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Lutetium-177 PSMA (Prostate specific membrane antigen) treatment is a form of radionuclide therapy that aims to destroy prostate cancer cells that have spread into parts of the body, including lymph nodes and bones.
The destruction of the prostate cancer cells may prolong life expectancy and also potentially alleviate any symptoms such as bone pain frequently associated with deposits of cancer in the skeleton.
Lutetium-177 is a radionuclide substance that emits damaging radiation which will destroy nearby cells. It is combined with PSMA protein that seeks out PSMA receptors which are found on majority of prostate cancer cell surface.
Once Lutetium-177 PSMA is infused into a patient’s bloodstream, it will target and bind to PSMA receptors on prostate cancer cells.
Damaging radiation from the Lutetium-177 will, over time, result in death of the prostate cancer cells.
Currently, Lutetium-177 PSMA is used in patients with metastatic prostate cancer who have failed other forms of treatment such as hormone therapy or chemotherapy.
Before commencing treatment, patients will need to undergo a PSMA PET-CT scan to confirm PSMA receptors on the cancer cells, which will be targeted by Lutetium-177 PSMA.
Currently, Lutetium-177 PSMA is used in patients with metastatic prostate cancer who have failed other forms of treatment such as hormone therapy or chemotherapy. Before commencing treatment, patients will need to undergo a PSMA PET-CT scan to confirm PSMA receptors on the cancer cells, which will be targeted by Lutetium-177 PSMA.
Approximately 60-70% of patients who have the treatment will experience a positive response (e.g. alleviation of symptoms) and in some patients, it may produce a relatively long-term remission of disease. Life expectancy could also be extended. Large-scale trials are ongoing in Australia and the USA to determine the precise extent of benefit of this treatment.
Administration of Lutetium-177 PSMA is by injection into the bloodstream every 6-8 weeks. On the day of treatment, an intravenous line is placed and the Lutetium-177 PSMA is infused over 30 minutes.
Anti-emetics and a diuretic (to encourage urinary clearance) are also administered simultaneously.
A SPECT scan is performed after 24-72 hours to ensure disease sites have been adequately targeted.
Most patients require about 4 cycles of treatment. After two cycles, a repeat PSMA PET-CT is performed to evaluate for treatment response. If there has been a positive response with decreased PSA levels and on repeat PSMA scan, then another two cycles will be administered to complete the full treatment course of 4 cycles.
The most common side effect is dry mouth and dry eyes. Occasionally, some patients may experience nausea or vomiting. Mild lethargy is also a side effect. Most of these side effects are transient and usually resolve after a few days. In patients with very extensive bone disease, marrow suppression is also a potential side effect due to "collateral damage" from the radiation on adjacent bone marrow.
To access Lutetium-177 PSMA treatment, patients will need to be referred by their treating oncologists. Scanned referral letters can be emailed to firstname.lastname@example.org or call us on (09) 632-5862