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 Imaging: Shedding Light on Cancer Diagnosis and Treatment

Summary (10 sec read)

Medical imaging technologies like X-rays, CT, MRI, and PET scans are vital for cancer detection and staging. Advancements in PET scans and the rise of theranostics offer improved accuracy and personalized treatment options.

Medical imaging has dramatically transformed the field of cancer diagnosis and treatment, offering doctors an unprecedented ability to see inside the human body with exceptional clarity. These technologies are vital tools in identifying, diagnosing, and guiding the treatment of cancer, significantly enhancing patient care.

The Importance of Medical Imaging in Cancer Diagnostics

Medical imaging involves various techniques that use different forms of energy—such as X-rays, sound waves, magnetic fields, and radioactive isotopes—to generate detailed images of internal structures. These images provide critical information about the presence, size, location, and characteristics of cancerous tumors.

1. X-rays: X-rays are fundamental in medical imaging, commonly used to detect bone tumors and lung cancers. Mammography, a specialized type of X-ray, is crucial for early breast cancer detection.
2. Computed Tomography (CT): CT scans produce cross-sectional images of the body, offering more detail than traditional X-rays. They are extensively used to diagnose and stage various cancers, including those in the lungs, liver, pancreas, and lymph nodes.
3. Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to create detailed images of soft tissues, making it particularly useful for diagnosing brain tumors, spinal cord cancers, and cancers of the prostate and female reproductive organs.
4. Ultrasound: Ultrasound, which employs high-frequency sound waves, is a non-invasive technique widely used to image the breast, thyroid, liver, and other abdominal organs. It is also valuable for guiding biopsies and other minimally invasive procedures.
5. Nuclear Medicine: Techniques like positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in nuclear medicine use radioactive isotopes to create functional images that reveal tissue and organ metabolic activity. These scans are particularly useful for detecting cancer spread and monitoring treatment effectiveness.

Radioisotopes and Imaging Technologies in Cancer Diagnostics and Treatment

Radioisotopes, or radioactive isotopes, are essential in both cancer diagnosis and treatment. In diagnostic imaging, radioisotopes are integrated into specialized molecules, known as radiotracers, that target specific tissues or processes within the body.

1. PET Scans: PET scans use radiotracers that emit positrons, which interact with electrons in the body to produce gamma rays. These gamma rays are detected by the PET scanner, creating images that highlight areas of increased metabolic activity, often indicating cancerous cells.
2. Gamma Cameras: Gamma cameras detect gamma rays emitted by radiotracers in the body. They are used alongside radioisotope-based therapies, like radioiodine treatment for thyroid cancer, to monitor the distribution and effectiveness of the treatment.
3. DOTATATE and DOTANOC Scans: These specialized PET scans utilize radiotracers that attach to specific receptors on neuroendocrine tumor cells. They are critical for diagnosing and staging neuroendocrine tumors and monitoring treatment responses.

Advancements in PET Scan Technology

Recent advancements in PET scan technology have significantly enhanced the ability of physicians to diagnose and monitor cancer. These advancements include:

1. Improved Sensitivity and Resolution: Newer PET scanners offer higher sensitivity and better resolution, enabling the detection of smaller tumors and more detailed imaging of cancerous tissues. This improvement allows for earlier diagnosis and more precise staging of cancer.
2. Faster Scanning Capabilities: Enhanced technology has led to the development of PET scanners that can perform scans more quickly, reducing the time patients spend in the machine and minimizing discomfort. Faster scans also increase patient throughput, allowing more individuals to benefit from this critical diagnostic tool.
3. Hybrid Imaging Systems: The integration of PET with other imaging modalities, such as CT and MRI, in hybrid systems provides a comprehensive view of both the anatomical and functional aspects of tumors. This combination enhances the accuracy of cancer diagnosis and treatment planning.
4. Siemens Healthineers Biograph Vision: This advanced PET/CT scanner represents a leap forward in precision oncology. It features the world’s fastest time of flight, reducing scan times and enhancing workflow efficiency. FlowMotion Technology offers seamless scanning and improved patient comfort, while Wholebody Dynamic Imaging and Multiparametric Imaging deliver critical insights into disease progression and molecular-level understanding. The system also reduces radiation doses by 50%, ensures patient safety, and detects tiny lesions as small as two to three millimeters, aiding early cancer detection and precise staging.

The Rise of Theranostics

Theranostics is an innovative approach to cancer treatment that integrates diagnostics and therapy into a single strategy. Utilizing paired radioactive molecules, this method personalizes cancer care by combining the ability to precisely image tumors with targeted treatment delivery. In practice, agents like Ga68 PSMA are used for imaging, followed by treatment with therapeutic counterparts such as Lu177 PSMA. This approach has shown significant success in treating prostate cancer, neuroendocrine tumors, and other cancers, improving patient outcomes and quality of life.

Recent Advances in Imaging Technologies

1. New PET Scan Machines: Advances in PET technology have resulted in scanners with enhanced sensitivity, resolution, and speed. These machines allow for faster, more accurate imaging, leading to earlier and more precise diagnoses.
2. Hybrid Imaging Systems: Hybrid systems, like PET/CT and PET/MRI, combine the strengths of different imaging modalities to provide comprehensive information about tumors’ anatomical and functional characteristics.

Also Read

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

From Awareness to Action: How Prostate Cancer Month Can Save Lives

Frequently Asked Questions

What is medical imaging?

Medical imaging encompasses a range of techniques using X-rays, sound waves, magnetic fields, or radioactive isotopes to create detailed images of the body's internal structures. These images are crucial in cancer diagnosis, staging, and treatment monitoring.
How is medical imaging used in cancer diagnosis?
- Detecting tumors: Various imaging modalities like X-rays, CT, MRI, ultrasound, and nuclear medicine scans can identify the presence, size, and location of tumors.
- Staging cancer: Imaging helps determine the extent of cancer spread within the body, aiding in treatment planning and prognosis.
  Guiding biopsies and procedures: Imaging can assist in accurately targeting biopsies and other minimally invasive procedures.
What are radioisotopes and how are they used in cancer imaging?

Radioisotopes, or radioactive isotopes, are integrated into molecules called radiotracers. These radiotracers are administered to the patient and accumulate in specific tissues or organs, allowing imaging techniques like PET scans and gamma cameras to visualize and assess metabolic activity, often highlighting cancerous cells.
What are the recent advancements in PET scan technology?
- Improved sensitivity and resolution: Newer PET scanners offer higher sensitivity and better resolution, leading to earlier and more accurate cancer detection.
- Faster scanning capabilities: Advancements have enabled quicker scan times, reducing patient discomfort and increasing efficiency.
  Hybrid imaging systems: Combining PET with CT or MRI provides a more comprehensive view of tumors, enhancing diagnosis and treatment planning.
- Siemens Healthineers Biograph Vision: This advanced PET/CT scanner offers faster scans, improved patient comfort, reduced radiation dose, and the ability to detect tiny lesions, further advancing precision oncology.
What is theranostics and how is it used in cancer treatment?

Theranostics combines diagnostics and therapy by using paired radioactive molecules. One molecule is used for imaging to precisely locate tumors, while its counterpart delivers targeted treatment. This approach has shown promise in treating prostate cancer, neuroendocrine tumors, and other cancers.
What are the latest advances in imaging technologies beyond PET scans?

New PET scan machines: Ongoing developments continue to improve PET scanners' sensitivity, resolution, and speed.
Hybrid imaging systems: The integration of different imaging modalities (PET/CT, PET/MRI) offers a more complete picture of tumor characteristics for enhanced diagnosis and treatment planning.

Consult Dr Ishita B Sen

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