Lu-177 PSMA Therapy in Metastatic Prostate Cancer
Prof. Marcus Hacker
Specialist in nuclear medicine
Prof. Dr. Werner Landsteger
Specialist in nuclear medicine
What does theranostics mean?
Theranostics in nuclear medicine means diagnosing a disease with a diagnostic radiopharmaceutical (= radioactive drug) using imaging methods and treating the disease with a therapeutic radiopharmaceutical. This enables very targeted treatment of specific tumors.
Nuclear medicine treatments of tumors, i.e. treatment with a radiopharmaceutical, have been applied for a long time in the field of thyroid diseases. The principle of theranostics is now also used for the diagnosis and treatment of metastasizing prostate carcinoma. Prof. Dr. Marcus Hacker and Prof. Dr. Werner Langsteger are proven specialists and have been using this method at the Vienna University Hospital (“AKH”) for 9 years.
Late stage Lu-177 PSMA therapy
Prostate carcinoma is the second most common malignant tumor in men worldwide, accounting for 25% of all carcinomas in Austria. PSMA therapy is currently used in advanced stages of prostate CA where chemotherapy or hormone therapy has not been able to stop the progression of the disease. The prerequisite for the therapy is a strong expression of the PSMA antigen on the surface of the cancer cell, as this antigen serves as the target. The PSMA uptake and the indication to implement the therapy is determined through a PET-CT scan using the diagnostic radiopharmaceutical Gallium-68 - a very short-lived radioactive substance that is injected through the vein.
Before the examinations, patients receive a questionnaire to be filled in. On the basis of this information, the specialists identify whether the patient is eligible for Lu-177 therapy. A video consultation to clarify the details is possible and recommended before the patient arrives at the hospital. PET-CT diagnostics using Ga-68 is then carried out. This examination can be done at the Vienna University Hospital or in the patient’s home country if the examination is available in good quality there. Based on the results of 68GA PSMA PET scans and other findings (check of kidney function, laboratory checks, etc.), the interdisciplinary tumor board decides whether the patient is suitable for therapy.
How does the PSMA therapy work?
The therapeutic radiopharmaceutical Lutetium-177, which is also administered into the vein, is used for therapy. It allows very precisely targeted radiation with a high radiation dose, i.e. drugs can penetrate directly into the tumor cell. Healthy cells surrounding the tumor cell are not damaged. Clinical studies have shown that the growth of tumors can be slowed down or greatly reduced. By reducing pain, a striking improvement in quality of life and life extension can be achieved.
Due to the radioactivity, rules of conduct must be observed for a few days immediately after the therapy (e.g. patients have to keep away from small children or pregnant women). As a rule 4-6 treatment cycles are required, usually at intervals of about 4-6 weeks. After the 3rd cycle, a follow-up examination is carried out and the treatment course is evaluated.
Side effects and complications
In general, the therapy is very well tolerated. Serious or acute complications are not to be expected. Fatigue and malaise may occur immediately after therapy, other side effects are rare. In any case, comprehensive individual information and advice is provided by the specialists of the Center.
Outpatient therapy at the Döbling Private Hospital
The Döbling Private Hospital has an institute for nuclear medicine and isotope diagnostics with the necessary radiation safety requirements that are required for this innovative treatment method. With their many years of experience, Prof. Hacker and Prof. Langsteger are among the leading national and international centers in the field of theranostics. Their philosophy is to offer personalized medicine that puts the patient's needs first, with competent, disciplinary care.
The great advantage of the center at the Döbling Private Hospital is the possibility to offer this therapy to private patients by renowned specialists on an outpatient basis - i.e. without the necessity of a hospital stay of several days for each therapy cycle - but in the safe setting of the largest private hospital in Austria.
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