THERANOSTICS in Prostate Cancer

177Lutetium-PSMA

Therapeutic radioactive doses for Prostate Cancer 

Peptide-Receptor Radionuclide therapy (PRRT)

General Concept

  1. Prostate cancer cells have receptors on their surface called prostate specific membrane antigen (PSMA).
  2. We perform diagnostic PET/CT study using 68Gallium-PSMA to detect tumors in the body and confirm presence of receptors on tumor cells.
  3. We then inject the therapeutic dose (177Lutetium-PSMA). 177Lutetium emits short ranged Beta rays of average length of 0.23mm leading to tumor cell damage and at the same time low risk to surrounding healthy cells.

THE FUTURE OF TARGETED RADIATION THERAPY

  • The therapy is indicated in patients with metastatic cancer prostate that failed to respond any more to hormonal and/or chemotherapy.
  • The treatment is composed of an intra-venous dose every 2 months, repeated according to response. (Usually with maximum of 4-6 doses)
  • It is performed as an outpatient procedure; the whole process takes about 4-5 hours.

Post procedure radiation safety:

  • Patients should be encouraged to drink large quantities of water in first 2 days (1 glass every 2 hours).
  • For the first 3 days:
    • Restricted contact with adults to a maximum of 6 hours per/day of close contact <1 meter.
    • Avoid contact with children and pregnant women (then restricted contact for further 3 days).
  • High PSMA receptor expression based on 68Ga-PSMA PET/CT exam.
  • Adequate bone marrow, renal and hepatic functions.
  • Exclude urinary outflow obstruction.

  • 68Ga-PSMA PET/CT exams before and after 177Lutetium-PSMA in 6 patients with metastatic prostate cancer who exhausted standard therapeutic options.
  • The patients showed PSA decline ≥ 98 percent. PSA values are written under each photo.

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