About the therapy with Lutetium-177-PSMA in prostate cancer spoke prof. Hoffmann from WPK

1. Prof. Hoffman, can you tell us about the latest methods for treatment of metastatic prostate cancer?

In cases where standard treatments do not provide the desired results, a new, innovative therapy with Lutetium-177-PSMA is now being used in patients with metastatic prostate cancer. Its goal is to extend life expectancy and is designed for patients who have already undergone chemotherapy with the drug docetaxel and hormone therapy.

2. What is the exact effect of this type of therapy on patients?

This type of therapy (Lutetium-177-PSMA) associates with specific receptors in cancer cells and produces a local radiotherapeutic effect by emitting β particles. To date, studies have confirmed its outstanding effectiveness. However, therapy with Lutetium-177-PSMA is not yet officially recognised. Its application to patients occurs after standard treatment methods have been exhausted. I am referring to chemotherapy, radiotherapy, surgery and hormonal therapy. 

3. What are the necessary tests before undergoing this type of therapy?

Prior to initiating therapy, the patient should undergo prostate-specific membrane antigen PSMA , as well as computed tomography. In this way, information can be obtained as to whether the affected organs, such as lymph nodes, bone system, etc., are able to withstand the amount of Lutetium-177-PSMA therapy ingested. Also, it is necessary to assess the blood cell count and kidney function. Occasionally, scintigraphy of the kidneys and salivary glands is also necessary in the patient. 

4. What is the process for developing a treatment plan for Lutetium-177-PSMA therapy?

At our hospital, the first step is discussing the patient's case with the WPK Academy Cancer Center board, as well as the specialists on the multidisciplinary team. If, after discussion, therapy with Lutetium-177-PSMA is recommended, specific blood and imaging tests are performed on the patient. The radioactive isotope, Lutetium-177-PSMA, is ordered for each patient individually, as it cannot be stored for long periods of time in the clinic like conventional medications.

5. Can patients with different types of cancer undergo this treatment?

Lutetium-177 therapy represents the radioactive portion of the Lutetium-177-PSMA combination. It is currently only prescribed to patients with advanced prostate cancer. It is important to note that Lutetium-177 as a radioactive isotope also has applications outside of prostate cancer therapy. For example, the use of Lutetium-177-labeled somatostatin receptor agonists is a long-standing practice. It has been used for neuroendocrine tumor therapy since before prostate-specific membrane antigen treatments were introduced. 

6. This type of therapy is not widespread. What are the other methods used to treat prostate cancer in WPK?

It is important to understand that Lutetium-177-PSMA therapy cannot be prescribed as a treatment for every patient with prostate cancer. We take an individualized approach and carefully analyze each patient's medical history. This way we can prescribe the right treatment depending on the case. Before deciding whether this therapy is appropriate, we perform a computed tomography scan (PET-CT), positron emission tomography and a PSMA (prostate-specific membrane antigen) diagnosis. After performing therapy with Lutetium-177-PSMA, we perform a whole-body scan with a gamma camera. It gives us information about the absorption of Lutetium-177-PSMA in different parts of the body, after different stages of therapy. 

7. What are the contraindications and potential side effects of the treatment?

Treatment with this type of therapy is accompanied by some contraindications, including renal failure, low erythrocyte and platelet counts, and a life expectancy of less than 3 months. As for side effects, they include temporary impairment of salivary gland function, local discomfort, loss of taste, and a dry mouth sensation. In addition, the treatment may negatively affect kidney function, while platelet and leukocyte counts may decrease significantly. It is therefore extremely important to monitor these parameters carefully.