Radiotherapy has always had a role in the treatment of men with prostate cancer. It is one of the primary prostate cancer treatments for newly diagnosed men. In this role, it has been administered either by some form of external beam administration process or by radioactive seeds. Both of these delivery systems are localized and are targeted specifically to the prostate gland.
Men with advanced metastatic prostate cancer have also benefited from radiotherapy. The use of radiotherapy for men with advanced prostate cancer was originally limited to external beam therapy to the prostate bed in situations when primary surgery failed; to specific metastatic lesions to provide pain relief and to the use of certain injectable treatments using gamma throwing radionuclides that caused significant bone marrow destruction.
In the past few years, there have been breakout therapies in radiotherapy treatment for men with advanced, metastatic prostate cancer.
Radium 223 (Xofigo), approved by the FDA, is a bone targeting injectable radiotherapy that uses alpha radiation to diminish bone lesions without causing significant damage to the bone marrow. Although not on the FDA label because of how the clinical trials were structured, the vast majority of men report that Xofigo also has significant palliative effects (provides pain relief).
What will probably be the next breakout radiotherapy relies on the fact that approximately 85% of prostate cancer cells over express, by up to 1000 times, an antigen called prostate-specific membrane antigen (PSMA).
This over expression serves as an excellent target for PET imaging. In those men who do express PSMA, it has shown itself to be more sensitive than our current contrast agents and is able to identify the location of prostate cancer tumors that otherwise might have escaped detection.
There are now a number of clinical trials that are looking to exploit the over expression of PSMA by targeting it for radionuclide therapy for men with metastatic prostate cancer.
One of the more advanced emerging targeted radiotherapies for metastatic castrate-resistant prostate cancer relying on the PSMA over expression in metastatic prostate cancer is Lutetium-177 (Lu-177). Lu-177 is attracted to and attaches to the PSMA in the cancer cells, delivering the cells a targeted dose of radiation.
Lu-177’s attraction to the PSMA could, shortly provide us with another game changing treatment for men with advanced prostate cancer.
Lu-177 has been undergoing clinical studies evaluating its safety and efficacy. To date, the clinical work has been done mostly (but not exclusively) at the University of Heidelberg in Germany. According to reports from the research facilities and from American men we have spoken with who have traveled to Germany for this treatment, Lu-177 PSMA radiotherapy has demonstrated promising results in many, but not all, men with metastatic prostate cancer who have already failed many other therapies and have Gleason Grades of 8 or higher.
In addition to the work happening in Germany (and other European centers), there are now a few clinical trials offered in the United States, including one at Weill Cornell Medicine in New York City. Check the Clinical Trial web site to search for the other trial sites.
If you do elect to go to any of the European centers you should plan on spending between $2,500 and $4,000 as well as the air transportation, hotel, and food costs to receive the treatment. Insurance will not cover any of these expenses.
Radiotherapy using Lu-177, though very encouraging, is still in its early days. There remains much work to be done in identifying optimal dosing, the optimal number of treatments, optimal patient/disease characteristics, as well as adjuvant therapies.
However, this investigational treatment holds great promise, especially for men that have exhausted other alternatives.
If you are interested in going to Germany for the treatment one, of many, facilities offering treatment can be reached by clicking here.
Joel T. Nowak, MA, MSW wrote this Post. Joel is the CEO/Executive Director of Cancer ABCs. He is a Cancer Thriver diagnosed with 5 primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma and a rare cancer, Appendiceal Cancer.