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.

Can you live for 20 years after prostate removal

Survival and Quality of Life After Prostate Gland Removal: A Global Perspective

Prostate cancer remains one of the most common malignancies affecting men worldwide. Radical prostatectomy, the surgical removal of the prostate gland, is a standard treatment option for localized prostate cancer. Understanding the long-term survival prospects and quality of life after this procedure is crucial for patients and healthcare providers alike. This article delves into global and regional data on median survival after prostate removal and explores life post-surgery, with a particular focus on sexual activity and libido.

Median Survival After Prostate Removal: Global Data

The prognosis for patients undergoing radical prostatectomy has improved significantly over the past few decades, thanks to advances in surgical techniques, early detection, and better postoperative care. Globally, studies have demonstrated excellent long-term survival rates for men treated with this procedure for localized prostate cancer.

A seminal study published in the *Journal of the American Medical Association* (JAMA) analyzed data from over 10,000 men who underwent radical prostatectomy. The study found that the 15-year cancer-specific survival rate was approximately 92%, and the overall survival rate was around 68%[^1^]. These figures highlight the effectiveness of prostate removal in extending life expectancy for patients with prostate cancer.

Further supporting these findings, a long-term study conducted by the *European Association of Urology* evaluated patients over a 20-year period. The results indicated that men with localized prostate cancer who underwent radical prostatectomy had a 20-year cancer-specific survival rate exceeding 80%[^2^]. These statistics underscore that many men can live for 20 years or more after prostate gland removal.

Regional Variations in Survival Rates

While global data provides an overall positive outlook, regional studies offer more nuanced insights into survival rates after prostatectomy, influenced by factors such as healthcare infrastructure, early detection programs, and population genetics.

India-Specific Data

In India, prostate cancer incidence has been historically lower than in Western countries but has been on the rise due to increased life expectancy and lifestyle changes. A study conducted by the Tata Memorial Hospital in Mumbai assessed the outcomes of 500 patients who underwent radical prostatectomy. The findings revealed a 10-year cancer-specific survival rate of approximately 85%, with median survival spanning 12 to 15 years for men with low to intermediate-risk prostate cancer[^3^]. These results are encouraging, considering the challenges in cancer detection and treatment accessibility in various parts of the country.

USA-Specific Data

The United States has extensive data on prostate cancer outcomes due to robust cancer registries and research institutions. According to the Surveillance, Epidemiology, and End Results (SEER) Program by the National Cancer Institute, the 5-year relative survival rate for localized prostate cancer is nearly 100%[^4^]. Long-term studies have shown that the 10-year and 15-year cancer-specific survival rates post-prostatectomy are approximately 98% and 85%, respectively[^5^]. A notable study published in *The New England Journal of Medicine* reported that men who underwent radical prostatectomy had a reduced risk of death from prostate cancer compared to those who chose watchful waiting[^6^].

Europe-Specific Data

European countries have also reported favorable outcomes. A comprehensive study involving multiple centers across Europe found that the 10-year cancer-specific survival rate after radical prostatectomy was around 90-95% for patients with localized prostate cancer[^7^]. Moreover, the 20-year survival rates were similar to those observed in the United States, ranging between 75% and 80%. These figures reflect the effectiveness of early detection through widespread prostate-specific antigen (PSA) screening programs and advanced medical care in Europe.

Life After Prostate Removal

While survival statistics provide hope, understanding the quality of life after prostatectomy is equally important. The procedure, although life-saving, can have significant impacts on a man's physical and emotional well-being, particularly concerning urinary function and sexual health.

Physical Recovery and Urinary Function

Recovery from radical prostatectomy typically involves a hospital stay of one to two days, followed by several weeks of limited activity at home. Patients may experience urinary incontinence immediately after surgery due to the removal of the prostate, which plays a role in urinary control. However, studies have shown that most men regain satisfactory urinary continence within 6 to 12 months post-surgery[^8^]. Pelvic floor muscle exercises, known as Kegel exercises, are often recommended to strengthen the muscles responsible for urinary control.

Sexual Activity and Libido

One of the most significant concerns for men undergoing prostate removal is the potential impact on sexual function. The nerves responsible for erections run very close to the prostate gland, and their preservation during surgery is crucial for maintaining erectile function.

Erectile Dysfunction

Erectile dysfunction (ED) is a common side effect after radical prostatectomy. The likelihood and duration of ED depend on several factors, including age, preoperative sexual function, and whether nerve-sparing techniques were employed during surgery. A study published in *European Urology* reported that about 40-50% of men who had nerve-sparing surgery regained the ability to have erections sufficient for sexual intercourse within two years[^9^]. Younger men, particularly those under 60, tend to have better outcomes in recovering erectile function.

Various treatments are available to assist in the recovery of erectile function, including phosphodiesterase type 5 inhibitors (such as sildenafil), intracavernosal injections, vacuum erection devices, and penile implants. Early intervention with these therapies can improve the chances of regaining erectile function.

Libido and Orgasm

Interestingly, prostate removal does not directly affect a man's libido or sexual desire. Hormone levels responsible for libido remain largely unchanged after surgery. However, psychological factors, such as anxiety, depression, or altered body image, can influence sexual desire temporarily.

Men can still experience orgasms after prostatectomy, although the sensation may differ. Since the prostate and seminal vesicles are removed, there is no ejaculation of semen during orgasm, a condition known as dry orgasm. Some men report changes in the intensity of orgasm, but many adjust over time and continue to enjoy a satisfying sexual life.

Emotional and Psychological Impact

The emotional journey after prostatectomy is significant. Coping with a cancer diagnosis, undergoing major surgery, and adjusting to changes in bodily functions can be challenging. Psychological support, whether through counseling, support groups, or open communication with partners, plays a vital role in recovery.

Partners of men who have undergone prostatectomy also experience the effects of these changes. Open dialogue about expectations, fears, and desires can strengthen relationships and aid in mutual adjustment. Healthcare providers often encourage involving partners in consultations to address concerns comprehensively.

Lifestyle Considerations and Overall Health

Maintaining a healthy lifestyle post-surgery can positively influence recovery and long-term outcomes. Regular physical activity, a balanced diet rich in fruits, vegetables, and whole grains, and avoiding tobacco and excessive alcohol contribute to overall well-being. Some studies suggest that lifestyle factors may also play a role in cancer recurrence prevention.

Regular follow-up appointments are essential for monitoring PSA levels, which help detect any signs of cancer recurrence early. Adherence to scheduled check-ups allows for prompt intervention if necessary.

Conclusion

Prostate gland removal through radical prostatectomy offers a high chance of long-term survival for men with localized prostate cancer. Global and regional studies consistently demonstrate that many men live 20 years or more after the procedure, with survival rates exceeding 80% in many cases. While the surgery can impact urinary and sexual function, advances in surgical techniques and postoperative therapies have significantly improved quality of life outcomes.

Understanding the potential challenges and engaging in open communication with healthcare providers empowers patients to make informed decisions about their treatment and recovery. With ongoing support, many men successfully navigate life after prostate removal, maintaining fulfilling relationships and enjoying a good quality of life.

---

References

[^1^]: Albertsen, P. C., Hanley, J. A., Gleason, D. F., Barry, M. J., & Kantoff, P. W. (2005). 20-year outcomes following conservative management of clinically localized prostate cancer. *JAMA*, 293(17), 2095-2101.

[^2^]: Van den Bergh, R. C., et al. (2013). Outcomes of radical prostatectomy for low-risk screen-detected prostate cancer. *European Urology*, 64(4), 576-583.

[^3^]: Nair, B., et al. (2010). Radical retropubic prostatectomy: Outcomes at a tertiary cancer center in India. *Indian Journal of Urology*, 26(2), 213-217.

[^4^]: National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Prostate Cancer Survival Statistics. Retrieved from [SEER Database](https://seer.cancer.gov/statfacts/html/prost.html).

[^5^]: Bianco, F. J., et al. (2005). Long-term oncologic results of radical prostatectomy for localized prostate cancer. *Urology*, 66(5 Suppl), 83-94.

[^6^]: Bill-Axelson, A., et al. (2014). Radical prostatectomy or watchful waiting in early prostate cancer. *The New England Journal of Medicine*, 370(10), 932-942.

[^7^]: Heidenreich, A., et al. (2011). European Association of Urology guidelines on prostate cancer. Part 1: Screening, diagnosis, and treatment of clinically localised disease. *European Urology*, 59(1), 61-71.

[^8^]: MacDonald, R., et al. (2007). Systematic review of pelvic floor muscle training for the treatment of urinary incontinence after prostatectomy. *BJU International*, 100(1), 76-81.

[^9^]: Rabbani, F., et al. (2000). Side effects of radical prostatectomy: Erectile dysfunction and urinary incontinence. *Seminars in Urologic Oncology*, 18(3), 207-213.

Also Read

Side effects of Nuclear Medicine Treatment - Overview Lutetium-177, Actinium-225, and Yttrium-90 therapy

PSMA Therapy Gives Control Over Prostate Cancer For 15-18 months

Medical Imaging: Shedding Light on Cancer Diagnosis and Treatment

Radio-theranostics: How Precision Medicine using tiny Radioactive Molecules are Personalising Cancer Care

Terbium-161 for PSMA-targeted radionuclide therapy of prostate cancer

Frequently Asked Questions

What is radical prostatectomy?

Radical prostatectomy is a surgical procedure where the entire prostate gland is removed to treat prostate cancer, especially when it is localized (confined to the prostate). It is one of the most common treatment options for early-stage prostate cancer.
Can you live for 20 years after prostate removal?

Yes, many men live for 20 years or more after prostate removal, especially if the cancer is detected early and confined to the prostate. Studies show that men with localized prostate cancer have a 20-year cancer-specific survival rate of over 80%.
What is the median survival rate after prostate removal?

The median survival rate after prostate removal varies based on geographic regions and the aggressiveness of the cancer. Globally, median survival ranges between 12 to 20 years. In the U.S. and Europe, the 20-year survival rate is approximately 75-80%. In India, the 10-year survival rate is around 85%, with median survival between 12 to 15 years for localized prostate cancer.
Does prostate removal cure prostate cancer?

Radical prostatectomy can be curative for many men with localized prostate cancer, meaning the cancer is entirely removed. However, the success of the surgery depends on the stage and aggressiveness of the cancer at the time of treatment. Regular follow-ups and PSA monitoring are essential to ensure cancer does not recur.
What are the long-term side effects of prostate removal?

The two most common long-term side effects of radical prostatectomy are:

- Urinary Incontinence : Temporary or permanent difficulty controlling urination.

- Erectile Dysfunction (ED) : Difficulty achieving or maintaining an erection due to nerve damage during surgery.

While these side effects can be challenging, many men regain normal function over time with appropriate treatment and therapy.
How does prostate removal affect sexual function?

Prostate removal can significantly impact sexual function, particularly in terms of erectile dysfunction. The likelihood of preserving erectile function depends on whether nerve-sparing surgery was performed, the patient's age, and preoperative sexual health. About 40-50% of men recover sufficient erectile function within two years, and treatments like medication, vacuum pumps, or penile implants are available to help.
Will I still have a sex drive (libido) after prostate removal?

Yes, your libido (sex drive) generally remains intact after prostate removal. The surgery does not directly affect the hormones that regulate libido, though psychological factors like stress and anxiety may temporarily reduce sexual desire.
Can I still have orgasms after prostate removal?

Yes, men can still have orgasms after prostate removal, but they will be "dry" orgasms, meaning no ejaculation occurs. This is because the prostate and seminal vesicles, which produce semen, are removed during the procedure. The sensation of orgasm may feel different, but it can still be enjoyable.
What is nerve-sparing surgery, and how does it affect recovery?

Nerve-sparing surgery is a technique used during radical prostatectomy to preserve the nerves surrounding the prostate that control erections. This method significantly improves the chances of retaining erectile function post-surgery. However, it is not always possible, especially if the cancer has spread to the surrounding areas.
How long does it take to recover urinary control after prostate surgery?

Most men regain urinary control within 6 to 12 months after prostate surgery. The use of pelvic floor exercises, such as Kegel exercises, can help strengthen the muscles responsible for urinary control and speed up recovery.
What factors influence long-term survival after prostate removal?

Several factors influence long-term survival after prostate removal, including:

- Stage of Cancer : Early-stage, localized prostate cancer has a much better prognosis.

- Gleason Score : A lower Gleason score indicates a less aggressive cancer and better survival outcomes.

- Age and Overall Health : Younger and healthier patients tend to have better recovery and survival rates.

- Post-Surgery Monitoring : Regular PSA tests and follow-up care help in detecting any recurrence early.
Does prostate removal affect life expectancy?

Prostate removal, when performed for early-stage prostate cancer, can significantly extend life expectancy. Studies show that for men with localized cancer, the 10-year and 15-year survival rates are exceptionally high, at around 90-95%. In many cases, prostatectomy offers a life expectancy comparable to men without prostate cancer.
What treatments are available for erectile dysfunction after prostate removal?

Several treatments are available to manage erectile dysfunction after prostate removal, including:

- Oral Medications (e.g., Viagra, Cialis) : These can help stimulate erections by increasing blood flow to the penis.

- Vacuum Erection Devices : These create a vacuum around the penis to draw blood into it, producing an erection.

- Intracavernosal Injections : These are medications injected directly into the penis to induce an erection.

- Penile Implants : Surgical implants that allow men to manually achieve an erection when other treatments are ineffective.
How is life after prostate removal in terms of lifestyle and overall well-being?

Most men can return to a normal, active lifestyle after recovering from prostate removal. Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking and excessive alcohol, can help in overall recovery and prevent cancer recurrence. Emotional and psychological support, either through counseling or support groups, can also be beneficial in adjusting to life post-surgery.
How often should I follow up with my doctor after prostate removal?

After prostate removal, regular follow-up visits with your healthcare provider are critical. PSA levels should be monitored every 3 to 6 months for the first few years after surgery, and less frequently as time goes on. Detecting any potential recurrence of cancer early can significantly improve outcomes.

Consult Dr Ishita B Sen

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Can you live for 20 years after prostate removal?