End-stage prostate cancer with metastases is perceived by many patients as a death sentence. In fact, everything is not so bad. In countries with advanced medicine, doctors have learned to deal with even severe end-stage cancers. They use systemic treatments that influence not only the tumor but also its metastases. One of the breakthroughs in the treatment of stage 4 prostate cancer was Lutetium PSMA therapy. This allows doctors to shrink the size of tumor foci, and in some patients, it is possible to achieve the complete disappearance of all tumors.
What is Lutetium-177 PSMA therapy?
PSMA therapy is one of the outstanding achievements of nuclear medicine. This is one of the options for radiotargeted therapy (radioimmunotherapy). The essence of the method is as follows:
1. A radioactive substance is injected into the body.
2. This radioactive substance accumulates only in cancer cells but not in healthy tissues.
3. For several days, the radionuclide (Lutetium-177) emits radiation that affects cancer cells.
4. Having realized its therapeutic effect, the radionuclide is excreted from the body.
5. After 4-8 weeks, the treatment is repeated, improving its results.
Why does radioactive Lutetium accumulate only in cancer cells but not in healthy tissues? This is due to the fact that ligands are used to deliver it to the tumor. These are molecules that can selectively bind to other molecules. In this case, they target PSMA (a prostate-specific membrane antigen), which is found in cancer cells but is largely absent from healthy tissues.
Why does radioactive Lutetium not damage tissues after accumulation in tumor foci? This can be explained by the fact that it emits very short radiation. It extends to 1 mm. Consequently, only tissues in the area of accumulation of the radiopharmaceutical are irradiated. Therefore, PSMA therapy is well tolerated and rarely leads to any severe complications.
When can Lutetium-177 PSMA therapy be used?
Radiotargeted therapy is not the first-choice treatment for prostate cancer. This can be used when other standard methods of cancer control fail.
Hormone therapy is considered the first-line treatment. Following it, and sometimes in addition to it, chemotherapy can be used. Much less often, doctors use targeted therapy and immunotherapy. This is a personalized cancer treatment that is not suitable for all patients.
If standard treatments have been used but the tumor continues to grow, then doctors switch to radiotargeted therapy. Although it is used in the most complex cases, this type of treatment gives good results.
Does PSMA therapy cause any side effects?
PSMA therapy does cause side effects, the most common of which is dry mouth. The salivary glands contain a small amount of PSMA, so the radionuclide can accumulate here. Doctors take measures to reduce the risk: they cool the salivary glands during the injection of the drug in order to reduce blood flow to them and reduce the accumulation of the radionuclide.
Other complications are uncommon. Kidney damage may occur. Doctors periodically do blood tests to understand whether it is possible to continue PSMA therapy or whether it is contraindicated for the patient.
When metastases are located in the liver, the bile ducts can be blocked. Some patients will require stenting for normal bile flow.
The results of Lutetium-177 prostate cancer treatment
Lutetium therapy is effective in most patients. Already after the first procedure, a partial response is often achieved: the total diameter of the tumors is reduced by a third or more. After several procedures, a complete response can be achieved: no tumor can be detected by imaging diagnostic methods anymore.
The therapy is repeated every 8 weeks. With each subsequent injection of the radiopharmaceutical, the results improve. Oncology treatment is continued as long as the response persists and the patient tolerates cancer care well.
Even the complete disappearance of tumors does not mean that metastatic prostate cancer is completely cured. Cancer may recur, but therapy still allows for long-term remission. In some patients, it may continue for many years. Cases are described when cancer did not recur after Lutetium treatment, which may well mean a cure for end-stage prostate cancer.
You are welcome to visit the Booking Health website if you want to undergo your Lutetium treatment at one of the foreign hospitals. On our website, you can select the most suitable hospital, find out prices, and compare the cost of services at different medical centers. The Booking Health specialists will advise you on all issues and help you organize your trip. The treatment with an appointment through our service will cost you less due to the absence of additional taxes for foreign patients.