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Information About the Field of PSMA therapy
What is Lutetium 177 PSMA Therapy (Prostatis Treatment)?
One of the most frequent malignant cancers in men is prostate cancer and Lutetium 177 or PSMA therapy is the abbreviation for Prostate-Specific Membrane Antigen treatment. In the year 2012, 63.000 new prostatitis cases were diagnosed in Germany alone. PSMA may sound complicated at first glance but is actually quite simple: It is a surface feature of degenerated cells of the prostate that can produce the PSMA.
With help of PSMA therapy, physicians are able to detect the characteristic surface of cancer cells and to dock them to a radioactive molecule (for example the Lutetium-177-PSMA-617). On one hand, doctors can make cancer cells visible, and on the other, they are able to radiate and destroy them. Studies have shown this therapy is well handled by patients and over 50% of all treated patients showed positive results.
PSMA therapy is not a routine therapy for patients with prostate cancer. It is more likely a worst case scenrario therapy when all past treatments have failed. Allthough a cure of the prostate is not always fully achieved, this therapy reduces the growth of cancer cells and relieves patients' discomforts.
Who is Eligible for PSMA Therapy?
PSMA therapy is for prostate cancer patients who have had unsuccessful operations, chemotherapies and hormone therapies, and whose cancer cells keep growing steadily. It is for those patients who have no other alternatives.
The extent to which PSMA treatment makes sense depends on several tests, which mainly concern kidneys and bone marrow. Only fully functional kidneys and healthy bone marrow with stable haematopoiesis (blood formation) provide suitable preconditions. Affected patients should seek the advice of their urologist.
How Exactly Does PSMA Therapy Work?
Before starting therapy, it is important to perform some examinations. These include parotid scintigraphy and kidney scintigraphy. During a scintigraphy, short-lived radioactive molecules are delivered to a patient’s organ so PSMA tissue can be detected by means of imaging techniques. In particular, kidney scintigraphy is accomplished to assess drainage between the kidneys.
After taking a blood sample to determine the important laboratory parameters, the therapy itself is applied intravenously via a catheter. In addition, it is important to cool the parotid glands to prevent the radioactive substance from accumulating and possibly damaging tissue. Moreover, it is necessary for the patient to drink a lot. He also receives a kidney infusion to protect the kidney in the best possible way and to quickly excrete the excess radiopharmaceutical.
When all of these conditions are met, Lutetium-177-PSMA-617 is injected intravenously through a vein into the arm. The following days at the hospital are used to monitor the patient and the therapy’s success. For this purpose, further scintigraphies of different body regions are performed to see if and how effectively the medicine works.
The radioactive molecule is lutetium-177 and the carrier protein is PSMA-617. Since both substances are linked and the PSMA-617 is mainly expressed by cancer cells of the prostate, it is possible to perform this therapy very efficiently. Entering the cancer cells, the Lutetium-177 radiates up to two millimeters into the surrounding tissue, whereas healthy parts of the prostate mostly remain undamaged. It does not matter how big or small the cancer cells are, the PSMA-617 acts as a navigator and directs the radioactive drug directly to its destination, the cancer cells.
If the patient's radioactive radiation level has fallen below the legal maximum value, he can leave the clinic. Normally, a new and final scintigram will be made after about 8 to 10 days. The therapy usually consists of three cycles, but may vary from patient to patient.
Are there Side Effects or Complications?
As with any radionuclide therapy, side effects and complications may occur during PSMA therapy. Generally, however, the treatment is very well tolerated. Occasionally, nausea may occur, although this can be treated with conventional medications. In addition, taste disorders and dry mouth (xerostomia) can occur due to the radioactive activity in the salivary glands. Since the radiopharmaceutical is excreted through the urine and intestines, the patient should drink and eat a lot to keep the activity of these organs high.
The Lutetium-177-PSMA-617 is also metabolized in the salivary glands. Here it can be so severely damaged that the typical form of xerostomia (dry mouth) occurs. To minimize this complication, the salivary glands (especially the parotid glands, the biggest salivary glands) are cooled down prior to treatment to reduce activity and thus protect them. Discrete changes in the blood chemistry can also appear, requiring regular blood check ups.
What Happens After Therapy?
Usually, patients can leave the hospital within two days after completion of therapy and follow-up examinations, provided they have fulfilled the radiation protection requirements. At least one week after treatment, a final scintigraphy is performed, with blood counts created every two weeks, and PSA levels monitored approximately four to eight weeks after the end of therapy.
Since patients still suffer from radioactivity even after leaving the clinic, they should take hygienic precautions and radiation protection very seriously. This initially includes reducing direct contact to other people or groups and to avoid travel as much as possible. When leaving the hospital, the patient will normally receive an information sheet containing important behavioral recommendations.
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