Advanced prostate cancers call for active treatment methods
The key to treating patients with advanced prostate cancer is an individualised treatment program. The front-line treatment of metastatic prostate cancer always includes medicine treatments, most commonly hormone therapy and chemotherapy, or a combination. If cancer has metastasised to the bones, a medication to strenghten them is often administered.
Radiotherapy can be included in the treatment with special techniques, even if there are extensive metastases. Local radiotherapy for a prostate combined with pharmacotherapy has also proved to be an effective treatment for advanced prostate cancer. If remission of prostate cancer is achieved by means of medicine treatment, and the patient has not received radiation before, we at Docrates Cancer Center always consider adding localised radiation therapy. Irradiating of the prostate may for instance prevent urinary retention later on.
Radionuclide therapies in treating metastatic prostate cancer
Hormonal treatments and chemotherapy can remain effective for long periods but usually lose their efficacy over time.
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. This also makes it possible to simultaneously irradiate bone metastases at very different sites of the body. Clinical trials have proven the radium-223 radionuclide therapy to be well tolerated and efficient with even further chances of survival. Solitary, or a small number of, bone metastases can also be effectively treated with external radiotherapy if necessary.
The new lutetium-PSMA drug is an effective treatment method
In addition to radium and samarium, a new radioactive drug, lutetium-PSMA (also Lu-PSMA)*, has now been discovered.
Most prostate cancer cells are PSMA positive, which means that they include PSMA (Prostate Specific Membrane Antigen). A prostate cancer patient with PSMA positive metastases confirmed by means of F-PSMA-PET-CT imaging is a candidate for treatment using a drug carrier that transports the attached radioactive drug lutetium-PSMA directly to the cancer cells.
Lutetium-PSMA is a reasonably new and still experimental radioactive drug in the treatment of cancer, but the therapy has proven very effective and well-tolerated. Docrates Cancer Center was the first hospital in the Nordics to offer this treatment in 2017.
Lu-PSMA is a targeted radiotherapy treatment administered intravenously. Lu-PSMA targets prostate cancer cells regardless of their location and allows for radiotherapy to be administered even in the advanced stages of cancer, and it effectively treat metastases both in the soft tissues and the bone. The radiation caused by the radioactive drug is very local, emitting only a few millimeters, thus exposing the surrounding tissues to minimal unnecessary radiation stress. Therefore multiple metastases can be irradiated simultaneously with the same medicine dose.
The Lu-PSMA treatment regimen is tailored to the needs of each individual patient and is usually administered 2–6 times over the course of 4–6 weeks and the patients can usually be discharged on the same day. Our medical team monitors the patient’s blood values throughout the treatment cycle.
The most common side effect of the treatment is a dry mouth. This is a side effect we seek to prevent and reduce by cooling the salivary glands during the infusion.
*Lu-PSMA has a special permission for compassionate use by the Finnish Medicines Agency (Fimea). The international randomised controlled trials are also in their third phase, after which official and more detailed Current Care Guidelines can probably be issued for the cancer cases selected for treatment. However, some results were already presented in October’s ESMO2018 conference, according to which the dose escalation study had shown that even a dose three times larger than that proved effective at Docrates was found safe and well tolerated without the appearance of the toxicity that restricts the dosage.
Customised treatment without delay
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.
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