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Information about the field of PSMA therapy

What is the PSMA therapy?

One of the most frequent malignant cancers of man is the cancer of the prostate. In the ...

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Information about the field of PSMA therapy

What is the PSMA therapy?

One of the most frequent malignant cancers of man is the cancer of the prostate. In the year 2012 63.000 new cases of prostate cancer were diagnosed just in Germany. PSMA stands for the prostate-specific membrane antigen. What may sound very complicated at first sight is actually easy to understand: It is a surface marker of degenerated cells of the prostate that can produce the PSMA. With the help of this therapy it is able to detect those cancer cells and radiate them with a radioactive molecule (for example the Lutetium-177-PSMA-617). On the one hand you can make the cancer cells visible this way and on the other hand you are able to radiate and kill these cells. Studies could show that this therapy was handled very good by patients and over 50% of all treated patients showed positive results.

The PSMA therapy is not a routine therapy for patients with prostate cancer. It is more likely a worst case scenrario therapy when all past therapies did not help killing the cancer cells. Not always is a full healing of the prostate achieved but this therapy may stop growth of the cancer cells and ease the patient’s complaints.

Who is eligible for the PSMA therapy?

The PSMA therapy is for patients who have prostate cancer that couldn’t be killed by operations, chemotherapies and hormone-therapies, and whose cancer cells grow steadily.

If there are no alternatives anymore one can consider carrying out the PSMA therapy.

In what way the PSMA therapy makes sense depends on several tests primarily concerning the kidneys and bone marrow: Only fully functional kidneys and a healthy bone marrow with a stable haematopoiesis (blood formation) give appropriate preconditions for a PSMA therapy.

How does the PSMA therapy proceed?

Before starting the therapy it is important to make some examinations: A parotid scintigraphy and a kidney scintigraphy belong to those examinations for example. During a scintigraphy the patient is given short-living radioactive molecules which then make the organs visible. Especially the kidney scintigraphy is to review the drainage between the kidneys.

After taking a blood sample to determine the important laboratory parameters the therapy itself is applied intravenously through a catheter. Furthermore, it is important to cool the parotid glands to prevent the radioactive substance from enriching itself in this tissue and possibly damaging it. Patients treated with the PSMA therapy are to drink a lot, therefore they also get a kidney-infusion to make the kidneys excrete all the excessed radioactive substance.

When all these preconditions are fulfilled the Lutetium-177-PSMA-617 is applied intravenously through a vein on one’s arm. The following days in hospital are to monitor the patient’s condition and to review the success of the therapy. Therefore more scintigraphies of other body regions are made to see if and how well the medicine has worked so far.

The radioactive molecule is the Lutetium-177 and the carrier protein is the PSMA-617. Because both substances are connected to each other and because the PSMA-617 is mostly expressed only from cancer cells of the prostate it is able to make this therapy work very efficient and purposeful. Approaching the cancer cells the Lutetium-177 radiates up to two millimeters into the surrounding tissues whereas healthy parts of the prostate mostly remain undamaged. It does not matter how big or small the cancer cells are, the clue is that the PSMA-617 as a surface marker functions as a navigation and leads the radioactive molecule directly to the cancer cells.

When the patient’s radiation has undercut the legal maximum value he can leave hospital. More scintigraphies are usually made approximately eight to ten days after fulfilling the therapy. The therapy itself is split into three cycles but the amount of cycles can vary from patient to patient.

Are there any negative side effects or complications?

Just like any radionuclide-therapy there may also be side effects and complications during or after a PSMA therapy but the therapy is handled very well by patients in general. Sometimes nausea appears but can be treated very well by conventional medicine. Moreover patients may face problems in the sense of their taste temporarily, and even Xerostomia (dry mouth) can appear due to radioactive activity in the salivary glands. Because the radioactive substance is eliminated through urine and bowels the patient is to drink and eat very well to hold the activity of these organs high.

The Lutetium-177-PSMA-617 is also metabolized in the salivary glands and can damage them that much that the typical form of Xerostomia (dry mouth) appears. To minimize this complication the salivary glands (especially the parotid glands as the biggest salivary glands) are cooled down before and during the whole therapy to keep their activity low. Discrete changes in the blood chemistry can also appear so that regular blood counts get necessary.

What happens after the therapy?

Patients can leave hospital usually two days after the therapy’s end and corroboratative investigations if their radiation undercuts the legal maximum values. Approximately one week after the therapy another closing scintigram is made just for check-up, and every two weeks blood counts are made. Four to eight weeks after therapy the PSA-Values are also checked.

Since the patient still radiates even after leaving hospital he should take hygienic precautions and radiation protection seriously. This means direct contact to other persons or group of persons should be avoided instantly or cut off to only two hours a day. Journeys should also be avoided. After leaving hospital the patient normally gets an explanatory leaflet on recommendations of behaviour.

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