Treatment of advanced prostate cancer requires strong experience

Widespread prostate cancer can be effectively treated today. The latest, yet experimental, treatments for 177-lutetium-PSMA and 225-actinium-PSMA have been shown to be effective in treating both skeletal and non-skeletal prostate cancer.

The key to treating patients with advanced prostate cancer is an individualized treatment program. The front-line treatment of metastatic prostate cancer always includes medical treatments , most commonly hormone therapy and chemotherapy, or a combination. If cancer has metastasized to the bones, a medication to strenghten them is often administered.

Radiotherapy can be included in treatment with special techniques, even if there are extensive metastases. If remission of prostate cancer is achieved by means of medical treatment, we at the Docrates Cancer Center always consider adding localized radiation therapy. This has been shown to be effective in the treatment of advanced prostate cancer. Irradiating of the prostate may also prevent urinary retention later on.

Hormonal treatments and chemotherapy can remain effective for long periods but usually lose their efficacy over time.

Radionuclide Therapies in treating metastatic prostate cancer

In these situations, the second-line treatment of radionuclide therapy with a radioactive substance (radium or samarium) that targets the bones has been found to be both an effective and safe treatment option when metastases exist only in bone structures. The principle in this type of radionuclide therapy is to introduce the radioactive substance to the immediate vicinity of the cancer cells and thus irradiate the cancer cells there. Clinical trials have proven radium-223 radionuclide therapy to be well tolerated and efficient. Solitary, or a small number of, bone metastases can also be effectively treated with external radiotherapy if necessary.

New, yet experimental, 177-lutetium-PSMA and 225-actinium-PSMA treatments are effective therapies

Alongside radium and samarium, new, yet experimental radioactive drugs have been found, such as 177-lutetium-PSMA * and 225-actinium-PSMA.

177-lutetium-PSMA and 225-actinium-PSMA are relatively new and still experimental treatments in Finland, but they have proven to be effective and well tolerated. 177-lutetium-PSMA and 225-actinium-PSMA treatments may be particularly suitable for elderly patients for whom traditional chemotherapy is challenging and sometimes contraindicated due to, among other things, severe side effects. Docrates was the first in the Nordic countries to start 177-lutetium-PSMA treatments in 2017 and 225-actinium-PSMA treatments in 2021.

Radiopharmaceuticals target prostate cancer cells, regardless of their location, and allow cancer treatment even if the cancer is widespread. The treatments are so-called precision radiotherapy and are given as an intravenous drip. Radiation from the radiopharmaceutical is very local and carries a range of only a few millimeters or less, leaving very little unnecessary radiation exposure to healthy surrounding tissues. Therefore, multiple metastases can be treated simultaneously with the same dose of drug.

177-lutetium-PSMA treatments are given individually, depending on the patient’s condition, usually 2 to 6 times approximately every 4 to 6 weeks. 225-actinium PSMA treatments are given approximately every 8 weeks. Usually the patient gets home the same day. The patient’s blood levels are monitored during treatment.

The most common side effect of treatments is dry mouth. The aim is to prevent and reduce this by cooling the salivary glands during treatment.

Clinical trials ongoing

* 177-lutetium-PSMA and 225-actinium-PSMA are still experimental, Fimea’s licensed drug treatments. International randomized controlled trials of 177-lutetium-PSMA therapies are already in their third phase, after which more specific official routine treatment recommendations are likely to be issued for cancer cases selected for treatment. At the ESMO2018 meeting, the results of a dose escalation study * were presented, in which up to three times the dose of Docratee was shown to be safe and well tolerated. The ESMO2021 meeting presented the results of the VISION study **, which found a statistically significant survival benefit with 177-lutetium-PSMA treatments compared to standard treatment.

* (Tagawa, Annals of Oncology (2018) 29 (suppl_8): viii271-viii302. 10.1093 / annonc / mdy284)
** Published on September 16 at NEJM.

Experienced and multi-professional team

An integral aspect of treatment of advanced prostate cancer is a consultation with an oncologist immediately after the diagnosis, and seamless collaboration between the different specialists. Our experienced specialists use reliable examinations to determine, without delay, whether the patient is a candidate for new treatment options and subsequently draw up a tailored treatment plan for each patient.

At Docrates Cancer Center, radionuclide therapy is provided by a multi-disciplinary team, led by Chief Physician of Nuclear Medicine Jukka Kemppainen.

We are here to help you if you have a cancer diagnosis or suspect cancer. Our service consultation and appointments are available at your service at tel. + 358 10 773 2010 or by e-mail:  international (a) docrates.com

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