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.

Find Best Nuclear Medicine Therapy & Theranostics in India

WHAT IS NUCLEAR MEDICINE?

Nuclear medicine is a branch of medicine that uses small amounts of radioactive material (Radiopharmaceutical) in diagnosis and treatment of various diseases

Nuclear Medicine Tests are safe and painless. They allow quick and accurate diagnosis of a wide range of conditions and diseases.

Nuclear Medicine Therapy is used to control, and in some cases cure, a range of conditions such including overactive thyroid (hyperthyroidism) and selective cases of inflamed joints (Radiation synovectomy).

It is also used in treatment of various cancers including Thyroid Cancers, Neuroendocrine tumors, Prostate cancers, Lymphomas and Liver tumors. Few of the radiopharmaceuticals are used for palliation of bone pain in patients with extensive bone metastases.

Nuclear Medicine diagnostic procedures help to identify the disease in early stages and also help to assess immediate response to various therapies. It is because of their ability to exactly pinpoint the molecular activity within the body.

HOW IS NUCLEAR MEDICINE USED FOR DIAGNOSIS?

Nuclear Medicine Imaging Procedures are mostly non-invasive procedures. With the exception of an intravenous injection in some scans, these usually do not cause much discomfort. The Radiopharmaceuticals or Radiotracers used in these scan saccumulate at the area of the body being examined and emits energy mostly in the form of gamma rays or positrons. These are detected by a special camera that produces pictures and provides molecular information.

Whenever required doctors can superimpose nuclear medicine images with Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) to produce special views that provide more precise information and accurate diagnoses.

WHAT ARE SOME COMMON USES OF NUCLEAR MEDICINE IMAGING PROCEDURES?

Nuclear Medicine has applications across a broad spectrum of disease, focusing in particular on Oncology, Cardiology, Nephro-Urology, Orthopaedics, Rheumatology, and Nuropsychiatry. Nuclear Medicine Imaging Procedures are used by Physicians to visualize the function of an organ, tissue, bone of system within the body.

HEART

Visualize heart blood flow and function (such as myocardial perfusion scan)
Detect coronary artery disease and the extent of coronary stenosis
Assess damage to the heart post a heart attack
Evaluate treatment options, such as a bypass heart surgery and angioplasty
Evaluate the results of revasclularisation (blood flow restoration) procedures
Detect heart transplant rejection
Evaluate heart function before and after chemotherapy (MUGA)

LUNGS

Scan lungs for respiratory and blood flow problems
Assess differential lung function for lung reduction or transplant surgery
Detect lung transplant rejection

BONES

Evaluate bones for fractures, infection and arthiritis
Evaluate for metastatic bone disease
Evaluate painful prosthetic joints
Evaluate bone tumours

BRAIN

Investigate abnormalities in the brain in patients with certain symptoms or disorders, such as seizures, memory loss and suspected abnormalities in blood flow
Detect the early onset of neurological disorders, such as Alzheimer’s disease
Assist in surgical planning and identify the areas of the brain that may be causing seizures
Evaluate for abnormalities in a chemical in the brain involved in controlling movement in patients with suspected Parkinson's disease or related movement disorders
Evaluation for suspected brain tumour recurrence, surgical or radiation planning or localization for biopsy

CANCER

Stage of cancer by determining the presence of spread of cancer in various parts of the body
Localise sentinel lymph nodes before surgery in patients with breast cancer or skin & soft tissue tumours
Plan treatment
Evaluate response to therapy
Detect the recurrence of cancer
Detect rare tumours of the pancreas and adrenal glands

RENAL

Analyse native and transplant kidney blood flow and function
Detect urinary tract obstruction
Evaluate for hypertension (high blood pressure) related to the kidney arteries
Evaluate kidneys for infection versus scar

OTHER SYSTEMS

Identify inflammation or abnormal function of the gallbladder
Identify bleeding into the bowel
Assess post-operative complications of gallbladder surgery
Locate the presence of an infection
Measure thyroid function to detect an overactive or underactive thyroid
Help diagnose hyperthyroidism and blood cell disorders
Evaluate spinal fluid flow and potential fluid leaks

WHAT ARE THE BENEFITS OF NUCLEAR MEDICINE?

Nuclear Medicine Procedures provide unique information that is often unattainable using other imaging procedures – details on both function and anatomic structure of the body.
Nuclear Medicine offers the potential to identify disease in its earliest stage, often even before symptoms occur or abnormalities detected with other diagnostic tests.
By detecting whether lesions are likely benign or malignant, PET scans may eliminate the need for surgical biopsy or may identify the best biopsy location.
PET CT guided biopsies help in more accurate diagnosis of cancer.

HOW DOES NUCLEAR MEDICINE WORK?

Unlike ordinary X-ray examinations, an image is made by passing x-rays through a patient’s body, Nuclear Medicine Procedures use a radioactive material, called a Radiopharmaceutical or Radiotracer that is injected into the bloodstream, or swallowed or inhaled as a gas. The radioactive material accumulates in the organ or area of the body being examined, from where it gives off a small amount of energy in the form of gamma rays. Special cameras detect this energy, and with the help of a computer, create pictures that offer details on both the structure and function of the organs and tissues.

Also, unlike other imaging techniques, nuclear medicine imaging exams focus on depicting physiological processes, such as metabolism or levels of various other chemical activity, instead of showing anatomy and structure.

HOW DOES NUCLEAR MEDICINE DIFFER FROM OTHER TYPES OF RADIOLOGY?

Nuclear Imaging Techniques show the physiological function of the tissue or organ being investigated, whereas, traditional Imaging Systems, such as CT (Computed Tomography) Scan, MRI (Magnetic Resonance Imaging) Scan etc., show only the anatomy or structure.

HOW ARE THE VARIOUS NUCLEAR MEDICINE PROCEDURES PERFORMED?

The patient is positioned on an examination table, and depending on the type of Nuclear Medicine Exam, the dose of radiotracer is then injected intravenously, swallowed or inhaled as a gas. It can take anywhere from several seconds to several days for the radiotracer to travel through the body and accumulate in the organ or area that is to be studied. As a result, imaging may either be done immediately, a few hours later, or even several days after receiving the radioactive material.

When it’s time for imaging, the camera or scanner will take a series of images by either rotating around the patient’s body or by staying in one position where the patient is asked to change positions in between images. While the camera is taking pictures, that patient is asked to remain still for brief periods. In certain cases, the camera may come very close to the body to obtain best quality images. If a patient is claustrophobic, he/ she should inform the technologist before the exam begins.

The length of time for Nuclear Medicine Procedures vary greatly depending on the type of exam. The actual scanning time can take from 20 minutes to several hours and may be conducted over several days in some special cases.

HOW IS NUCLEAR MEDICINE USED FOR THERAPY?

Nuclear Medicine Therapy works on a revolutionary concept called “Theranostics”. It is a relatively new field that combines specific targeted therapy based on specific targeted diagnostics. Theranostics uses specific molecular pathways to acquire diagnostic images. And then, it uses the same molecular pathway to deliver a therapeutic dose of molecular level radiation to the disease foci.

Nuclear Medicine Therapy takes the mode of treatment away from the contemporary methods of one-medicine-fits-all and trial & error. Theranostics is about offering the right treatment, for the right patient, at the right time, and with the right dose. Iodine-131 to treat an overactive thyroid gland and thyroid cancer, PRRT for neuroendocrine tumors and PSMA therapy for prostate cancer patients are few examples of this approach.

IS NUCLEAR MEDICINE THERAPY SAFE?

While, there is small amount of radiation used and it largely benefits the patient, but not other people. And therefore, the patient will need to take some safety measures so that the radiation does not affect other people.

If you are pregnant or you think you could be pregnant, or you are breastfeeding, it is important that you tell your doctor and the nuclear medicine service team before they give you the therapy dose. Many Nuclear Medicine Procedures require all women of child-bearing age to have a pregnancy test within 24 hours before therapy. The patient needs to make sure that she does not become pregnant for at least six months after some types of therapy.

BEFORE YOU LEAVE, OUR NUCLEAR MEDICINE TEAM WILL EXPLAIN IN DETAIL THE VARIOUS SAFETY MEASURES THAT A PATIENT NEEDS TO FOLLOW FOR THE TYPE OF THERAPY AND FOR HOW LONG.

PLEASE SPEAK TO YOUR DOCTOR ABOUT THE SAFETY MEASURES.

ARE THERE ANY SIDE-EFFECTS OF NUCLEAR MEDICINE THERAPIES?

Side-effects can occur after nuclear medicine therapy, but usually these are minor. Our Nuclear Medicine Specialist will discuss in detail the side-effects and other complications that could occur. The specialist will also explain the things you can do to reduce or avoid side-effects.

Is Nuclear Medicine Therapy Safe?