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Information on the therapy of metastatic prostate carcinoma with 177LU - PSMA

Below are the main explanations of the general issues:

- What is personalized medicine ?

- What is nuclear medicine ?

- General information about prostate carcinoma ?

- What is prostate carcinoma ?

- What are the reasons for prostate carcinoma ?

- What are symptoms of prostate cancer ?

- What are the stages of prostate cancer ?

- What forms of therapy are available for prostate carcinoma ?

What is personalized medicine ?

Personalized medicine is a concept where diagnostics and treatment are tailored to the individual, rather than one-size-fits-all. There are many factors that determine how high your risk is for certain diseases and how well you respond to treatments - for example, your genetics, lifestyle and environment. By analyzing this information along with your diagnosis and clinical records, your doctors can determine the most effective treatment plan for you and your needs.

Theranostics is a form of personalized medicine that tailors your treatment based on information from your diagnostic scans. These scans are very detailed and allow your doctors to determine if the treatment is working for you, and if so, at what dose and how often it should be administered.

What is nuclear medicine ?

In nuclear medicine, small amounts of radioactive substances, so-called radioactive isotopes or radioisotopes, are used for the diagnosis and treatment of diseases. These are also called radiotracers for diagnosis (such as 68Gallium) and radiopharmaceuticals for treatment (such as 177Lutetium). Nuclear medicine is commonly used to diagnose and treat cancer. Theranostics is a subfield of nuclear medicine.

General information about prostate cancer ?

Prostate cancer is the most common malignant tumor in men worldwide, with an estimated 1.4 million new cases per year.

In Austria alone, about 73,000 men are currently diagnosed with prostate cancer, about 5,700 men develop the disease each year, and about 1,200 men die of the disease each year. Prostate carcinoma thus accounts for about 25 percent of the incidence of all carcinomas in Austria.

In advanced stages, prostate carcinomas metastasize to lymph nodes, skeleton but also to various organs. In patients with metastasized prostate carcinoma, 177LU (lutetium) PSMA radio-ligand therapy (RLT) can be used if disease progression is evident despite previous conventional local and systemic - not nuclear medicine - therapies (surgery, hormone therapy, chemotherapy, radiotherapy, etc).

What is a prostate carcinoma ?

Prostate carcinoma is a type of cancer that develops in the prostate gland. The prostate is a small, walnut-shaped gland in the male reproductive system that surrounds the first part of the urethra immediately below the urinary bladder like a cuff. The prostate produces seminal fluid that nourishes and transports sperm.

Prostate cancer occurs when cells in the prostate gland change abnormally and begin to grow uncontrollably, forming a malignant tumor. If left untreated, the cancer cells can spread beyond the prostate to nearby tissues and organs, such as lymph nodes, bones or other distant parts of the body.

In its early stages, prostate cancer virtually never causes noticeable symptoms. As the cancer progresses, the following symptoms may occur: Difficulty urinating, weak urine flow, frequent urination (especially at night), blood in the urine or semen, erectile dysfunction, pain or discomfort in the pelvic area, and bone pain.

Prostate cancer is usually diagnosed through a combination of methods, including a digital rectal exam, a blood test to measure prostate specific antigen (PSA), and, if needed, a prostate biopsy to examine the prostate tissue for cancer cells. Imaging tests such as ultrasound, MRI or bone scans may also be used to determine the extent and spread of the cancer.

Treatment options for prostate cancer depend on a variety of factors, including the stage of the cancer, the aggressiveness of the tumor tissue, the patient's overall health, and his or her beliefs and wishes. Treatment may include active surveillance (regular check-ups without immediate intervention), surgery (radical prostatectomy), radiation therapy, hormone therapy, chemotherapy, immunotherapy, or a combination of these methods.

Regular screening and early detection are critical to the treatment of prostate cancer. Men are advised to talk with their healthcare providers about the benefits and risks of prostate cancer screening and make an informed decision based on their individual circumstances.

What are the reasons for prostate carcinoma ?

There are several factors that can increase the risk of developing prostate cancer. Here are some possible reasons:


  • Age: The risk for prostate cancer increases with age. Men over age 50 have a higher risk than younger age groups.


  • Family history: a family history of prostate cancer may increase the risk. Men whose father or brother has prostate cancer have a higher risk of also developing it.


  • Genetic factors: Certain genetic changes or mutations may increase the risk for prostate cancer. Mutations in the BRCA1 and BRCA2 genes, which are usually associated with breast and ovarian cancer, may also increase the risk for prostate cancer.


  • Ethnicity: Prostate cancer is more common in African-American men than in men of other ethnic groups. The risk tends to be lower in Asian and Hispanic American men.


  • Hormonal factors: the male sex hormone testosterone and its breakdown products can affect prostate cell growth. An imbalance or increased sensitivity to these hormones may increase risk.


  • Lifestyle and diet: a high-fat diet, especially consumption of red meat and saturated fat, and a lack of fruits and vegetables may be associated with a higher risk of prostate cancer. A healthy diet high in fruits, vegetables, and fiber-rich foods may reduce the risk.


  • Overweight: Obesity and high body fat have been linked to an increased risk of more aggressive forms of prostate cancer.


  • Smoking: Smoking may increase the risk for prostate cancer, especially more aggressive forms of the disease.


​It is important to note that the presence of these risk factors does not automatically lead to prostate cancer, and men without these risk factors may also develop the disease. Regular screening beginning at age 45, or 50 at the latest, and open communication with the physician are critical to assessing risk and taking appropriate action for early detection or treatment.

What are the symptoms of prostate cancer ?

Symptoms of prostate cancer may often go unnoticed in the early stages. However, as the tumor enlarges or spreads to other areas, various symptoms may appear. Here are some possible signs of prostate cancer:

  • Problems urinating: difficulty starting or stopping the flow of urine, weak urine stream, frequent urination (especially at night), feeling like you can't empty your bladder completely.

  • Blood in urine or semen: The presence of blood in the urine (hematuria) or semen (hemospermia) may be a sign of prostate cancer.

  • Pain or discomfort: Pain or discomfort in the pelvic area, lower back, hips, or upper thigh may indicate advanced disease or the presence of metastases.

  • Erectile dysfunction: difficulty getting or maintaining an erection may indicate involvement of the nerves or blood vessels by the tumor.

It is important to note that these symptoms may also indicate other diseases or conditions unrelated to prostate cancer. Nevertheless, if symptoms persist or are noticeable, men should see a doctor to determine the cause. Early detection of prostate cancer is usually done through regular screening examinations, primarily by determining the prostate-specific antigen test (PSA test) and rectal examination.

What are the stages of prostate cancer ?

In prostate cancer, the following stages are commonly used to describe the degree of spread of the tumor:

  • Stage I: Prostate cancer is confined to the prostate gland and cannot be detected by physical examination or imaging. The tumor is usually small and growing slowly.

  • Stage II: The tumor is still confined to the prostate, but it can be detected by a doctor or imaging tests. The tumor may be slightly larger than in stage I, but does not yet spread beyond the prostate capsule.

  • Stage III: The tumor has spread beyond the prostate capsule and may have invaded surrounding tissues, such as the surrounding fatty tissue or seminal vesicles. At this stage, the risk of lymph node involvement may already be increased.

  • Stage IV: The tumor has spread to distant organs or tissues.

The stages of prostate cancer help physicians evaluate the extent of the tumor and determine appropriate treatment options. Staging is based on various diagnostic procedures, including physical examination, imaging techniques such as MRI, PET - CT, or bone scintigraphy, and the result of tissue biopsies taken.

What forms of treatment are available for prostate carcinoma ?

There are several options available for prostate cancer, depending on the stage and aggressiveness of the tumor, as well as the individual needs and preferences of the patient. Here are some common treatment options:

  • Active Surveillance: For small tumor extent within the prostate and slower-growing, non-aggressive tumors, close monitoring of tumor growth can be performed without taking immediate treatment measures.

  • Surgery: prostatectomy, in which the entire prostate and, if necessary, the surrounding lymph glands are surgically removed, may be an option. Especially in the early stages of the tumor when it is still confined to the prostate.

  • Radiation therapy: radiation to the prostate can be delivered either externally (external beam radiation therapy) or by inserting radioactive implants into the prostate (brachytherapy). This may be required as a primary treatment or as an additional measure after a prostatectomy.

  • Hormone therapy: In advanced prostate cancer, hormone therapy - actually anti-hormonal therapy - may be used to block the production or action of testosterone, since prostate cancer growth is usually dependent on the male sex hormone.

  • Chemotherapy: chemotherapy may be used for advanced prostate cancer when the tumor has spread to other organs. It aims to fight cancer cells throughout the body.

It is important to note that the treatment decision is individualized and should be made in close consultation between the treating physician and the patient. In terms of theranostic treatment, which combines the use of radiopharmaceuticals to diagnose and treat cancer, this method is used in certain patients with advanced prostate cancer. It is a personalized medicine in which an appropriate radiopharmaceutical is selected that specifically binds to tumor cells and is then used for both diagnosis (e.g., PET scan) and targeted therapy (radionuclide therapy). Theranostic treatment has shown promising results and is considered one of the most effective forms of therapy for certain prostate cancer patients.

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