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.

Medical Travel to India’s Fortis Memorial Research Institute

Summary (10 sec read)

A prostate cancer patient from the USA recounts his journey to Fortis Memorial Research Institute (FMRI) in Gurugram, India, for Lu177 PSMA Therapy. He selected FMRI for its advanced treatments and lower costs. The process involved securing a triple-entry visa with an invitation letter from FMRI, filling out Air Suvidha self-declaration forms, and preparing necessary documents like money orders for the Indian government. He advised arriving a few days before treatment to manage jetlag and suggested packing light for convenience.

Upon landing at New Delhi International Airport, the hospital’s concierge service facilitated immigration and customs procedures. The patient stressed the importance of organizing all required documents, including the passport, visa, Covid-19 test results, and boarding pass. He stayed at the Westin in Gurugram, enjoying the hotel's amenities and services. On the day of treatment, the hotel arranged transportation to FMRI, where he underwent therapy and stayed for 24 hours.

He praised the helpfulness and professionalism of both the hospital and hotel staff, advising future patients to inform their credit card companies of their travel plans to prevent transaction issues. The experience was positive, with exceptional care provided by FMRI. The patient recommended contacting hospital liaison Manav Sadhwani for assistance, ensuring a smooth and supportive medical journey.

I am a Prostate Cancer patient from the USA (name withheld on request) and I decided to come to India to undergo Lu177 PSMA Therapy at the Department of Nuclear Medicine & Molecular Imaging at the Fortis Memorial Research Institute based in Guruguram, Haryana, India. Gurugram is a city that borders India’s capital New Delhi and is just a few kilometers away from the New Delhi International Airport.

I am writing this blog to guide patients who would want to come to India for medical treatment. This is a step-by-step logistics guide and is entirely based on my experience and what steps I went through before landing in New Delhi, India for my treatment.

1. Decision

The decision to travel to India for treatment.

2. Passport & Visa Formalities

For my Lu177 PSMA Therapy for Prostate Cancer, I had to take a triple entry visa from the Indian Embassy as my treatment required three treatment cycles at intervals of 8-12 weeks.

To apply for the visa, one needs an invitation letter or a medical letter of necessity from the hospital. After receiving the invitation letter, you can visit the Indian embassy in person or Fedex the documents to them. This process usually takes about one to two weeks

3. Airport Formalities

Next, search for “Air Suvidha” on Google, and click on the following link - https://www.newdelhiairport.in/airsuvidha/apho-registration - to register yourself. Air Suvidha is a self-declaration form that has to be mandatorily filled by all international arriving passengers to India. There are two types of documents that need to be filled here – a Self-Reporting Form and an Exemption Form. These are important as you would need them to depart on your flight and clear customs at New Delhi International Airport.

While the forms are simple and self-explanatory; for the exemption form, you would need to upload a scanned copy of your passport and the invitation letter from the hospital that describes the medical necessity. Make sure you print these document and keep it handy for later use.

Another step here is to also keep $100 & $10 money orders ready. These money orders need to be made out to the Indian Government.

4. Set a date for the treatment & book tickets

A piece of advice here, set the date of the treatment at least a couple of days after you arrive in India so that you can sleep-off the jetlag. I left on a Friday and arrived on Saturday for my treatment procedure that was scheduled for Monday.

I deliberately chose a Friday for travel for the most obvious jetlag reason and secondly I wanted to have some extra time on my hand in case there were any travel issues, such as flight delays or cancellations.

Another piece of advice, pack light and carry as cabin baggage for an easy transition through New Delhi airport.

5. Hotel Booking

Reserve a hotel room for five nights with an option for late check-out. I stayed at the Westin in Gurugram and I paid around $80 a night. You could spend some extra to splurge on a suite.

6. Arriving/ Landing in New Delhi

When you land in New Delhi, you need to pass through several stages to leave the airport. To make things easier, the hospital (FMRI) arranges for a concierge and you can usually find him holding a placard with your name as you exit the jetway. The concierge, thankfully, handles all the formalities. All you need to make sure is that you have your file of documents ready.

NOTE:

Make sure you have all your documents in one place. Here is a checklist of the documents, you shouldn’t miss:

Passport with the Indian Visa, of course – you cannot travel without it.
Self-reporting form (from Air Suvidha, download and fill)
Exemption letter (from Air Suvidha, download and fill)

Covid-19 Test – this is important. One needs to get a Covid-19 test at least 72 hours prior to departure in order to travel.
Boarding pass – make sure you don’t lose this. In India, the officials stamp the boarding pass and it becomes a major hassle if you misplace your boarding pass. Keep an e-boarding pass as a back-up but trust me, a paper boarding pass really speeds up things.

These documents need to presented at several stations where you would need to stand in a queue. The concierge stays with you through all the processes and guides you through the terminal.

7. Exiting the Airport:

As you exit the airport, the concierge puts you in a pre-arranged taxi that will take you to the hotel. The concierge and the taxi are all paid for and you don’t need to pay them anything, tips, of course are always appreciated. A tip of $5 - $10 each is good enough.

8. Driving to the hotel:

The drive to the hotel takes about 30 minutes or so. Traffic in India seems a bit crazy with a lot of honking, but surprisingly accidents are uncommon. <

9. Reaching the Hotel:

Once you arrive at the hotel, there is a security check going into the hotel property. And as you reach the hotel lobby, you would be received by the hotel staff and they will put your bags through a mandatory scan. And in order to be safe during these Covid-19 times, your temperature would be taken and the executive at the front desk will ask for your passport and Covid-19 test. The hotel staff is very welcoming and extremely hospitable.

I reached the hotel late on a Saturday night, so the restaurant was shut but there is 24x7 room service with a great menu.

There is a full gym and salon in the hotel where you can get several treatments and remember, these have to paid for separately. The hotel has an excellent pool which was closed because of Covid-19 restrictions, but one can sit on the lounge chairs in the shade.

My wife and I spent the Sunday in the hotel lazing around. And by the way, the breakfast and dinner buffets are simply extraordinary.

10. Treatment Day

It’s Monday morning and I coordinated with the front desk at the hotel for transportation to Fortis Memorial Research Institute. The hotel arranges for a car to drop you off and pick you up for a nominal fee that’s added to your room. The driver spoke good English and he gave us his phone number to text him when we were ready to return to the hotel.

TIP: iPhones can text in India but it always advisable to check with your carrier for details and fees. Secondly, make sure you call your credit card company and let them know about your travel to India so that they don’t suspect fraud and disrupt card transactions.

The treatment is scheduled to start at 9 AM (India Time) and I was advised against being late because it would be a long day and you should beat the rush of patients that show up after 10 AM. Do not forget to carry your medical file that has all the reports, scans, bloodwork, and meds. My wife and I also carried bottled water from the hotel.

I was travelling with my wife, though she didn’t have much to do except wait, speak to the doctors at times and sign off some essential paperwork. During these Covid-19 times, we were advised to not go around the city, however, I was told that you could ask the hotel’s staff driver to drive your companion for shopping or do some touristy things. A friend of mine had our hotel staff driver pick up a local smartphone which came in handy especially with the mandatory social distancing app called ‘Arogya Setu’. And he can also help in picking up an Indian sim-card for your own phone.

11. Back at the hotel after treatment:

I spent around 24 hours in the hospital before getting discharged. And I would say that I had a good experience with both the hospital staff and hotel staff being extremely helpful and hospitable If you have any questions, you could email the hospital liaison Mr. Manav Sadhwani (manav@nuclearmedicinetherapy.in).