Lutetium 177 PSMA Therapy in India

Lu PSMA Therapy

Lutetium Prostate-Specific Membrane Antigen (Lu-PSMA) therapy is a treatment for patients with advanced-stage prostate cancer or those who have become refractory to standard treatment approaches. The therapy is a high precision treatment that can help prevent damage to healthy surrounding tissue while delivering high dose radiation to the tumour cells.

The therapy aims to:

  • Stop multiplication of tumour cells or slow their growth.
  • Reduce tumour size.
  • Provide relief from symptoms such as pain caused by cancer and improve the quality of life of the patients.

How does it work?

  • Prostate-Specific Membrane Antigen (PSMA) is a unique receptor present on the surface of cells of the prostate gland. 
  • PSMA is overexpressed in prostate cancer cells and increases with tumour progression. 
  • If cancer spreads to the other parts (metastasizes), the PSMA receptor also appears on the sites where cancer has metastasized. 
  • Therefore, this receptor is an excellent target for nuclear imaging as well as treatment for prostate cancer.
  • The radionuclide therapy uses a molecule that can attach to the PSMA receptors present on the cancer cells in the body
  • Lutetium-177 is a radioactive element that emits low-energy beta radiations that can damage or kill the cancer cells when in close proximity. 
  • In Lu PSMA therapy, the radioactive substance is bound to a small protein molecule that can attach to the PSMA receptor on prostate cancer cells. 
  • This Lu-177 – PSMA complex targets the prostate cancer cell specifically and emits radiation to destroy these cells. 
  • As the penetration of the emitted beta radiation is low, it does not affect the healthy normal cells near the tumour.

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Who are the suitable candidates for Lu PSMA?

Currently, the therapy is being offered to patients with advanced castration-resistant prostate cancer that is metastatic and has evidence of cancer progression.

Tumour progression can be determined by:

  • High serum PSA levels
  • Increase in the tumour size or number of the metastatic lesions as seen by CT/MRI scan or Ga68 PSMA scans
  • Worsening of pain or other symptoms

Contraindications

  • High-grade renal insufficiency
  • Bone marrow depletion
  • Acute haematological problems

Lu PSMA therapy is not contraindicated to patients having subsequent chemotherapy or radiation therapy if needed.

Procedure

  • The patient is admitted to the hospital for 24 hours and has to stay in a Specialised High Dose Radioisotope Therapy Unit for radiation protection.
  • Lu177-PSMA compound is administered intravenously as an infusion.
  • MAG3/EC scan, a kidney function test, is done before Lu177 PSMA is administered.
  • Usually, patients are hydrated with intravenous fluids and an amino acid solution before and after Lu177 PSMA administration. This is to protect the renal functions.
  • Most patients need 3-4 treatment cycles with an interval of 8-12 weeks. 
  • The number of cycles, as well as interval duration, varies on the basis of the patient’s response to the treatment and medical assessment.
  • The average dose of the Lu 177 PMSA is in the range of 5.5 – 11GBq per treatment cycle. 
  • Required doses for every patient is determined on the basis of pre-treatment dosimetry (calculation of the ionising radiation dose absorbed by the human body).

Outlook 

  • Lu PSMA Therapy is a highly specific and precise therapeutic technique that has been showing great potential for the management of metastatic prostate cancer especially when other types of treatment methods fail to show improvement.
  • After Lu177 PSMA therapy, Over 70% of patients have experienced a reduction in Prostate-Specific Antigen (PSA) level and a reduction in tumour size. 
  • Almost all the patients had a reduction in pain and an overall improvement of health following the second dose of therapy.

Side effects

  • Lu PSMA is typically well tolerated by patients and does not have any significant adverse effects following the injection.
  • Some common side effects include a slightly dry mouth, tiredness and nausea. 
  • There may be a small drop in the number of white blood cells and platelets around 2 – 3 weeks after the Lu177 PSMA therapy. 
  • The side effects are usually mild and temporary. 
  • Patients recover soon without any treatment and the risk of serious or life-threatening complications is very low.

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Dr. Joya Dubey

Written By Dr. Joya Dubey

Dr. Joya Dubey, a proficient healthcare professional, serves as a dedicated member of the organization, committed to assisting patients worldwide with empathy. Armed with a medical degree, coupled with a master's in healthcare management, Dr. Dubey takes the lead in pioneering efforts to transform healthcare delivery, with a primary focus on enhancing patient welfare and organizational advancement.
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