A targeted treatment option for advanced prostate cancer

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Prostate-specific membrane antigen (PSMA) is expressed on most prostate cancer cells and can be visualized using PSMA PET/CT. This makes it possible to identify patients whose tumors may be suitable for PSMA-targeted radioligand therapy.

I have been involved in the clinical development and application of PSMA-targeted radionuclide therapy in Vienna for many years and have treated more than 500 patients with ¹⁷⁷Lu-PSMA.

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¹⁷⁷Lu-PSMA radioligand therapy

¹⁷⁷Lu-PSMA therapy combines molecular targeting with radiation treatment. A PSMA-targeting molecule carries the radioactive isotope lutetium-177 directly to PSMA-expressing tumor cells, where beta radiation can damage and destroy tumor tissue.

Today, ¹⁷⁷Lu-PSMA is an established treatment option for selected patients with advanced metastatic prostate cancer. The strongest evidence is currently available for patients with PSMA-positive metastatic castration-resistant prostate cancer after progression on androgen-receptor pathway-directed treatment and taxane chemotherapy. Earlier use is also being investigated and is increasingly incorporated into treatment guidelines for selected patients.

Treatment is usually administered intravenously at intervals of approximately six weeks, with the number of treatment cycles adapted to the individual clinical situation. Laboratory tests, imaging and the patient's clinical condition are assessed before and during treatment

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Who may benefit?

The decision to recommend ¹⁷⁷Lu-PSMA is based on more than the diagnosis of metastatic prostate cancer alone.

Important factors include:

• PSMA expression on recent PSMA PET/CT

• distribution and extent of metastatic disease

• previous systemic treatments

• disease progression and kinetics

• blood counts

• kidney function

• overall clinical condition

• presence of relevant PSMA-negative disease

A recent PSMA PET/CT is particularly important because the treatment can only target tumor lesions that express sufficient PSMA. Relevant PSMA-negative lesions may require a different therapeutic approach. 

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What can patients expect from treatment?

¹⁷⁷Lu-PSMA can lead to substantial reductions in tumor burden and PSA levels in appropriately selected patients. The randomized VISION and TheraP trials established clinically meaningful benefits in advanced PSMA-positive prostate cancer, including improved disease control and, in the VISION setting, overall survival. 

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Treatment is generally well tolerated, but side effects can occur. Depending on the individual situation, these may include temporary reductions in blood counts, fatigue, dry mouth and effects on kidney function. Appropriate laboratory and clinical monitoring is therefore an integral part of treatment.

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What if the disease progresses after ¹⁷⁷Lu-PSMA?

Progression after ¹⁷⁷Lu-PSMA does not automatically mean that no further radionuclide treatment is possible.

The pattern of progression is important. I assess the current PSMA PET/CT together with previous imaging, the response to earlier cycles, PSA kinetics, previous treatments and the patient's overall condition.

Depending on these findings, possible options may include further systemic treatment, selected retreatment with ¹⁷⁷Lu-PSMA, or consideration of a different radionuclide approach.

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Selected patients: ²²⁵Ac-PSMA

Actinium-225 (^225Ac) delivers high-energy alpha radiation over a very short tissue range. This provides a different biological mechanism of radiation delivery and has generated considerable interest in patients with advanced PSMA-positive prostate cancer.

²²⁵Ac-PSMA is particularly relevant in selected patients who have progressed after ¹⁷⁷Lu-PSMA. However, the clinical evidence is currently less mature than for ¹⁷⁷Lu-PSMA, and the optimal sequencing and patient selection are still being investigated.

I therefore consider ²²⁵Ac-PSMA on an individual basis, taking into account PSMA expression, the pattern of progression, previous response to ¹⁷⁷Lu-PSMA and the patient's overall clinical situation.

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Individual assessment

If you or a family member has metastatic prostate cancer and you would like to know whether PSMA radioligand therapy may be appropriate, you can submit your medical records and recent imaging for an individual assessment.

A recent PSMA PET/CT, pathology reports, previous treatment history and recent laboratory results are particularly helpful.

If treatment is considered appropriate, therapy can be arranged in Vienna.

 

International Patients

Expert assessment and treatment in Vienna

Patients from outside Austria are welcome to submit their medical records and imaging for an initial assessment.

In many cases, an initial consultation can be arranged before travelling to Vienna.

If radionuclide therapy is considered appropriate, treatment can subsequently be arranged in Vienna.

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How it works

1. Submit your medical records
PET/CT scans, pathology reports, previous treatments and relevant laboratory results.

2. Individual medical assessment
Your case is reviewed personally, including the imaging and previous treatment history.

3. Consultation
We discuss the treatment options, expected benefits, limitations and alternatives.

4. Treatment in Vienna
If radionuclide therapy is appropriate, the treatment can be coordinated in Vienna.

5. Follow-up
Further treatment and follow-up can be discussed according to the individual course of the disease.

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Why choose Dr. Haug?

​Vienna is an established international center for Nuclear Medicine and Theranostics, with a long history of clinical innovation in radionuclide therapy. Radionuclide therapy requires careful patient selection and an individual treatment strategy. My clinical career has been closely connected with the development and clinical implementation of radionuclide therapies at the University Hospital Vienna.

My approach is deliberately personal: your case is assessed individually by an experienced Nuclear Medicine specialist, rather than simply being assigned to a standard treatment program.

 

Experience

20+ years
Clinical experience in Nuclear Medicine and radionuclide therapy

1,000+
177Lu-DOTATATE treatments

500+
177Lu-PSMA treatments

160+
Scientific publications

 

Request an Individual Assessment

If you are considering PSMA radioligand therapy, you can send us your relevant medical records and imaging for an initial assessment.

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International patients:

kontakt@dr-haug.at