Your nearest centre is Windsor. At GenesisCare, we provide specialist cancer care to thousands of people worldwide, with 14 treatment centres in the UK. We offer the most cutting-edge cancer treatments including advanced radiotherapy and Theranostics — a highly personalised approach to cancer medicine combining diagnostic imaging with therapy Lutetium PSMA therapy.
This innovative therapy is available in a state-of-the-art Theranostics suite at our centre in Windsor. When required, we will help our patients with transport depending on treatment and locations.
Please enquire for more details. The tracer is a combination of a special carrier molecule and a radioactive substance called 68 Gallium. The carrier molecule is attracted to a substance called prostate specific membrane antigen PSMA. PSMA is a type of protein found in high concentrations on the surface of prostate cancer cells, including those that have spread to other parts of your body.
This means the carrier molecule takes the 68 Gallium directly to cancerous prostate cancer cells — even in the smallest tumours. This time, another radioactive substance that can destroy cancer cells, called Lutetium, is attached to a carrier molecule that is attracted to PSMA. This sends a localised radiation dose to destroy the tumour avoiding damage to healthy tissues in your body.
Your treatment will be personalised according to your response and symptoms.
Study of 177Lu-PSMA-617 In Metastatic Castrate-Resistant Prostate Cancer (VISION)
Your consultant will advise how often you should have them. You may also have reduced production of blood cells for a while. This is because bone marrow — which produces blood cells — can also take up some of the Lutetium.
Your doctor will discuss this with you before your treatment begins. The Theranostics team will be available during and after treatment should you have any questions and will continue to follow up on your health and wellbeing by phone or email. The scan will show whether the special carrier molecule selectively targets the prostate cancer cells and not healthy cells. Your consultant will discuss your prostate cancer, treatments to date and overall health with you in detail before advising if this is right for you.
We offer many state-of-the-art treatments for prostate cancer, including chemotherapy and advanced radiotherapy.LuPRLT gave mild and transitory adverse effects. Sinceincreasing attention has been given for prostate specific membrane antigen PSMA as a tool for diagnosis and treatment.
The present study reports a longer follow-up of the 20 patients and expanded the number of patients to a total of 45 patients with predominant LNM with or without one or two bone metastases. One German patient had been treated with cabazitaxel whereas none of the Australian patients had been given abiraterone.
Two relapsing patients were given ADT, two enzalutamide, and one chemotherapy. At end of follow-up, two other relapsing patients were followed with active surveillance before they later might be reconsidered for salvage treatment. The p -values were based on t tests. Generally, LNM patients with or without one or two bone metastases had grossly similar clinical characteristics. None of the 45 patients had severe hematologic or non-hematologic adverse effects.
There were neither reported or observed severe adverse effects. Many Australian patients reported fatigue, and a few Australian patients reported nausea and vomiting. These findings supported the promising results indicated in two previous papers [ 45 ]. As to a previous case report [ 4 ], the present study incorporates an additional 44 patients with predominant LNM. Further, the evidence is weak for supporting third-line treatment with established drugs for patients with mCRPC who are resistant to two established drugs.
Previously, patients with PSA recurrence after the initial treatment of PC were routinely restaged only with chest roentgenograms and bone scans.
In addition, progressive use of lymph node dissection in connection with RP may also increase the proportion of patients diagnosed with presence of only LNM. Two previous studies indicated that patients with LNM may have progression of PC only in the lymphatic system [ 49 ].
The present study also found that the LNM patients progressed mainly in the lymphatic system. Early detection of relapse may lead to early start of salvage treatments that may benefit the patients. In the present study, 22 relapsing patients showed the same trend. The difference might reflect that the patients in the present study had a lower extent of the PC than the patients in the other studies.
The similarities in outcomes between the two groups of centers indicate that the findings in the present study appear to have consistency, reproducibility, and internal validity. The promising results of the present study might be validated in prospective randomized phase II trials. One option for such a prospective randomized phase II trial would be to evaluate the impact of three cycles of LuPRLT before salvage radiotherapy for patients with relapse after an initial RP.
The present study has strengths. The present study also had important limitations. It is a retrospective study of a small number of patients followed less than five years. Six centers participated in the study. The study is a retrospective multicenter single-arm open labelled cohort study. The present study selected patients with PC from prospectively recorded databases of consecutive patients treated with LuPRLT at the six centers.
The present study included the 20 patients with LNM who had been reported in two previous studies [ 45 ], now reported with longer follow-up. Before LuPRLT, all patients were fully informed with respect to the investigational nature of LuPRLT and were made aware of the regulatory status of the investigational drug and of possible and potentially unknown short-term and long-term adverse effects.
The patients had been informed that the routine treatment was established life-prolonging drugs. In accordance with the Declaration of Helsinkiall patients had given written informed consent to be treated with LuPRLT before the treatment was instituted.
Blood tests included total blood counts, liver and kidney function tests, and PSA measured and reported with 2 decimals. LuPSMA was injected intravenously over 5—15 minutes.
Follow-up after LuPRLT was carried out as follow-up visits at the six centers at 4—12 months intervals. OS was defined as the time to end of follow-up or to the death of any cause.Lutetium PSMA therapy aims to improve your symptoms and reduce the size of your tumours.
It can also slow their growth. It can help when other treatments have failed, are causing significant harm or side-effects. PSMA is a type of protein found on the surface of a cell.
If the prostate cancer has spread to other parts of the body metastasisedthe PSMA will also be there. This is a radioactive substance that damages and destroys the prostate cancer cells in a targeted way. The PSMA molecule transports the lutetium direct to the tumour site. As the PSMA travels to the tumour locations, it targets unhealthy cells.
As well as the prostate gland and cancer cells, PSMA is also found in the salivary glands, lacrimal glands, kidneys and small intestine. That means, in some cases, the PSMA molecule can also carry the damaging radiation to these healthy areas. However, damage to these areas is minimal. Like all cancer treatments, there can be side-effects.
These may include a dry mouth, tiredness, mild nausea, and loss of appetite. You may also produce fewer blood cells than normal for a while. Your doctor will explain the procedure to you carefully. Special clinical interest in Nuclear Medicine - Theranostics. Central Highlands Healthcare Ltd. Mater Private Clinic Suite 5. Pindara Specialist Suites Suite 4. Make an enquiry Refer a patient Search for:. Skip to content Toggle navigation Open search bar.Nuclear Medicine: A Potential Game Changer for Advanced Prostate Cancer
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What is lutetium PSMA therapy? How does lutetium PSMA therapy work? Further information Is this treatment safe?
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The prostate-specific membrane antigen PSMA is a transmembrane protein that is overexpressed in prostate cancer and tends to increase with disease aggressiveness Figure 1. There has been a significant increase in research related to PSMA in the last several years Figure 2. Before it is administered, the PSMA molecule is bound with Lutetium, which emits beta radiation, a destructive type of radiation that damages the cancer cells when it is near them Figure 3.
Over time, it destroys the prostate cancer cells. The PSMA molecule acts as a means of transporting the radiation to the tumor site so that the whole body does not get exposed to the radiation. Figure 3 — PSMA-targeted radiotherapeutic:. It has high PSMA binding affinity, prolonged tumor uptake, high tumor to background ratio and rapid kidney clearance. There have been multiple clinical trials at multiple sites in Germany. The biodistribution and clearance of this compound are in the renal, gastrointestinal, salivary and lacrimal glands, and very little normal marrow uptake Figure 4.
In this trial, men have been recruited, and the recruitment has been completed. The recruited patients all needed to have:. The intervention was 7. This was given every 6 weeks intravenously for a maximum of 6 cycles. The secondary objectives included:. Kuo moved on to discuss several of the ongoing phase 2 trials.
This trial had shown an incredible PSA response as seen in Figure 7. There are currently at least 8 other phase 1 or 2 clinical trials involving Lutetium-PSMA, of which five trials are open for recruitment.
Future relevant trials will provide us with more data regarding the role of these treatment combinations. In the near future, we will also see studies assessing treatment given with Iodine, which is a small molecule inhibitor of PSMA.
The patient population will be PSMA-avid mCRPC patients whose disease has progressed despite abiraterone, and who are planned for treatment with enzalutamide. Kuo concluded his talk mentioning the several open questions that hopefully will be answered in the near future, assessing the role of LutetiumPSMA and other radiopharmaceuticals. Specific important questions include defining the role of imaging prior to therapy, understanding whether dosimetry is necessary for safety or useful for optimization of dose, ascertaining the role of imaging in the post-therapy setting, and figuring the role of combination with other therapies.
There was no control group in either trial, so we can only guess at what overall survival would have been without the therapy. The ALSYMPCA trial was conducted before abiraterone and enzalutamide were approved, so it is impossible to know how prior treatment with one of those might have changed survival. So in heavily pre-treated patients, LuPSMA seems to improve survival about as well as Xofigo or Jevtana when used as a third-line therapy.
PSA is not always a good indicator of effectiveness, as has been found for Xofigo and sipuleucerl-T Provenge. That leaves about one-third of patients who derived no benefit even though they had PSMA-avid tumorsand waterfall plots showed that a few patients had large increases in PSA following PSMA-targeted therapy. It is worth noting that the PSMA protein contributes to the survival of the cancer, and just the PSMA ligand that attaches to it has some activity in delaying progression, even without a radioactive component similar to the way an anti-androgen attaches to the androgen receptor, delaying progression.
It has long been known that PSMA is a moving target. Radiologists determine avidity by comparing the uptake of the tracer in cells that express PSMA to the uptake of the tracer in cells known to not express PSMA. Early low-grade prostate cancer does not express PSMA at all.
Higher grade prostate cancer may express some PSMA. PSMA expression really starts to take off when the cancer metastasizes, although it is highly variable between patients. About 90 to 95 percent of metastatic men express at least some PSMA on their prostate cancer cells.
At some point, however, as genomic breakdown continues, PSMA is no longer expressed by metastases. Thus, there is an optimal point for treating each patient with PSMA-targeted therapy.
Treatment too early — or too late — may exert selective pressure on the predominant non-PSMA-types, allowing them to take over. Other opportunities for early use include LuPSMA treatment for those in the following settings:. Centers in Germany may be willing to treat patients per protocol i.Clinical trials are research studies that involve people. All trials on the list are supported by NCI. Clinical trials look at new ways to prevent, detect, or treat disease.
You may want to think about taking part in a clinical trial. Talk to your doctor for help in deciding if one is right for you. This phase Ib trial studies the dose and schedule of Lu-PSMA and pembrolizumab in treating patients with castration-resistant prostate cancer that has spread to other places in the body. Its radiation component destroys the tumor cell.
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Lutetium PSMA Therapy, also called Prostate-Specific Membrane Antigen Therapy, is becoming a popular treatment choice for men experiencing advanced prostate cancer with metastatic or treatment-resistant prostate tumours.
In many patients, the treatment has proven to be a successful way to reduce the size of the tumours.
Despite Early Trial Closure, 177LuPSMA-617 Demonstrates Safety and Improved PFS in mCRPC
Men who have undergone radical prostatectomy or primary radiotherapy but show symptoms of metastatic recurrence may find Lutetium PSMA Therapy a viable treatment option. The therapy has proved effective at reducing the size of tumours while also stopping them from multiplying. The therapy is not yet part of routine clinical care; yet in many patients, the therapy has been able to achieve long-term remission.
Prostate cancer is the most common form of cancer in men over the age of Currently, researchers are unable to determine exactly what causes prostate cancer. DNA changes that are inherited or caused by certain lifestyle choices are believed to play a role in why some individuals develop cancer and others do not.
It is believed that inherited genes account for about 5 to 10 percent of prostate cancers. Exposure to radiation, chronic inflammation, exposure to cancer-causing chemicals, high levels of androgens, or insulin-like growth factor-1 IGF-1 are also all believed to cause gene changes which lead to cancer. When caught early, prostate cancer treatments are usually highly successful. However, once metastasis has developed the disease prognosis changes dramatically. Advanced prostate cancer may cause:.
The Sheba Medical Center is one of the few medical centers in the world to offer such a progressive cancer treatment option to patients with advanced and metastatic prostate cancer. Most types of prostate cancers express high levels of PSMA.
Rarely, about 5 to 10 percent of prostate cancers do not create PSMA. PSMA is a type of protein expressed on the membrane of prostate cells, that is believed to have numerous cellular functions. Although the epithelium of the prostate naturally creates very low levels of PSMA, cancerous prostate tumors prostate extremely high levels often 1, times higher than a normal prostate cell.
If prostate cancer has metastasized to other areas of the body the PSMA will be detectable in those areas. Lutetium is a radiation-based treatment that utilizes a molecule to attach itself to the PSMA receptors located on the cancer cells.
Lutetium emits beta radiation that effectively damages cancer cells and, over time, destroys them. The radiation used in the Lutetium is designed to only destroy the cancer cells. With theranostic, treatment becomes more personalized so that cancer and its metastasis are effectively pinpointed but the whole body is never exposed to the radiation.
Only the cancer cells are irradiated and destroyed. Blood tests will be performed to makes sure that the radiation is not damaging healthy tissues.
Imaging tests are also performed to ensure that the radioactive material at the tumor sites has been correctly absorbed. Lutetium therapy is only used on men who suffer from cancer that has originated in the prostate and who have exhausted other previous lines of treatment.
It has proven itself to be an effective therapy for managing metastatic prostate cancer or cancer of the prostate after other types of treatment have failed. At Sheba, she is the leading physician-investigator.