Lutetium-177-PSMA radioligand therapy is an “internally” targeted irradiation of the prostate-specific membrane antigen (PSMA), which is increasingly present in prostate cancer cells. A radioactive isotope called Lutetium 177 (Lu-177) is used in this treatment. Lu-177 binds to the prostate-specific membrane antigen and acts directly on the cancer cells. This treatment is usually used when other treatment methods, such as surgery, radiotherapy, chemotherapy, and hormone treatment, are no longer effective. Treatment with Lutetium-177-PSMA ligand can slow down the progression of prostate cancer or even regress it and improve the patient's quality of life. In Germany, this treatment is only carried out under inpatient conditions for radiation protection.

When is lutetium-177-PSMA radioligand therapy indicated?

Treatment with the lutetium-177-PSMA ligand is used in patients with prostate cancer in whom the disease continues to progress despite optimal therapy (surgery, possibly radiotherapy, hormone therapy, chemotherapy).

Whether PSMA therapy can help and whether it is the right approach should always be decided on an interdisciplinary basis with your urologist/oncologist and in a personal discussion between doctor and patient. Diagnostic examinations (68Ga-PSMA radioligand PET/CT or PET/MR) should show in advance whether the tumor has the desired characteristics and whether it accumulates enough radiolabeled drugs.

Aim of lutetium-177-PSMA radioligand therapy

delay tumor growth

reduce the tumor tissue

reduce the symptoms

Prolonging life
The therapy is palliative. This means that no cure can be expected with PSMA radioligand therapy

Procedure for lutetium-177-PSMA radioligand therapy.

On the day of admission, you are not allowed to eat anything from 7 a.m. onwards. However, you should take your medication and have breakfast beforehand. For your treatment, therapeutic substances will be administered intravenously on the therapy ward according to the optimal therapy activity for you. To minimize kidney damage, intravenous fluid infusions will be administered immediately before, during, and following days after treatment. Sufficient fluid intake is also recommended on the day of treatment and the following days, as this can reduce the radiation load on the kidneys and the rest of the body. After the treatment, whole-body scintigraphy images and blood samples are taken to monitor the storage of Lu-177 in the tumor cells and the degradation of the therapeutic agent. To avoid unnecessary radiation exposure for the staff, you should ensure that you keep as much distance as possible from the treatment application. Activity measurements are carried out in your room. A detector is installed in the ceiling above your bed for this purpose. We measure your total body activity in the morning.

You are not allowed to leave the therapy ward or receive visitors during your stay. There is an absolute smoking ban on the therapy ward. We recommend that you bring nicotine patches with you if necessary. You can use your private clothing without hesitation. Before you are discharged, you will also receive recommendations on how to behave in the first few days after discharge.

Possible side effects

Most patients tolerate PSMA treatment well and have no serious side effects. If side effects do occur, they are less severe than with chemotherapy. The following side effects are possible but do not necessarily occur:Allgemeine Nebenwirkungen

• - allergic reactions
• - Nausea, vomiting and loss of appetite
• - tiredness, fatigue

Unique side effects 

• Kidney damage to the point of requiring dialysis (very rare)
• - Bone marrow damage up to myelodysplastic syndrome
• - Dry mouth
• - Risk of secondary malignancy

Discharge

Patients are not allowed to leave the therapy ward for 48 hours. Treated patients can be discharged from the hospital after an observation period of approx. 3-5 days. After a final consultation with the ward doctor, you will receive information on further check-ups. It is recommended that you keep your distance from small children and pregnant women for a certain period or limit contact. There are no restrictions on living with pets.

Follow-up care

After discharge, laboratory checks (blood, liver, and kidney values) should be carried out weekly for the first four weeks and then at fortnightly intervals. The family doctor, urologist, or oncologist can carry this out close to home.
Follow-up examinations (e.g., PET/CT, kidney scintigraphy) are carried out at regular intervals to check the response to therapy, side effects, and complications. In the event of a good response or stabilization of the disease and continued good deposition in the Ga-68-PSMA ligand PET/CT, further treatment cycles can usually be planned if the blood count and kidney function allow this.