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.

TACE Vs TARE by Dr Ishita B Sen

TACE or Transarterial Chemoembolization is one of the modalities which is used in patients who have got isolated liver metastasis, small volume liver metastasis. What they do is to actually do a Hepatic Angiography and implant the Chemotherapeutic Agent right into the tumor in the liver. Now while TACE is often used in small Hepatocellular Carcinomas where it can actually be ablative, it can actually cure the tumor. Often in patients of Neuroendocrine Tumors there are Widespread Disease. There are multiple lesions in the liver. They usually present with a high volume of tumors in the liver. And in such a situation TACE is not really the ideal way. Now, If you look at the NCCN Guidelines or you look at any of the Australian Guidelines, the European Guidelines if the tumor is a lowgrade tumor and it expresses somatostatin receptors or is positive on a dotanoc scan the ideal treatment of choice in such a situation would be PRRT. There are some tumors which do not express the receptors and in such situations a Transarterial Radioembolisation is a much better technique than a Transarterial Chemoembolization in patients of Neuroendocrine Tumors. The Advantages of a Transarterial Radioembolisation is that the post embolisation syndrome is much less with a Transarterial Radioembolisation as compared to a TACE so post TACE there may be a deterioration of liver function, there may be pain, there may be a fever, the patients feels unwell. Now all these things are not very common with TARE infact they don' t exist with TARE. The other advantages that even if a person has got multiple lesions in both lobes of the liver you can still undergo TARE while TACE is not an option in patients who have got tumors in both lobes of the liver. If their is evidence of any portal vein thrombosis, so if the portal vein is infiltrated by the tumour even in such a situation TACE cannot be done but TARE can still be done. If cost is not an issue because TARE is typically more expensive than TACE. A Transarterial Radioembolisation often costs almost two to three times more than a Transarterial Chemoembolization across the world. But if cost is not an issue then a TARE is probably a prefer technique in all situations unless you are looking at a very small tumor where you can actually do an ablation with the TACE.

TARE for Neuroendocrine Tumor

Second Opinion