Lutetium-177 PSMA radionuclide therapy

PSMA is a type of protein that is found on the surface of prostate cancer cells, although it can be found in a much lower degree on normal cells as well.

Lutetium-177 PSMA therapy uses a specifically designed molecule which attaches itself to the PSMA receptors in your body, therefore binding to the prostate cancer cells. The therapy transports Lutetium- 177, a highly radioactive substance, directly to the tumour sites. The high radioactivity of the Lutetium-177 is, thus, delivered to the tumours where it damages or destroys the cancer cells in a targeted way. This means that the rest of the healthy tissue of the body is less exposed to significant amounts of radiation.

All treatments and procedures have some risks and side effects and we will talk to you about the risks and benefits of Lutetium-177 PSMA therapy at your appointment.

The radiation used in this therapy is designed to damage and kill the prostate cancer cells. However, aside from the prostate gland and prostate cancer cells, PSMA is also found in a low degree in other areas of the body such as the salivary gland, lacrimal (tear) glands, kidneys and small intestine. There is, therefore, a low risk that the PSMA therapy can also carry damaging radiation to these healthy areas. Any damage to these areas, however, is minimal.

Common side effect which can happen in more than 1 out of every 10 men treated with Lutetium-177 PSMA therapy (10%) include a dry mouth, tiredness, nausea, vomiting, constipation or diarrhoea.

A rare side effect that can happen in 1 to 10 out of every 100 men treated with Lutetium-177 PSMA therapy (1 to 10%) can include a reduction in the cells produced by the bone marrow; this is usually temporary. This can result in an increased risk of infections due to a reduction in white cells and a risk of bleeding due to a reduction in platelets which help the blood to clot.

These side effects will be discussed fully with your doctor before you start this therapy and you will be monitored carefully and regularly with blood tests for any side effects during and after treatment. This would ensure that your doctor commences supportive treatment or monitoring of these side effects as soon as possible.

If you choose not to be treated with Lutetium-177 PSMA, you can discuss other forms of treatment for prostate cancer with your doctor or ways to control any symptoms you may be experiencing from the prostate cancer.

There are several different types of treatments available for men with castrate resistant metastatic prostate cancer. These include hormone therapy, chemotherapy, Radium-223 radioactive isotope treatment, clinical trials or therapy to control symptoms such as pain killers and radiotherapy to treat affected painful areas of prostate cancer.

You should discuss with your doctor which options may be suitable for you. It is important that you consider any alternative treatments with your doctor before starting Lutetium-177 PSMA therapy. You need to discuss the benefits and side effects of these other treatments and how they could affect you individually before making a decision.

There is no preparation required regarding medication or fasting prior to treatment unless you are told to by your doctor. Before the treatment you will complete a questionnaire regarding contact with children, pregnant women and people you see regularly. Depending on this information you may need to make arrangements before your appointment to ensure you can follow necessary restrictions when you go home (see section 10).

The therapy itself will take approximately 30 mins and then you will need to stay for a few hours afterwards, until your radiation levels come down to a safe level where you can go home. You may want to bring something to read or a DVD that we can play for you during this time.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with this treatment, we will ask you to sign a consent form. This confirms that you agree to have the treatment and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to consent to this treatment. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with a senior member of staff again.

When you arrive in the Nuclear Medicine department on the 5th floor of UCH, the reception staff will log you in. A member of staff will collect you from the waiting area and take you to your treatment room. You will go through the consent procedures and be asked a few questions before having some standard observation measurements, such as blood pressure, before treatment.

The treatment is given as a drip into your bloodstream (intravenously). After the treatment your blood pressure and heart rate will be monitored. You will be asked to remain in the treatment room until your radiation levels are low enough to return home. This will be measured by a physicist who will hold a monitor a metre away from you.

Following your treatment with Lutetium-177 PSMA you will need to take steps to prevent radiation exposure to other people by increasing your distance from them. Further information can be found on the ‘Therapy Discharge Instructions’ which will be given to you and discussed with you prior to treatment to ensure individual instructions can be given for your personal circumstances. The physicist will monitor you and will be able to adjust the timings based on the radiation levels at the time you leave and issue a yellow card with these details. The below gives you a guide:

You should have an appointment arranged with your Oncology Consultant prior to the next Lutetium-177 PSMA treatment.

More information can be found on Prostate Cancer UK’s website: https://prostatecanceruk.org/about-us/news-and-views/2021/6/behind-the-headlines-lutetium-therapy

Oncology Consultants: 0203 447 9287
Nuclear Medicine Consultant: 0203 447 0560 (between 09:00-17:00)
07984288596 (out of hours)
Nuclear Medicine Physics: 0203 447 0559/ 07984288596
UCLH Direct line: 020 3447 0565
Switchboard: 020 3456 7890
Fax: 020 3447 0598
Email: uclh.nucmed@nhs.net
Website: www.uclh.nhs.uk

The nearest tube stations are Warren Street (Northern and Victoria Lines) and Euston Square (Hammersmith & City, Circle and Metropolitan Lines) which are within 2 minutes’ walk.

Euston, Kings Cross and St. Pancras railway stations are within a 10-15 minutes’ walk. Bus services are shown on the above map. Further travel information can be obtained from http://www.tfl.gov.uk (tel: 020 7222 1234).

No car parking is available at the hospital. Street parking is limited and restricted to a maximum of 2 hours. Please note the University College Hospital lies outside but very close to the Central London Congestion Charging Zone.

If you think that you may be eligible for hospital transport please telephone 020 3456 7010 at least 7 days before your appointment.