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.

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

Summary (10 sec read)

Terbium-161 PSMA-targeted therapy at FMRI Gurgaon offers advanced treatment for metastatic prostate cancer, providing precision-targeted radiation with enhanced potency over Lutetium-177. Led by Dr. Ishita B. Sen, FMRI’s nuclear oncology team brings breakthrough cancer care in India, combining treatment and real-time imaging for personalized, effective results.

Terbium-161: A New Era in PSMA-Targeted Radionuclide Therapy for Advanced Prostate Cancer

Authored by Dr. Ishita B. Sen, Director and Head of Nuclear Medicine & Molecular Imaging at Fortis Memorial Research Institute (FMRI), Sector 44, Gurgaon, Haryana, India

Introduction: The Challenge of Advanced Prostate Cancer

Prostate cancer remains a leading health challenge, particularly when it progresses to advanced, metastatic stages. Castration-resistant metastatic prostate cancer (mCRPC) represents one of the most difficult stages to treat, as traditional methods often fall short. At FMRI in Gurgaon, we are proud to offer an innovative solution for patients with advanced prostate cancer: PSMA-targeted radionuclide therapy using Terbium-161 (^161Tb), a novel molecule with promising potency and precision.

“With Terbium-161, we can now deliver highly focused, intense radiation directly to prostate cancer cells, offering a new hope for patients with advanced disease,” shares Dr. Ishita B. Sen, a seasoned expert with over 20 years in nuclear oncology.

What is Terbium-161? Understanding the Molecule and Its Potential

Terbium-161 is a radionuclide that, when paired with PSMA-targeted agents like PSMA-617, delivers cancer-killing radiation directly to prostate cancer cells with unprecedented precision. This molecule holds unique advantages, combining beta particles with Auger and conversion electron emissions, which intensify its therapeutic potential while sparing healthy tissue.

“Terbium-161 represents a breakthrough in targeted radionuclide therapy. It has unique properties that, in many cases, make it more potent than Lutetium-177, the current standard in PSMA-targeted treatments,” Dr. Sen explains. At FMRI, we are proud to offer Terbium-161 therapy every week, ensuring accessible, state-of-the-art care for patients in India.

PSMA-Targeted Therapy: Precision Cancer Treatment

Prostate-Specific Membrane Antigen (PSMA) is a protein highly expressed in prostate cancer cells, especially in metastatic and castration-resistant forms. Its high presence in cancer cells, coupled with minimal expression in normal tissues, makes PSMA an ideal target for therapies like Terbium-161. This targeting capability allows for:
• Precision treatment: Directs the radiation payload to cancer cells.
• Minimal off-target effects: Reduces damage to surrounding healthy tissue.

“With PSMA as a target, Terbium-161 therapy allows us to focus the full power of radiation on the tumor cells, minimizing side effects and maximizing efficacy,” says Dr. Sen. “This approach embodies the best of what nuclear oncology can offer today.”

How Terbium-161 Outperforms Lutetium-177

1. Enhanced Radiation Impact Through High Linear Energy Transfer (LET)

Terbium-161’s unique profile includes beta particles and Auger and conversion electrons. These short-range, high-energy particles deliver concentrated radiation, significantly enhancing DNA damage within cancer cells. In particular, Auger electrons play a crucial role:
• Localized DNA damage: Auger electrons travel just a few nanometers, allowing them to damage tumor cell DNA directly and intensely.
• Reduced side effects: The short-range emissions mean that healthy tissues surrounding the tumor are spared from excessive radiation exposure.

“Terbium-161’s emission of Auger electrons gives it a high linear energy transfer, increasing the likelihood of tumor cell death,” Dr. Sen explains. “The result is a treatment that is more powerful, more targeted, and, ultimately, more effective for patients.”

2. Targeting Microlesions and Micrometastatic Disease

The compact reach of Terbium-161’s emissions makes it exceptionally effective at treating small cancer clusters and micrometastases—tiny, dispersed tumor cells that are often missed by conventional treatments. Terbium-161’s high LET enables it to penetrate these challenging cell clusters with precision, proving beneficial for advanced-stage prostate cancer where metastases may be widespread.

3. Optimized Treatment Duration and Dosimetry

The half-life of Terbium-161, approximately 6.89 days, is ideal for balancing treatment efficacy with patient safety. This half-life allows Terbium-161 to remain active long enough to maximize its cancer-fighting potential without subjecting the patient to lingering radiation.

“With Terbium-161’s half-life, we can deliver a sustained therapeutic effect that targets tumors effectively and clears from the body at an optimal pace. This balance is essential for patient safety and quality of life,” says Dr. Sen.

4. Theranostic Potential: A Combined Approach for Treatment and Monitoring

One of Terbium-161’s key advantages is its theranostic capability, meaning it can be used for both therapy and imaging. Terbium-161 emits gamma rays that allow for real-time SPECT imaging, enabling clinicians to track and monitor treatment progress.

“This theranostic approach means we can treat and observe the effects simultaneously, adjusting the treatment as needed based on real-time data,” Dr. Sen explains. “It’s a level of personalization and precision that’s changing how we approach cancer care.”

Clinical Insights and Research: Backing Terbium-161’s Efficacy

Preclinical and Clinical Studies Supporting Terbium-161

Extensive studies support the unique effectiveness of Terbium-161, especially compared to Lutetium-177:
• DNA Damage and Cell Death: Research has shown that Terbium-161’s emissions result in clustered DNA damage, creating double-strand breaks that are significantly more challenging for cancer cells to repair. This increased DNA damage leads to a higher rate of tumor cell death and improved long-term outcomes for patients.
• Increased Efficacy in Small Tumors: Preclinical studies by Müller et al. demonstrated Terbium-161’s superiority in eradicating microlesions, showing a marked delay in tumor progression and improved survival rates compared to Lutetium-177.
• Optimized Dosimetry: Preliminary clinical trials suggest that Terbium-161 can deliver a higher dose to cancer cells with a favorable safety profile, supporting its use as a more potent option for patients with metastatic prostate cancer.

Patient-Centric Care at FMRI: Leveraging Terbium-161’s Potential

FMRI’s adoption of Terbium-161 is part of our commitment to providing state-of-the-art care for patients with advanced prostate cancer. With Dr. Ishita B. Sen at the helm, our center combines expertise and technology to deliver cutting-edge nuclear medicine therapies, including weekly access to Terbium-161 for our patients.

“Each patient deserves the most effective treatment available. Terbium-161 provides us with a powerful, precise option to help patients who may have limited alternatives,” Dr. Sen says. “At FMRI, we’re excited to make this breakthrough available every week, offering a ray of hope for those battling advanced-stage prostate cancer.”

Dr. Ishita B. Sen: Leading the Advancement of Nuclear Oncology in India

Dr. Ishita B. Sen, a renowned expert in nuclear medicine, leads FMRI’s Nuclear Medicine and Molecular Imaging Department with over 20 years of specialized experience in nuclear oncology. Dr. Sen’s extensive training includes programs at Lady Hardinge Medical College, Memorial Sloan Kettering Cancer Centre in New York, AIIMS New Delhi, and international research initiatives, making her uniquely qualified to guide FMRI’s innovative treatment offerings.

Dr. Sen’s dedication has led her to hold prestigious roles, including President of the Association of Nuclear Medicine Physicians of India and a co-investigator for international projects with the International Atomic Energy Agency (IAEA). Her contributions to the field of nuclear medicine oncology continue to set standards and improve patient care across India.

“With Terbium-161 and other advancements in nuclear medicine, I am proud to help patients receive the highest standard of care in India,” Dr. Sen states.

Benefits of Terbium-161 Therapy at FMRI Gurgaon

Our commitment at FMRI is to offer personalized, high-impact treatments with a focus on precision and patient well-being. By choosing Terbium-161 therapy at FMRI, patients with advanced prostate cancer can benefit from:
• Precision-targeted radiation that spares healthy tissues.
• Higher efficacy in treating micrometastases and microlesions.
• Compounded radiation effects due to Auger electrons for enhanced DNA damage.
• Theranostic capabilities to monitor and adjust treatment in real-time.
• Regular access to this cutting-edge therapy, available weekly at our Gurgaon center.

“Terbium-161 brings new possibilities for patients who are facing the most challenging stages of prostate cancer,” Dr. Sen says. “At FMRI, we are honored to provide a treatment that not only enhances outcomes but also represents the next generation of nuclear oncology.”

How to Access Terbium-161 Therapy at FMRI

If you or a loved one is facing advanced prostate cancer and looking for an effective, precision-targeted treatment, Terbium-161 therapy may be the right choice. At FMRI, located in Sector 44, Gurgaon, Haryana, our nuclear oncology team is ready to provide comprehensive, personalized care, bringing the most advanced cancer treatments to patients globally.

Contact us at FMRI Gurgaon to learn more about Terbium-161 therapy and how it can make a difference in your treatment journey.

Also Read

From Diagnosis to Cure: How Nuclear Medicine is Transforming the Fight Against Cancer

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

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

What are the adverse effects of PSMA Therapy

Frequently Asked Questions

What is Terbium-161 therapy?

Terbium-161 therapy is a PSMA-targeted radionuclide treatment that delivers precise radiation to prostate cancer cells, particularly effective for metastatic castration-resistant prostate cancer (mCRPC). It utilizes Terbium-161 (^161Tb), a radionuclide with enhanced therapeutic properties compared to Lutetium-177 (^177Lu).
How does Terbium-161 differ from Lutetium-177?

Terbium-161 emits additional Auger and conversion electrons, offering higher energy delivery and more localized DNA damage to cancer cells. This makes it particularly effective in targeting microlesions and micrometastases, which are challenging to treat with Lutetium-177.
Is Terbium-161 therapy available in India?

Yes, Terbium-161 therapy is available at Fortis Memorial Research Institute (FMRI) in Gurgaon, Haryana. It is offered weekly under the expert guidance of Dr. Ishita B. Sen, a leading authority in nuclear oncology.
How often is Terbium-161 therapy performed at FMRI?

Terbium-161 therapy is performed weekly at FMRI Gurgaon, ensuring regular availability for patients seeking advanced prostate cancer treatment.
Who can benefit from Terbium-161 therapy?

Patients with advanced or metastatic prostate cancer, particularly those with castration-resistant forms, can benefit significantly from Terbium-161 therapy. It is most effective in cases where precision targeting and higher potency are required.
What are the advantages of Terbium-161 therapy?

Key advantages include:
• Enhanced tumor cell eradication due to high linear energy transfer (LET).
• Effective treatment of micrometastatic disease.
• Reduced side effects by minimizing damage to surrounding healthy tissues.
• Real-time imaging capabilities for personalized treatment adjustments.
What is the role of Auger electrons in Terbium-161 therapy?

Auger electrons are short-range, high-energy particles emitted during Terbium-161 decay. They cause intense, localized DNA damage in cancer cells, making the therapy particularly effective for microlesions and dispersed tumor cells.
How is Terbium-161 therapy administered?

Terbium-161 is paired with a PSMA-targeted ligand (e.g., PSMA-617) and administered intravenously. The ligand binds specifically to PSMA-expressing prostate cancer cells, delivering the radiation payload directly to the tumor site.
How safe is Terbium-161 therapy?

Terbium-161 therapy has a favorable safety profile. Its optimized half-life of 6.89 days ensures effective treatment duration while minimizing unnecessary radiation exposure. Patients are closely monitored throughout the therapy.
How can I access Terbium-161 therapy at FMRI Gurgaon?

Patients interested in Terbium-161 therapy can contact Fortis Memorial Research Institute (FMRI) in Sector 44, Gurgaon, for consultation. Dr. Ishita B. Sen and her team provide comprehensive care tailored to individual patient needs.
Is Terbium-161 therapy covered by insurance?

Coverage varies depending on your insurance provider and plan. It is recommended to discuss the specifics with your insurance company and the FMRI billing team for detailed guidance.
How soon can I expect results from Terbium-161 therapy?

The effectiveness of Terbium-161 therapy varies by patient. Results typically become evident after a few cycles, with improvements in tumor response, reduced symptoms, and better quality of life in many cases.
Can Terbium-161 be used for other cancers?

While primarily focused on prostate cancer, research is underway to explore the potential of Terbium-161 in treating other cancers that express specific molecular targets.

If you have further questions or wish to explore this innovative therapy, please contact Dr. Ishita B Sen at info@nuclearmedicinetherapy.in . Our team is here to guide you every step of the way. Remember, Terbium-161 therapy is performed weekly at our center for your convenience.

Consult Dr Ishita B Sen

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