The cells that make up prostate tissue have a specific enzyme that is located directly on its surface. It is called the “prostate-specific membrane antigen” (PSMA). When oncology develops in the prostate, the atypical cells begin to secrete this enzyme. In this case, PSMA can be a special “target” for conducting targeted therapy. Using Ga-68-PSMA-PET / CT, a doctor can determine whether in your case there is an increased expression of this enzyme.
The mechanism of Lutetium-177 action
By analogy with this diagnostics, specific therapy can be carried out using PSMA ligands, which are labeled with a special radionuclide, i.e. Lutetium-177. Due binding of the PSMA ligands to tumor cells, they are irradiated. This leads to the death of pathological cells and the shrinking of tumors and metastases.
The therapeutic effect does not depend on the intensity of the accumulation of the introduced radionuclide. The PSMA ligand labeled with Lutetium is administered once intravenously on the day of hospitalization.
At first, as a rule, 2 treatment cycles are carried out with an interval of 8 weeks. Each cycle lasts for 4 days. After talking with the doctor during the admission, you will have an intravenous catheter and a blood sample will be taken to determine the necessary parameters. After receiving all the results and excluding possible contraindications, you will receive preparation of the Lutetium-177-PSMA ligand intravenously. This procedure lasts for approximately 20 minutes. During the entire period of hospital stay, it is forbidden to leave the department, as well as receive visitors.
After each treatment cycle, patients undergo an outpatient follow-up examination. After completion of 2 cycles of therapy, the so-called “re-determination of the stage of the disease” is carried out, including PET / CT and dynamic renal scintigraphy. Depending on the results, additional therapeutic cycles may be required. Those patients who want to undergo this type of therapy in Germany and learn more in detail may follow the link Lutetium cost.
In what cases is the treatment contraindicated?
The PSMA enzyme is also present on the surface of kidney cells, and therefore the PSMA ligand marked with Lutetium-177 also accumulates in them. For this reason, determining the radiation dose in the kidneys during this therapy, as well as assessing the possible risk of their damage, are important tasks.
Therapy cannot be carried out in the following cases:
- Severe restriction of kidney, liver, or bone marrow function.
- Recent chemotherapy (less than 4 weeks).
- Recent administration of bone-specific radionuclides (less than 8 weeks).
- Presence of metastases in the brain (in the case of compression syndrome).
- Compression of the spinal cord.
- Presence of other cancers.
- Presence of an uncontrolled concomitant disease (for example, diabetes mellitus, infections).
Does it have any side effects?
Possible side effects of therapy include the following:
- In isolated cases, after administration of PSMA ligands, acute nausea and vomiting may develop.
- A decrease in the number of red blood cells, blood platelets, and white blood cells with the resulting increased risk of bleeding and infections. Very rarely, as a result of repeated courses of therapy, suppression of bone marrow function with the need for blood transfusion can develop. For this reason, after completing the course of treatment, it is necessary to monitor the complete blood count.
- Deterioration of kidney function. In rare cases, as a result of repeated courses of therapy, renal failure with the need for extracorporeal blood purification (dialysis) may develop. In this regard, after a course of treatment, renal function should also be monitored by appropriate blood tests and scintigraphy.
- In rare cases, a temporary violation of taste may develop. After several treatment cycles, there may be a persistent suppression of salivation with concomitant dry mouth. This may cause an increased incidence of caries or periodontal pathologies. In addition, severe dryness of the oral mucosa can significantly affect the patient’s speech. To prevent these side effects, the patient receives special cooling packets for the salivary glands before treatment. This slows down the blood flow in the glands and, therefore, reduces uptake of the radionuclide drug.
- In the presence of metastasis in the liver, the outflow of bile may be hampered due to treatment-induced swelling. This condition may require endoscopic placement of the stent in the bile ducts.
- Allergic reactions are extremely rare.
If you or your relatives need treatment in Germany, Booking Health can help with the selection of treatment or diagnostic programs. Website https://bookinghealth.com/ has been helping patients from all over the world for many years. Attentive staff will assist both in medical issues, organizational matters, and, if necessary, moral support.