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What is personalized medicine ?

Personalized medicine is a concept where diagnosis and treatment are tailored to the individual needs of the patients, 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 diease.

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 us 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 often used to diagnose and treat cancer. Theranostics is a subspecialty of Nuclear Medicine.

General information about prostate cancer 

Prostate cancer is the most common malignant tumor in men worldwide, with 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 are newly diagnosed each year, and about 1,200 men die with the disease each year. Prostate cancer thus accounts for about 25 percent of the incidence of all cancers in Austria.

In advanced stages, prostate cancer will metastasize to lymph nodes, skeleton but also to various organs. In patients with metastasizing prostate cancer, 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 prostate cancer ?

Prostate cancer 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 like a cuff immediately below the urinary bladder. The prostate produces seminal fluid that nourishes and transports semen.

Prostate cancer occurs when cells in the prostate gland change abnormally and begin to grow autonomously, 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 organs of the body.

In its early stages, prostate cancer usually has no specific 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 by a combination of different methods, including a digital rectal exam by the Urologist, 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 general conditions and his expectations 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 limitations to the treatment of prostate cancer. Men are advised to talk to their medical doctors about the benefits and risks of prostate cancer screening and finally come to an informed decision based on their individual circumstances.

What are the potential causes for prostate cancer ?

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

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

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  • 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.

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  • 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.​​

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  • 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 people.

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

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  • 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.

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  • Obesity: 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 discussions for early detection or treatment.

What are the symptoms of prostate cancer ?

Symptoms of prostate cancer may often remain unseen 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:

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  • Problems when 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.

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

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  • 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.

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  • 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.

Stages of prostate cancer ?

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

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  • 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.

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  • 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.

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  • 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, PETCT or bone scintigraphy and the result of tissue biopsies taken.

What forms of treatment are available for prostate cancer ?

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:

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  • 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.

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

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  • 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.

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  • 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.

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  • 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 approach in which an appropriate radiopharmaceutical is selected that exclusively binds to tumor cells and is then used for both diagnosis (e.g., PET scan) and targeted therapy (radionuclide therapy).

Theranostic treatment has proven its feasibility in various clinical trials and is considered to be one of the most effective therapeutic options for certain prostate cancer patients.

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