Lutetium 177 - PSMA Treatment

Just to complete my story this far:

The follow up scan showed that the secondary lesions - I had about two dozen - appear to have effectively all disappeared. My PSA has continued to fall and is now 0.76. This is a greater than 99% fall from its peak. My UK oncologist has simply recommended that we monitor over the coming months, i.e. no other adjuvant treatment. 

That is the good news. 

The less good news is that I was admitted to hospital with pulmonary embolisms in both lungs. I'm now on anti-coagulants for 3-6 months. But they seem to be working so far and I am still on track for my skiing trips in the new year - a key objective. 

I learned that PE is very common among cancer patients. In fact it is a major cause of death apart from the cancer itself. Apparently the risk of experiencing PE among prostate cancer patients taking hormone or chemo therapies is 3 to 4 TIMES as great. 

Be aware and ask your onco how to minimise this very real risk. If it is caught early it is relatively well treatable. I think I'm lucky on both fronts. 

This is not surprising John. Men from areas well outside the Marsden's are referred for evaluation and in some cases treatment . However, there is very limited capacity for treating with PSMA scan and the Marsden like at least some others, appear to be giving priority to their local patients. (Not to do so would mean being inundated with NHS requests from everywhere.)

The firm providing the necessary ligand are planning to expand and extend their operation in the UK and there is a meeting scheduled this month at UCLH in London about this. Prostate UK did invite Ulsterman to attend but he indicated he was unable to do so.

Very encouraging progress for Notabene

Edited by member 12 Dec 2018 at 00:50  | Reason: Not specified

A member here has said that the Royal Marsden were limiting PSMA on the NHS to their local patients and this seems likely will be adopted by the other hospitals who have it. G&T were developing their own tracer and if now available may have helped availability but it could also be that because you have had rare treatment Notabene, that G&T were particularly interested in doing the scan on the NHS and seeing your results even if you were outside the area.

Andy 

Thanks for this interesting post. It is clear that Ac225 is a much more effective killer of tumour cells, (previous poster explained why) but when allied to PSMA it also unfortunately is an effective killer of salivary glands too. 

I believe that there is research happening in Germany on how to find a suitable ligand that can be combined with Ac225 other than PSMA. 

Have not heard of Carbon Acetate previously and will double my efforts in this area. Perhaps it does not effectively bind to Ac225 to be a "carrier" to the tumour sites as well as PSMA (which IIRC is a Glucose compound) does. 

regards

Neil 

Sorry if this is a silly question (especially from a physicist) but, in addition to various other bits, my brain doesn't seem to work so well nowadays.

I was diagnosed two years ago with T4b N0 M1 Gleason 9 disease. My PSA was only 11 at the time. I had Prostap and five early Docetaxel cycles, but switched to a surgical HT option this year. My PSA dropped slowly to 0.18/0.19 this year - which is beginning to look like the nadir.

My question to those knowing something about this treatment, is whether my strangely low original PSA for an aggressive Gleason 9 disease might imply that I would be less likely to have the PSMA for this scan and treatment?

Many thanks,

Michael

Hello Michael 

The Lutetium 177 treatment relies on the PSMA molecule being a ligand - binding to - tumour cells that emit supernormal levels of PSA. 

Unfortunately about 20% of men with prostate cancer do not respond to the PSMA binding. 

You would probably know or be able to test if you could arrange a Ga68 PSMA scan and compare that to a Choline scan. If the latter showed mets and the former didn't you would not benefit from Lu177 PSMA. If the Ga68 showed mets glowing brightly then Lu177 PSMA is likely to have some benefit. 

Cheerio!
Neil 

Hi Neil

Very pleased you are responding so well to your treatment. All the information I have seen puts the number of men who don't express PSMA sufficient for 68 Gallium scan between 5 and 10% as for example here, this scan normally being a prerequisite to establish, confirmation that the Lut 177 will bind. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355374/

Interesting that this treatment is now being made available in the UK albeit in a small way at present.

Edited by member 03 Aug 2019 at 10:57  | Reason: to highlight link

PS It is of note that to date most treatment with Lu177 has been for metastatic castrate resistant PC. Since the Cr form is a mutation perhaps that is why some men with McrPC do not express PSA to the same degree or in the same way for PSMA binding to be effective. 

Given the mechanism and effectiveness of Lu177 PSMA there is not good reason why it should not be used as a first line treatment (apart from cost). There is some evidence that when used in this way it is even more effective. 

When I find the paper that refers to this I will post the link. 

Hi, 

My dad is embarking on the 177 journey and i wonder if it was successful for your father ??.

Thanks in advance for your help.

Regards

Robbie