department for eight weeks with intervals.

In most cases, a laboratory monitoring for about 10 weeks, every two weeks, is required. PSA checks must be carried out 4 and 8 weeks after therapy. Depending on the survey findings and the patient’s overall condition, the PSMA therapy is normally conducted in three cycles.

To evaluate the effectiveness of the preceding treatment cycle, a repeated PET/CT is performed about a week before the second treatment cycle. Besides, before each new cycle of therapy, you shall pass the blood count, as well as liver and kidney function tests in order to detect the eventual deterioration of their condition and the bone marrow status on a timely basis. Please, include the relevant examinations in your schedule.

Eventual risks and complications

In general, the treatment is well-tolerated. Sometimes, there are side effects, such as nausea and vomiting (medically treatable), taste sensation disorders and xerostomia (partially, temporarily), as well as fatigue. PSMA is excreted by kidneys, liver and bladder. Therefore, we must pay attention to an adequate intestinal activity and stimulate the same, when required. Along with this, a sufficient amount of liquid should be consumed. The liver and kidney functions shall be checked after treatment, too. The following organs at risk are the salivary and lacrimal glands, to which PSMA is bound. In order to minimize the damage to the salivary glands, they are cooled for a long period of time, thereby minimizing the risk of a long-term damage and loss of the gland functions (xerostomia). Besides, it can lead to a temporary change in the blood pattern.

Hospital stay

The Regulations on Radiological Protection require that the patient stayed in radiation medicine ward with a protective screen.

The visitors are not allowed in a shielded area. However, you will be able to receive the essentials from your family through the attendants. For your stay in the hospital, please, take comfortable casual clothes, nightwear and ordinary personal hygiene products. You should also take the items required for your pastime (e.g., magazines, books, laptop, handicraft items, etc.). They are not "irradiated" during treatment, and can subsequently be used in everyday life.

The radio, TV and telephone are at your disposal in the wards.

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