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.

What is Transarterial Radioembolization (TARE)

Summary (10 sec read)

Transarterial Radioembolization (TARE) is an advanced palliative treatment for liver cancers, including Hepatocellular Carcinoma (HCC) and Cholangiocarcinoma. Combining radiation therapy with embolization, TARE uses radioactive microspheres to block blood supply to tumors and deliver targeted radiation. It is effective for patients ineligible for surgery or liver transplantation. The procedure involves hepatic angiography to plan and simulate treatment, followed by the injection of radioactive particles. TARE can treat large or multiple liver tumors and is often better tolerated than Transarterial Chemoembolization (TACE), with fewer severe side effects. Patients typically spend two to three days in the hospital post-procedure due to temporary radioactivity. Complications are rare, making TARE a promising option for advanced liver cancer. For further details, contact Nuclear Medicine Therapy at +91 98111 27080 or info@nuclearmedicinetherapy.in

Liver malignancy, be it primary tumors like Hepatocellular Carcinoma (HCC) and Cholangiocarcinoma, is one of the top five most common cancers worldwide and is also a frequent cause of cancer-related mortality. In most of the cases, Hepatocellular Carcinoma (HCC) is often diagnosed late in the intermediate-advanced stage (stage B and C). Because of this often-late diagnosis, radical therapy doesn’t offer much success. While a few curative and/ or palliative therapies might help, but they are not often characterized by a favorable safety or efficacy ratio. Hence for this intermediate to advanced stages of HCC, internal radionuclide therapy is emerging as a good therapeutic option. And according to several studies, Transarterial Radioembolization (TARE) or intra-arterial injection of a radiolabeled embolising agent has led to extremely promising results, both in terms of demonstration of a good tolerability profile and disease control.

Transarterial Radioembolization (TARE) is also simply known as Radioembolization is a combination of Radiation Therapy and a procedure known as Embolization – a minimally invasive treatment in which blood vessels are blocked off to prevent blood flow. In TARE, tiny beads of glass or resin known as microspheres are administered inside the blood vessels that are feeding a tumor so that the supply of blood to the cancer cells can be blocked off. These microspheres are loaded with a radioactive compound – either Yttrium⁹⁰ or Lipiodol labelled with iodine¹³¹ or rhenium¹⁸⁸. Once they get lodged at the tumor site, they deliver a high dose of radiation to the tumor without affecting the normal tissues.

TARE is a palliative treatment (it means that it does not provide a cure) that helps slow down the disease growth and also helps alleviate symptoms. It is often used as a treatment option for patients who cannot undergo other treatment options such as liver surgery or liver transplantation.

Also Read: Prostate Cancer Treament

Now that we know what TARE is, we should now know about how the procedure is done and what happens before that. A few days before the procedure date, the patient would need to meet an Interventional Radiologist who will actually perform the procedure. The team of doctors (that include medical oncologists, radiation oncologists and surgeons) and the interventional radiologist first study the Triple Phase CT Scan of the patient. This is done to ascertain the feasibility of performing the TARE procedure. The patient is then admitted for a day or in the day care for a hepatic angiography. Hepatic angiography is a procedure that involves the insertion of an angiographic catheter through a puncture in the groin and it helps visualize the arterian anatomy of the patient’s liver. Some blood vessels may need to be coiled to ensure that the radioactive particles are delivered specifically to the tumor site and to also ensure that they do not run off into other organs due to any errant vessels.

The interventional radiologist, while performing the angiography injects a radioactive substance known as Tc99m MAA. This helps him simulate the exact distribution of the TARE particles in the liver before it is actually injected. The patient is then discharged from the hospital so that the interventional radiologist and the other team of doctors study the patient’s images so as to plan the actual procedure and also to calculate the dosage that needs to be delivered. It takes about a week to order the dose.

When the dose is ordered and received, the patient is admitted to the hospital again. An angiography catheter is once again inserted in the liver artery. Now the actual TARE pharmaceutical is injected and it finds its way to the tumors to get trapped there. They start emitting radiation to the tumor that kills it slowly.

Also Read: Everything you Need to know about Alpha PSMA Therapy

Once the procedure is over, the patient usually needs to spend two-three days in the hospital primarily because the radioactive material administered to the patient renders the patient radioactive for some time and he/ she needs to be kept in relative isolation to protect the attendants, caregivers and the general population from unnecessary radiation exposure.

TARE differs from other embolizing treatments such as Transarterial Chemoembolization (TACE). In TACE, chemotherapy loaded particles are injected into the liver and this modality is only effective in small liver tumors or in cases where there are only one or two secondaries in the liver, whereas TARE can be used even in cases where there is a large tumor in the liver or even when there are multiple tumors in the liver. While TACE is less expensive that TARE, the post-procedure side effects of TACE may in fact, be slightly more sever that TARE.

While speaking of side-effects, Transarterial Radioembolization (TARE) is typically well-tolerated. In some cases, patients have experienced some transient pain in the upper abdomen. In some other cases where there is extensive liver involvement, there may be a worsening of the liver function and in some extremely rare cases, an acute liver failure. However, complications because of TARE are extremely rare, with the incidence of serious complications being less than 1%.

For further information and/ or consultation, Visit Nuclear Medicine Therapy, do call or write to us: +91 98111 27080, info@nuclearmedicinetherapy.in