The therapy involves the injection of a radioactive substance (Lu-177) which is a beta particle emitter that causes damage to the DNA of cells within a 2mm range. This Lu-177 is chemically bound to an agent which is known to interact with the cell membrane receptor prostate-specific membrane antigen (PSMA). PSMA receptors are expressed in high concentrations on many prostate cancers, and can be identified using PSMA PET imaging. This includes any prostate cancer cells that have spread from the primary tumour in the prostate to other parts of the body. Once injected, Lu-177 PSMA acts much like a Trojan horse. As prostate cancer cells invite this destructive compound into their cell membrane, the beta particles are released and cause internal destruction of the cell.
Lu-177 PSMA therapy is generally referred by an oncologist, however can be referred by any medical doctor. In recent studies, Lu-177 PSMA therapy has shown some incredible results, however it should be understood that this therapy doesn’t cure prostate cancer. However, it has been shown to induce long periods of remission, reduce the size and growth rate of prostate cancer lesions and improve quality of life.
PSMA is not actually specific to the prostate and is also found in normal healthy organs such as the salivary glands, lacrimal glands, kidneys, liver and small intestines. Although these organs will also receive some of the damaging radiation, clinical trials have not demonstrated significant impacts from this treatment.
In contrast to other therapies, many patients experience few or no perceivable side-effects from the treatment. Some patients have described having a dry mouth, short term bone/joint pain, mild nausea and tiredness.
As prostate cancer is generally found in your bone, throughout the treatment you will have regular blood tests to check that your bone marrow is still functioning well. This will be done through open dialogue with your oncologist.
To decide whether this therapy is right for you, our nuclear medicine specialists will need to review your current stage of disease. If not recently performed, a PSMA PET scan, full blood test, and PSA will be arranged prior to your consultation. These tests are required to ensure that there are enough PSMA receptors for the therapy to be effective, your bone marrow and kidneys can tolerate the treatment, and to provide a baseline from which to measure response.
You will proceed to therapy only if the nuclear medicine specialist is satisfied that the therapy is likely to be effective and provide some benefit.
As there are no government subsidies there is a sizeable out of pocket cost for each cycle of Lu-177 PSMA. The exact amount will be discussed with you during your consultation.
On arrival a nurse or nuclear medicine technologist will prepare you for the infusion and perform routine observations. To avoid radiation exposure to staff, you will be made comfortable in your own private room for the uptake phase and any family member/ carer will be asked to stay in the waiting room. The nuclear medicine specialists will then have a final consultation with you prior to administering the Lu-177 PSMA. You will be encouraged to stay well hydrated, and to empty your bladder regularly. Prior to departure, you may require some diagnostic imaging to confirm uptake. Upon leaving you will be given written radiation safety instructions to follow once you are home. Please follow these instructions carefully.
Each treatment day will take between 3-4 hours depending on your individual metabolism.
How much will it cost?
Fees for radiology procedures will vary depending on a variety of factors. We will advise you about the cost of your service at the time of booking but if you do have any questions, contact us and one of our team will be happy to help with your query. You can read more about our billing information here.
How do I access my images?
At Queensland X-Ray, we provide our patients with their images and results online. To access your images and results, you’ll need to register for an account when you visit one of our practices. If you’ve already registered, you can access the Patient Portal here.