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  • Alexander Haug

When is a Lu-PSMA therapy useful for patients with prostate cancer?

Lu-PSMA therapy is a specific form of radiation that can be used for patients for whom conventional prostate cancer therapy has not been successful. For example, when metastases of the prostate continue to grow despite hormone therapy or chemotherapy and there is no improvement after treatment. It is an effective therapy, but it is not yet approved and should only be performed with patients for whom conventional therapies are not an option. This may be the case because the metastases no longer respond to these therapies, or the side effects of these therapies are too severe.

What happens during Lu-PSMA therapy?

It is a radiation therapy. Cancer cells originating from the prostate usually carry the prostate-specific membrane antigen (PSMA) on their cell surface. This acts like a magnet and can bind certain proteins. The proteins are radioactively labelled with a therapeutically effective beta emitter (lutetium 177).

The labelled protein is now injected via the vein and reaches the tumours precisely, which are thus irradiated internally. Medications can be administered concomitantly. The treatment lasts about 15 minutes and is repeated after 4-8 weeks.

Tolerance of irradiation

Lu-PSMA therapy responds very well for most eligible patients, with few side effects, most of which have only a moderate impact on one's quality of life. Fever may occur immediately following therapy, as well as nausea, vomiting and loss of appetite. In rare cases, mild hair loss, changes in taste, fatigue and exhaustion may occur.

Conditions for feasibility

1. The metastases caused by the cancer must be able to store sufficient PSMA so that the radiation can also reach all cancer cells. A PSMA PET CT (positron emission tomography with computed tomography) is used to check beforehand whether there is sufficient storage capacity.

2. The blood values must be examined in detail beforehand, and the result must be good enough, e.g. the haemoglobin values, because radiation therapy can always also damage the bone marrow and thus could promote anaemia.

3. There must be adequate renal function, as Lu-PSMA is excreted by the kidneys.

4. You should have already been treated unsuccessfully with approved therapies such as hormone therapy and chemotherapy or no longer respond adequately to these therapies. This requirement is also met if the side effects of these therapies seem too severe for you.

Outpatient or inpatient?

In most cases, Lu-PSMA therapy is performed as an inpatient procedure in a hospital. At Dr. Haug's practice, we perform the therapy exclusively on an outpatient basis. For the individual planning of the therapy, we will always have a detailed discussion considering your medical history.

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