What is Lu PSMA (Lutetium-Prostate Specific Membrane Antigen) Therapy?

Lu177 PSMA Therapy is a treatment for patients with prostate cancer, especially those who have become refractory to conventional therapy. Lutetium PSMA therapy helps to slow down the growth of the cancer cells, reduce the size of the tumours and most importantly improve the quality of life of the patients by reducing the pain caused by the cancer.

Many prostate cancers, in particular those that have spread or become resistant to hormonal therapies, express a unique receptor on their cell surface called Prostate Specific Membrane Antigen (PSMA). When Prostate Cancer metastasizes i.e. spreads to other parts of the body, the PSMA receptor is expressed over the sites of metastases as well.

How does Lu PSMA Therapy Work?

Lutetium-177 is a radioactive substance that emits beta radiation, a destructive kind of radiation. Lutetium-177 is bound to a small peptide which attaches to the PSMA receptor expressed on the cancer cell surface. The Lutetium 177 – PSMA complex, thus attached to the prostate cancer cell, then emits killing radiation causing cell death of the cancer cell. Since the penetration of the emitted beta particle is very small, the surrounding normal cells are spared.

How is the Therapy Done?

Lu177 PSMA is administered intravenously. The patient is admitted to the hospital for 24 hours. A kidney function scan called a MAG3/EC scan is done prior to the administration of the Lu177 PSMA.

What are the Side Effects of Lu PSMA Therapy?

Lu177 PSMA is well tolerated. The most common side effects are a slightly dry mouth, fatigue and nausea. There may also be a slight fall in the white blood cells and platelets about 2 – 3 weeks after the Lu177 PSMA administration.

What is the Response Rate With Lu PSMA Therapy?

The response rates of Lu177 PSMA depend on the tumour biology of prostate cancer, the initial Gleason Score, the extent of disease and the responses to prior therapies. Typically, more than 70% of patients demonstrate a reduction in S. PSA and a shrinkage of tumours following Lu177 PSMA therapy.

When would the doctor consider using this Therapy?

Lu PSMA Therapy is a very specific therapy and is used for managing metastatic Prostate Cancer or when Prostate Cancer is no longer responsive to other types of treatment.

What are the Treatment Schedules with Lu PSMA Therapy?

Most patients undergo three-four treatment cycles at intervals of 8-12 weeks. The number of cycles and the interim duration may vary between individuals depending on the response and interim assessments.

Why should I choose the nuclear medicine therapy center at Fortis Memorial & Research Institute (FMRI), Gurugram (Haryana, India)?

The Nuclear Medicine Therapy Centre at FMRI was one of the first institutes to offer Radio-ligand Therapy with Lu PSMA, and today, the center receives patients from the country and from across the world.

Is PRRT Safe for you?

Summary (10 sec read)

PRRT (Peptide Receptor Radionuclide Therapy) is a targeted cancer treatment primarily for Neuroendocrine Tumors (NETs), involving four cycles of Lu177 DOTATATE administered approximately eight weeks apart. At Fortis Memorial Research Institute, Gurgaon, the procedure is often outpatient but may require brief hospitalization. The treatment begins with a patient consultation, medical review, and pre-treatment with anti-nausea medication and an amino acid solution to protect the kidneys. The entire process takes about 7-8 hours, concluding with a dosimetry molecular imaging scan to track the radio-peptide's distribution.

PRRT offers personalized treatment by tuning radio peptides (Lu177 or Y90) to tumor characteristics, delivering high doses of radiation directly to tumor cells while sparing healthy cells. It is effective for inoperable, metastatic, or progressive NETs, improving symptoms, halting tumor growth, and enhancing progression-free survival.

While generally well-tolerated, PRRT can have side effects such as nausea, vomiting, and long-term risks like blood count suppression, permanent renal toxicity, and Myelo Dysplastic Syndrome (MDS). Post-therapy guidelines emphasize maintaining good bathroom hygiene and following radiation safety protocols provided by Nuclear Medicine Physicians.

My last article (Which patients can benefit with PPRT?) summed up the fundamentals of Nuclear Medicine PRRT and which patients may benefit from this therapy. Today, I shall be giving you a low down on PRRT again, and we shall cover some details such as

How is PRRT performed?
What are the advantages of PRRT?
Is PRRT safe?
Post therapy guidelines?

How PRRT Performed?

The most common procedure followed during the PRRT process (as per US FDA and European Medicine Agency Approval) includes a series of 4 cycles of PRRT Treatments with Lu177 DOTATATE approximately 8 weeks apart. The treatment at our Nuclear Medicine Department at Fortis Memorial Research Institute, Gurgaon India can be done on an outpatient basis or may require hospitalisation of a few days. The Nuclear Medicine Physicians at our centre led by Dr. Ishita B Sen and Dr. Vineet Pant decide if a particular patient requires hospitalization or can be discharged the same day from the hospital.

The procedure begins with a discussion with the Patient and the caregiver and proceeds with the patient's scan or review of the medical history and medical reports. The patient is then given appropriate anti-nausea pre-medicines followed by Amino acid solution. The amino acid solution is given intravenously to protect the Patient’s Kidneys from the effects of the treatment. The treatment in total last about 7-8 hours. The patient is then injected with the treatment followed by Amino Acid Solutions again.

Post the treatment a Dosimetry Molecular Imaging Scan is done to note where the injected radio-peptide has travelled in the patient’s body.

PRRT treatment advantages?

PRRT Treatment offers personalized cancer treatment, the radio peptides used (Lu 177 or Y 90) can be tuned to the tumour characteristics and the molecular property of the tumour cells.

PRRT is a selective therapy because the radio peptide cells bind themselves with the tumour cells directly and deliver a high dosage of radiation to kill tumour cells (Targeted Therapy). This also prevents damage to healthy cells in the body by limiting their exposure to radiation. PPRT has been found to be effective in inoperable or metastatic and progressive Neuroendocrine Tumours (NETs)

PRRT is well tolerated and is known to help relieve symptoms, arrest tumour growth, shrink tumour lesions, trials with PRRT have noted improved progression-free survival for the patients.

Is PRRT safe?

PRRT is generally well tolerated but like all other therapies it has its side effects and risks. Nuclear Physicians at our centre will take you through the details of the risks and side effects before the patient opts for this therapy

Side Effects of PRRT may include Nausea, vomiting, long term side effects include suppression of blood counts, permanent renal toxicity, Myelo Dysplastic Syndrome (MDS)

Post therapy guidelines?

Maintain good bathroom hygiene. Follow radiation safety protocols provided by highly skilled Nuclear Medicine Physicians at our centre.

If you find this article informative please leave a word in the comment section below. For more information do visit Nuclear Medicine Therapy in India or call us at +91 98111 27080 or write to us at info@nuclearmedicinetherapy.in.