Lutetium-177-PSMA therapy is a novel nuclear medicine procedure for the treatment of metastatic castration-resistant prostate cancer. It is considered in patients who have exhausted all other treatment options (chemotherapy, hormone therapy) and have further progression of the disease.
What is PSMA therapy?
PSMA stands for Prostate-Specific Membrane Antigen, a protein that is increasingly found on the cell surface of prostate cancer cells. According to the "key-lock" principle, the radioactive substance (lutetium-177) binds to the PSMA and is introduced into the cancer cells. The radiation accumulated there destroys the tumor cells in a targeted manner while largely sparing the surrounding tissue. Lutetium-177 PSMA therapy cannot cure the tumor, but it can slow its growth and alleviate symptoms. The mechanism has already been used successfully for several years in the recurrence diagnosis of prostate cancer (PSMA-PET/CT).
Effectiveness proven in studies
The efficacy of lutetium-177-PSMA therapy has already been demonstrated in several studies (TheraP, VISION). In March 2022, the first preparation of this substance group (Lu-177-PSMA-617) was approved in the USA. In Germany, too, some clinics are already offering lutetium-177-PSMA therapy as an "individual therapy". This includes therapies whose effect has been proven, but whose approval is still pending. Our patients are usually treated with LU-PSMA in cooperation with the Department of Nuclear Medicine at the University of Cologne.
Recommended for whom?
The German Society of Urology (DGU) has included the nuclear medicine procedure in the current guidelines and recommends a treatment trial with lutetium-177-PSMA in the following cases:
- castration-resistant advanced prostate cancer
- after exhaustion of all therapy options
- with good general condition of the patient
- with the participation of an interdisciplinary tumor conference
1. Michael S. Hofman, Louise Emmett, John Violet et al:TheraP: a randomized phase 2 trial of 177 Lu-PSMA-617 theranostic treatment vs cabazitaxel in progressive metastatic castration-resistant prostate cancer(Clinical Trial Protocol ANZUP 1603), BJU Int 2019 Nov;124 Suppl 1:5-13.
2 Oliver Sartor, Michael J Morris, Bernd J Krause et al: VISION: An international, prospective, open-label, multicenter, randomized phase 3 study of 177Lu-PSMA-617 in the treatment of patients with progressive PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). Journal of Clinical Oncology 37, no.15-suppl, May26, 2019
3rd S3 Guideline Prostate Cancer, 2021
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