What is Theranostics, Cancer Cells, Theranostics Singapore, Dr Andrew Tan

What Is Theranostics?

Theranostics is a viable method of treating cancer, especially when the cancer cells have spread or are at a more advanced stage and are unable to respond to other treatments.

While there is still a lot of potential to replicate the procedure for other types of cancers, to date, theranostics has shown success mostly in treating liver cancer, metastatic prostate cancer, and neuroendocrine tumours.

Who Invented Theranostics?

The term theranostics was invented in 2002 by John Funkhouser, who was the Chief Executive Officer of PharmaNetics at the time. The term is essentially a combination of the word “therapeutics” and “diagnostics” – a portmanteau describing the PharmaNetics business model for developing diagnostic tests to identify cancer cells and the application of specific therapies.

What Is Theranostics in Nuclear Medicine?

Theranostics in nuclear medicine, or nuclear theranostics, refers to a specific type of cancer treatment.

It targets infection sites by first using diagnostic imaging or a radioactive drug to identify if target receptors are present on cancer cells, followed by a second radioactive drug to deliver therapy to treat the primary tumour and any advanced or metastatic tumours.

Does Nuclear Medicine Have Side Effects?

Only small amounts of radioactive material, known as radiopharmaceuticals or radiotracers, are used in nuclear medicine. These radiopharmaceuticals emit radiation that travels a short and safe distance, which is why very few people experience side effects or allergic reactions from nuclear medicine tests.

Any adverse reactions or side effects are usually mild and need little to no medical treatment. Generally, you should not feel much difference after the radiotracers are administered.

What Is the Theranostic Approach?

The theranostic approach is personalised, using both diagnosis and therapy tools as part of the treatment.

Theranostics in the Treatment of Cancer

Theranostics eliminates the need for multiple procedures to treat cancer, which reduces delays in treatment and improves patient care. In the diagnosis stage, PET scan imaging is used to locate specific targets known as tumour receptors or target receptors present on tumour cells.

As for the therapy stage, once these targets are visible on the scan, a radioactive drug will be injected into the body. This drug is used to treat tumours by selectively targeting the tumour cells and avoiding healthy areas. The radioactive drug that is not utilised or cannot reach the target will be passed out of the body.

What Is Metastatic Prostate Cancer?

Metastatic prostate cancer is an advanced stage of prostate cancer where cancer cells have spread to other parts of the body. It occurs when cells break away from the tumour in the prostate.

During the metastatic stage, these cancer cells usually break away and travel through the lymphatic system in the lymph nodes and the bones or through the bloodstream to other parts of the body.

What Is the Survival Rate for Metastatic Prostate Cancer?

The survival rate of prostate cancer entirely depends on the various stages of cancer. The staging system uses three different aspects of tumour growth – tumour, nodes, and metastasis. Patients whose prostate cancer has spread to other areas like the bones, liver or lymph nodes are in the metastasis stage and may need more advanced treatment.

According to the American Society of Clinical Oncology, about one-third of patients with metastatic prostate cancer will survive for more than five years.

Can Metastatic Prostate Cancer Be Cured?

There are many types of treatment available to slow down the spread of metastatic prostate cancer. Your doctor or oncologist will develop a treatment plan that takes into account your symptoms, stage of cancer, and general health.

What Are the Treatment Options Available For Metastatic Prostate Cancer?

Radiation therapy: External radiation therapy shrinks the tumour in the prostate or kills any new metastasised cancer cells in other areas.

Hormone therapy: This form of therapy lowers the production of male sex hormones, which can help prevent the spread of cancer cells.

Chemotherapy: Chemotherapy prevents cancer cells from multiplying. Patients usually receive chemotherapy once the prostate cancer has stopped responding to hormone therapy.

Immunotherapy: This form of therapy triggers and boosts the immune system to attack cancer cells. Immunotherapy filters immune cells out of the body and stimulates them at a lab to target prostate cancer. These cells are then reinfused back into the patient’s body intravenously (IV).

Bisphosphonate therapy: Patients with prostate cancer that has spread to the bones may undergo bisphosphonate therapy which blocks a bone cell from breaking down other parts of the bone.

How Is Theranostics Used to Treat Metastatic Prostate Cancer?

Radium 223 (Xofigo) is a radioactive drug used in a theranostics procedure to treat castrate-resistant Prostate Cancer, symptomatic Bone Metastases and no known Visceral Metastatic Disease.

The aim of the therapy is to control the bony metastases and to reduce symptoms of bony pain (if present).

Lutetium 177 PSMA is another radioactive drug that is used to treat metastatic castrate resistant prostate cancer, and can target all prostate cancer lesions as long as they express the PSMA ligand on the cell surface.

What Is Hepatocellular Carcinoma (HCC)?

Hepatocellular carcinoma (HCC), also known as primary liver cancer, is a complex heterogeneous cancer. When diagnosing this form of cancer, the choices for treatment will depend heavily on the extent of the cancer and the severity of the underlying chronic liver disease.

What Is the Survival Rate for Hepatocellular Carcinoma?

As Hepatocellular carcinoma is generally diagnosed late in its course, its median survival rate is approximately 6 to 20 months from the time of diagnosis. Globally, it is the 6th most common cancer, and it has become the 2nd most common cause of cancer-related mortality.

Can Hepatocellular Carcinoma Be Cured?

If caught early, it can sometimes be cured with surgery or a transplant. In more advanced cases, it often cannot be cured, but consistent treatment and support can help you live longer, with an improved quality of life.

What Are the Treatment Options Available For Hepatocellular Carcinoma?

There are two types of treatments for Hepatocellular carcinoma; curative and non-curative treatment options.

Curative treatment options include partial liver resection or hepatectomy, local ablation, and liver transplantation, which may provide a high probability of long-term survival.

Non-curative treatment options can be administered when patients are no longer suitable for curative treatment options due to the severity of the disease and condition of the liver or individual’s overall fitness capacity.

Non-curative treatment options that may prolong life are transarterial chemoembolisation (TACE), selective internal radiation therapy (SIRT) with yttrium-90 and systemic therapy. These treatment options are also occasionally used as a neoadjuvant treatment to downstage patients for curative therapy.

How Is Theranostics Used to Treat Hepatocellular Carcinoma?

In theranostics procedures, Yttrium-90 SIRT therapy, a form of Selective Internal Radiation Therapy (SIRT), can be used to treat liver cancer. Yttrium-90 SIRT therapy aims to reduce the size of inoperable tumours that cannot be removed in surgery and/or decrease the number of abnormal cells in the liver. Occasionally, a successful Yttrium-90 SIRT treatment may make it plausible for tumours to be removed surgically.

This form of radiation therapy targets and damages the cancer cells in the liver, reduces the size of the tumours, and prevents the cancer from metastasising further. It is administered via an injection of Yttrium-90 into the main blood vessels in the liver.

What Are Neuroendocrine Tumours (NETs)?

Neuroendocrine tumours (NETs) or neuroendocrine neoplasms (NENs) are rare tumours that develop in cells of the neuroendocrine system.

The World Health Organization (WHO) groups neuroendocrine tumours according to three main categories of tumour grade:

Well-differentiated neuroendocrine tumours, further subdivided into tumours with benign and those with uncertain behaviour
Well-differentiated (low grade) neuroendocrine carcinomas with low-grade malignant behaviour
Poorly differentiated (high grade) neuroendocrine carcinomas, which are the large cell neuroendocrine and small cell carcinomas.

What Is the Survival Rate for Neuroendocrine Tumours?

According to a study conducted on NETs patients from 1973 to 2014, the median survival duration was 41 months. Out of 73,782 NETs patients, the 1-, 3-, 5-, and 10-year overall survival rates were 72.8%, 52.7%, 39.4%, and 18.1%, respectively.

However, general statistics on survival rates must be viewed within the proper context. Your physician should conduct further prognosis depending on your condition.

Can Neuroendocrine Tumours Be Cured?

There are treatments available to prevent the tumours from spreading further. In some cases, neuroendocrine tumours are dormant, small and slow-growing. Studies have shown that slow-growing tumours, when diagnosed early and with proper treatment, can reduce symptoms and limit spreading.

What Are the Treatment Options Available For Neuroendocrine Tumours?

The treatment of neuroendocrine tumours depends on the prognosis and diagnosis of your condition. Treatment options depend on the grade of tumour, which part of the body it originated from, the level of aggressiveness, and how advanced it has spread to distant parts of the body.

How Is Theranostics Used to Treat Neuroendocrine Tumours?

In theranostics procedures to treat neuroendocrine tumours, Lutetium-177 Octreotate therapy (Lu-Octreotate) can be considered a radioactive drug to target radiation on cancer cells without damaging much of the healthy tissue.

Also referred to as Peptide Receptor Radionuclide Therapy (PRRT), Lu-Octreotate therapy combines octreotate, a manufactured form of the naturally produced hormone somatostatin, and lutetium-177, a compound that releases radiation into a tumour.

This theranostic procedure kills abnormal cells, which in turn reduces the size of the NETs tumour from growing further and multiplying. This may mean that the tumour will be relatively dormant for longer periods of time, but it does not mean that NETs can be cured completely.

Coping With Prostate Cancer, Prostate Cancer Treatment, Theranostics for Prostate Cancer, Coping With Prostate Cancer

What Is Prostate Cancer?

The prostate is a small gland located below the urinary bladder and surrounding the urethra (pelvic cavity). This gland is regulated by the testosterone hormone and produces seminal fluid or semen.

Cancer occurs when abnormal growth occurs in the prostate gland, and in many cases, it usually spreads to the surrounding tissues.

Prostate cancer is one of the most common cancers in men. Statistically, it is known that 1 out of every ten men will be diagnosed with this disease.

In the United States, the diagnosis is usually in the initial stages, but it does not represent all cases, especially in Latin America, whose diagnosis is late. That is, cancer has metastasised to other organs and tissues.

The most affected population is the one between 65 years of age and older (representing 60% of cases), according to epidemiological data from the American Cancer Society (ACS).

What Are the Symptoms of Prostate Cancer? 

The symptoms of prostate cancer are not always perceptible by the subject since many can go years without knowing that they have such a disease. This event occurs commonly in those patients with slow-growing prostate cancer.

In general, the men who develop symptoms are those whose cancer has advanced in extension and/or size. Among these symptoms, we have:

  • Urinary problems: the frequent desire to urinate, slow urination stream, blood in the urine (hematuria).
  • Sexual issues: sexual dysfunction (impotence), bleeding after ejaculation.
  • Pelvic, back, or chest pain due to the spread of cancer to bone tissue, affecting these areas.
  • Numbness or loss of sensation in the legs and bladder due to the spread of cancer to the spinal cord.

The first symptoms to appear are urinary. However, some of these symptoms are associated with other pathologies such as benign prostatic hyperplasia and prostatitis.

It is important to note that if some of these symptoms occur – especially hematuria – a specialist doctor should be consulted immediately. Early diagnosis is the key to a speedy recovery.

How Is Prostate Cancer Diagnosed?

Prostate cancer is usually indolent and asymptomatic, and diagnosis is often through health screening. 

Digital Rectal Exam

The doctor will insert a gloved finger into your rectum to evaluate the presence of lumps, lumps, or an out-of-normal growth of the prostate.

Prostate-Specific Antigen (PSA) Test

This is a test that detects levels of an enzyme produced by the prostate gland and can be elevated in cases of prostate cancer. 

Medical Imaging (e.g. MRI, PET/CT)

Magnetic Resonance Imaging (MRI) can be used to image the prostate gland to determine if there are any usual or suspicious spots in the prostate that might be cancerous. 

Positron Emission Tomography (PET) imaging using PSMA ligands can similarly be used to image the patient with suspected prostate cancer, evaluate the prostate, and determine if there is any spread of disease. 

The ultimate diagnosis of prostate cancer will depend on a tissue sample. This requires a prostate gland biopsy to extract small tissue samples for testing. 

What Are Some of the Treatment Options & Side Effects of Prostate Cancer?

Your doctor will recommend the best therapeutic options, according to your age and stage of the disease. In some cases, it begins with active surveillance in the absence of symptoms.

In case of preexisting symptoms, the therapeutic alternatives for the treatment of prostate cancer are the following:

1. RADIATION

External Beam Radiation therapy is one of the options used to treat prostate cancer. This is typically done when the cancer is confined to the prostate, with low probability or no evidence of spread. 

Each radiotherapy session lasts from 10-30 minutes on average, and its frequency is approximately five a week for ten weeks. This may vary depending on the size of the cancer and the specialist’s criteria.

2. CHEMOTHERAPY

Chemotherapy is typically used when prostate cancer has spread and primarily for disease control. This can be combined with other forms of treatments (e.g. radiation or hormonal).

3. TARGETED THERAPY

Targeted therapy typically targets specific pathways in the tumour replication cycle. 

Among the most widely used drugs we have rucaparib (rubraca) and olaparib (Lynparza), which treat metastatic castration-resistant prostate cancer.

4. IMMUNOTHERAPY

Immunotherapy is nothing more than a treatment that stimulates the immune system of men with prostate cancer to attack cancer cells. The vaccine is called Sipuleucel-T (Provenge).

This vaccine treats patients with advanced cancer who do not respond to hormone therapy and have little or few symptoms. It is created specifically for each man from his white blood cells in combination with proteins.

The vaccine does not cure cancer, but it does increase survival rates. Once again, it will be the doctor, the one person who determines if you are a suitable candidate for this treatment.

5. SURGERY

Prostatectomy is often the mainstay for treatment in patients with early-stage prostate cancer. This involves removing the prostate gland with possible dissection of the regional pelvic lymph nodes. 

General or regional (spinal) anaesthesia is usually used, numbing the lower body.

Patients often choose laparoscopic surgery or robot-assisted prostatectomy since recovery is faster and has fewer side effects. Other types of surgery are laser and endoscopic, and – in both – a probe is inserted through the opening of the penis.

Transurethral Resection of the Prostate and Transurethral Incision of the Prostate (TUIP) is another procedure to cut enlarged prostate segments, which are removed through the bladder.

6. THERANOSTICS

Concerning theranostics as a form of treatment, we will mention two options aimed at prostate cancer:

  1. Radium-223 (Xofigo) Therapy: This drug works like targeted radiation therapy, used when cancer has spread to the bone and helps prevent symptoms of the disease.
  2. Prostate-Specific Membrane Antigen (PSMA) Therapy with Lutetium-177: Like all theranostics therapies, it is a nuclear medicine radionuclide treatment. This allows for very specific, targeted radiation therapy.

Coping With Prostate Cancer & Seeking Support

Every cancer treatment can cause side effects or result in changes to your body and how you feel. The side effects experienced vary between individuals. As such, it can be hard to predict and anticipate what you may feel during cancer treatment.

As you prepare to start cancer treatment, it is normal to feel anxious and concerned about the treatment-related side effects. Speak to your medical care team about your worries. It may help to know that they are prepared to help you cope with these side effects. 

Coping With the Physical Side Effects of Prostate Cancer

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects, so it is easier to explain any changes with your health care team. 

Some physical side effects can continue even after treatment ends. This is referred to as long-term side effects, and they can occur months or years after treatment. Treating these long-term side effects is an important part of survivorship care. 

Coping With the Sexual Side Effects of Prostate Cancer

Unfortunately, the treatment for prostate cancer can affect one’s sexual health. While some of these sexual side effects may be temporary and go away within a year after treatment, some can be longer-lasting.

Talk with your medical care team about how your treatment can affect your sexual health. Here are some side effects that you can expect from prostate cancer treatment: 

  • Reduced or a loss of sexual desire. Some treatments for prostate cancer can lower testosterone levels and affect your sexual desire, making you less interested in physical intimacy or intercourse. 
  • Erectile dysfunction
  • Treatment may cause patients to experience a reduction in semen production. This can affect one’s chances of fathering a child.
  • Some patients may find that their penis shrinks after prostatectomy by up to an inch. Research has indicated that this side effect is temporary, and the penis regains its size after a year. 

If you experience any of these side effects, speak with your health care team about how you can manage or cope with the sexual side effects of prostate cancer. While this may be uncomfortable for some, sexual recovery is an integral part of the quality of life, and your health care team will be able to help you. 

Additionally, patients may find that it takes longer to become aroused as they may feel distracted or anxious. Patients often find it challenging to address the sexual side effects of prostate cancer with their partners. However, it can be helpful to focus on other forms of intimacy, such as kissing and cuddling. This can aid in keeping the connection between you and your partner strong. 

Coping With the Emotional & Social Side Effects of Prostate Cancer

It is normal for you to experience emotional and social effects after a prostate cancer diagnosis. This may include dealing with challenging emotions, such as sadness, anxiety, anger. It is essential for you to manage your stress level during this period. 

If you find it challenging to speak to your family or loved ones about the feelings you are experiencing during this time, you may want to speak to a counsellor or seek support within your faith. 

Coping With the Costs of Prostate Cancer Treatment

Prostate cancer treatment can be expensive. It is often a significant source of stress and anxiety for patients with cancer. In addition to prostate cancer treatment costs, many patients find they have extra, unplanned expenses related to their care. The high cost of medical care stops some people from following or completing their cancer treatment plan. 

However, your health is a priority. Therefore, patients and their families are encouraged to talk about financial concerns with a member of their health care team. 

What Are Some Recommended Changes to My Diet if I Have Prostate Cancer?

While there is no evidence that any particular foods have an effect on prostate cancer, it is important to adopt a healthy diet to keep your body nourished. 

Treatment for prostate cancer can cause issues with your diet, such as diarrhoea after undergoing radiotherapy. Some men find it challenging to maintain a healthy weight. They may find themselves either under or overweight. Speak to our doctor about being referred to a dietitian if you find it difficult to keep within a healthy weight range. 

What Is a Healthy Diet for Prostate Cancer?

A healthy diet if you have been diagnosed with prostate cancer is about balancing the different food groups and choosing foods that are both tasty and nutritious. 

  • Aim for at least 5 portions of fruit and vegetables each day. This can be fresh, tinned, frozen or dried.
  • Aim for a range of different colours of fruit and vegetables. This gives you a variety of essential vitamins and minerals.
  • Include starchy foods daily, such as potatoes, bread, rice and pasta.
  • Opt for whole-grain versions of cereals, bread and pasta.
  • Remember to include pulses such as beans, lentils and peas; they are a low-fat alternative to meat and a healthy source of protein.
  • Avoid processed meats such as ham, bacon, and sausages.
  • Limit the amount of red and processed meat.
  • Choose lean meat, chicken, or fish instead.
  • Limit saturated fats found in fatty meat, biscuits, crisps, cheese, cream and butter.
  • Use healthier unsaturated fats like vegetables, olive and sunflower oils. 
  • Limit the amount of high-calorie in your diet.

Additionally, ensure you are getting enough water each day. Aim for 6 to 8 glasses daily. A well-balanced diet can help keep your body strong and aid you in recovering from prostate cancer. 

Bowel Problems With Prostate Cancer – When to Seek Help

Radiotherapy to the prostate gland can alter the way your bowel functions. You may find that your bowel movements are more frequent and loose. Changing your diet can help tackle this issue. 

Additionally, radiotherapy to the prostate gland can affect tissue and the surrounding organs in one’s pelvic area, leading to more long term side effects. Speak to your doctor if you find yourself:

  • Needing to poo at night
  • Rushing to the loo to have a bowel movement or not being able to make it in time
  • Bleeding from your rectum

If you experience other bowel symptoms that interfere with you living an active full life and find it challenging to stick to a healthy diet due to these side effects, speak to your doctor or dietitian about the steps you can take to cope. 

Where Can I Find Support in Singapore if I Have Prostate Cancer?

If you have been diagnosed with prostate and are looking for support groups in Singapore, here are two options that you may want to consider: 

How Can I Help Support a Loved One With Prostate Cancer?

If you are the primary caregiver for someone who has been diagnosed with prostate cancer, you may be wondering how you can better care for your loved one. 

Understanding the Caregiver Role

As a caregiver, you provide support in various forms. This may include day-to-day activities, medical needs, helping them make important decisions, and tending to their emotional needs. 

The role of a caregiver takes many forms. Understanding what is required of you can better prepare you to carry out your responsibilities in helping your loved one. The extent of help that your loved one needs may vary depending on their stage of diagnosis, age, and overall health. 

There are 5 broad categories of what is needed from a caregiver. They are: 

  1. Physical needs, which includes aiding with daily activities.
  2. Health and medical needs; where you ensure that the patient is taking medicine and attending their medical appointments. 
  3. Emotional needs; in which you show your love and support. 
  4. Spiritual needs; where you are there to help them continue their religious practices and beliefs. 
  5. Financial and legal needs; where you aid them in managing their insurance and assets when they cannot do so and planning for their future. 

Caregiving Is a Team Effort

It is important to talk to your loved ones and include them in the planning and decision-making process if the patient is comfortable with this. It helps to be able to share the load amongst different caregivers. 

For instance, one family member or friend could be handling financial affairs and another providing daily care. Sharing the load can make it easier for you to take care of your loved one. 

Caregiver Support

Taking on the role of a caregiver can come with its own set of stresses and uncertainties. It is important to recognise your own needs and capabilities. This will help you avoid caregiver burnout. Remember, you cannot care for your loved one if you are unwell or burnt out. 

Lutetium-177, Prostate Specific Membrane Antigen, PSMA, Cancer Treatment, What to Expect, Theranostics, Theranostics Singapore, Dr Andrew Tan

What Is Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Prostate-Specific Membrane Antigen (PSMA) is a type of receptor found on cell membranes throughout the body and is particularly increased on the cell surfaces of prostate cancer. 

Lutetium-177 PSMA Therapy uses two components. One of them is a PSMA molecule that binds to the PSMA receptor in cancer cells. The other is a radioactive drug known as Lutetium-177 (Lu 177), which, when transported to the cancer cell by the PSMA molecule, is able to kill the cancer through radioactivity. 

The purpose of the treatment with Lu-177 is to destroy cancer cells, preserving healthy tissue – and – although it is not a cure – it can minimise the cancer’s symptoms, slow tumour growth, and prolong the patient’s quality of life.

What Is Prostate Cancer?

Prostate cancer is one of the most common cancers among men. Approximately 1 in 9 men will be diagnosed with prostate cancer in their lifetime, and it is the second leading cause of cancer-related death in men in the United States. While the majority of prostate cancers are early stage at diagnosis, a significant portion will have regional or distant metastases. 

As men get older, the prostate increases in size. This abnormal growth often does not produce any symptoms, so prevention is key. However, this abnormal growth of the prostate gland usually oppresses the bladder and urethra, which can thus manifest the first symptoms. 

In turn, a man may present difficulties with his erection. Sterility is also a possibility.

If you suspect that you are suffering from some of the symptoms of prostate cancer, make an appointment with your doctor.

What to Expect Before Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Our doctor will conduct a series of tests – from blood tests to more specialised studies to evaluate the state of the kidney and salivary glands – that will determine if you are the right candidate for treatment with Lutetium-177 PSMA.

This will typically include a PET scan (Positron Emission Tomography) using PSMA as the ligand. This will allow us to stage the disease. Our doctor will explain the possible side effects of the treatment and clarify any concerns you may have. 

What to Expect During Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

This type of therapy is typically used for men with castrate-resistant metastatic prostate cancer who have undergone previous hormonal treatments and chemotherapy and are now progressing.

Typically, this type of treatment is done in a nuclear medicine department. Treatment with Lutetium-177 PSMA Therapy minimises the effects of prostate cancer and prevents its spread to neighbouring tissues and organs. 

How Long Does Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy Take?

Once you are in the treatment area, our doctor will briefly explain the procedure: a peripheral catheter will be placed in your arm to start treatment.

Generally, each treatment will take approximately 30 minutes. It consists of 2 – 4 doses with 4 – 8 weeks apart between each dose.

What to Expect After Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Our doctor may recommend the additional use of an antiemetic (for nausea) and a diuretic to help clear the lutetium from your body. 

After the administration, you must wait a few hours in the hospital while the effects of the radiation diminish. Approximately 1- 2 days after treatment, our doctor will request an imaging study, specifically a Single-Photon Emission Computed Tomography (SPECT) scan.

How Long Do I Have to Wait to Be Discharged After Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Once the first treatment session is over, the patient must stay in the nuclear medicine centre for roughly two hours. Patients must wait for the radioactivity to diminish in intensity before being allowed to go home.

How Am I Going to Feel After Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

In general, the infusion of the Lutetium 177 PSMA is usually fast and painless, with no complications encountered. 

As expected, any treatment brings with it potential side effects, which may or may not occur. Some of the more common side effects include

  • Tiredness or fatigue
  • Xerostomia (dry mouth). In some cases, this may be fairly severe, usually in patients undergoing multiple rounds of treatment. 
  • Nausea, not always accompanied by vomiting.
  • Effects on the bone marrow, resulting in reduced blood counts (platelets, red blood cells). This is usually transient and mild, but blood transfusion may be needed in some patients. 
  • Dry eyes

There may be radiation exposure to other organs such as the kidneys and small intestine, but reported side effects are rare. 

However, you should feel free to speak to our doctor if you have any concerns about how you feel post-treatment. 

What Questions Should I Ask My Doctor?

If you are feeling overwhelmed by your diagnosis, here are some questions that you can ask your doctor. 

  • How do I know if I am qualified to receive PSMA treatment with Lutetium-177?
  • Is Positron Emission Tomography (PET Scan) necessary?
  • How long does Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy last?
  • Should I stay long after the first therapy session is completed?
  • Will I have all the side effects, and for how long?
  • Will I have sexual dysfunction-related issues?
  • Will the therapy cure my cancer?

After treatment, it is normal for the body to experience different symptoms. The type and severity of symptoms vary between patients, and the more common side effects have been outlined. 

If you have any symptoms, consult your doctor immediately, especially if prolonged or increasing in severity. Our doctors are available to clarify any doubts or concerns you have and help you minimise the side effects.

Finally, it can be concluded that therapy with Lutetium 177 Prostate-Specific Membrane Antigen (PSMA) is often a satisfactory therapy option to reduce pain and other symptoms associated with mCRPC (castration-resistant metastatic cancer) – notably if other treatments have failed. Remember to consult with your doctor for any questions you may have.

Radium-223 Therapy, Xofigo, What to Expect, Theranostics, Theranostics Singapore, Cancer Treatment, Patient Information, Dr Andrew Tan

What Is Radium-223 Therapy (Xofigo)? 

Radium-223 Therapy (Xofigo) is a form of targeted radioactive therapy. It is a type of radioactive treatment that targets sclerotic bony metastases.

What Is Prostate Cancer?

Prostate cancer is one of the most common cancers among men. Approximately 1 in 9 men will be diagnosed with prostate cancer in their lifetime, and it is the second leading cause of cancer-related death in men in the United States. 

While most prostate cancers are early stage at diagnosis, a significant portion will have regional or distant metastases.

What to Expect Before Treatment With Radium-223 Therapy (Xofigo)?

Our doctor must confirm that you have prostate cancer through existing studies and tests. Once this is confirmed, our doctor typically requests a series of tests to assess your general health.

You will need a bone scan that demonstrates bony metastases. 

You may also be asked to stop taking calcium before the treatment session. Our doctor will sit down with you to look at your medical history, explain the severity of the disease and everything related to the treatment. Take advantage of this moment to clarify any possible concerns you may have.

What Will My Radium-223 Therapy (Xofigo) Treatment Schedule Look Like?

Our treating doctor will explain the damage to your body caused by prostate cancer and the consequences of not being treated. They will also explain the program you must follow to achieve the best possible treatment outcome with Radium-223 Therapy (Xofigo). 

Other information that will be provided to you will be regarding possible adverse effects and the therapeutic measures that you can take to minimise these effects. 

What happens after treatment and the prevention measures to keep in mind will be explained in detail. 

Finally, you may be advised to stop any other radiotherapy or chemotherapy treatments that you are undergoing before starting Radium-223 Therapy (Xofigo).

What to Expect During Treatment With Radium-223 Therapy (Xofigo)?

The treatment program for Radium-223 Therapy (Xofigo) consists of intravenous administration (peripheral route in one arm) of the drug. 

Treatment typically comprises 4-6 sessions, with a period of 4 weeks between each one.

The drug will be administered directly in the vein, and the procedure is typically fast and painless. 

Before each session, a blood sample will be drawn to evaluate health parameters and haematological conditions.

How Long Does Treatment With Radium-223 (Xofigo) Take?

Radium-223 Therapy (Xofigo) is a relatively quick procedure, which will take no more than half an hour. The application of the intravenous drug takes no more than a minute.

As mentioned, additional time will be required while the nurse places the catheter for the intravenous line and its subsequent removal.

What to Expect After Treatment With Radium-223 Therapy (Xofigo)?

After Radium-223 Therapy (Xofigo) treatment, there will be low-grade radioactivity from the patient. Small amounts of radioactivity may be present in the urine and stools. 

One of the advantages of this type of treatment is that it will not be necessary to avoid contact with family and friends since the radiation levels received is very low. Still, the doctor will give you a card stating that you have received such treatment.

How Long Before I Can Be Discharged After Treatment With Radium-223 (Xofigo) Therapy? 

As it is an outpatient procedure, discharge after intravenous application will be quick – it will not take more than a couple of hours for the first side effects to subside. Generally speaking, within 1-2 hours, you may be on your way home.

How Will I Feel After Treatment With Radium-223 (Xofigo) Therapy? 

Once the treatment is complete, you may feel somewhat dizzy or, in some cases, fatigued. It is normal to have some discomfort since you have received radiation treatment. However, try not to worry as these symptoms should disappear relatively quickly. In case of persistence, consult our doctor.

This type of therapy for prostate cancer is one of the few that generates minimal side effects. Among them, we have:

  • Nausea
  • Diarrhoea
  • Anaemia
  • Oedema in the ankles and wrist 

If you have had a therapy session and you have persistent side effects, feel dizzy, confused, and weaker than normal, or have any other symptoms that are not expected, notify our doctor immediately.

Any prolongation of the symptoms may be a cause for alarm, so you must notify your medical care immediately. Our doctor will take the necessary therapeutic measures to correct any discomfort as your body responds to the treatment.

Radiation Safety Precautions

As mentioned above, there will be small traces of radiation particles in the urine, blood, and faeces. Therefore, you must comply with the following radiological safety conditions:

  • Flush the toilet twice and wash your hands properly.
  • Wash clothes and sheets stained with vomit, blood, urine, and faeces separately. Handle with gloves.
  • Stay well hydrated before and after therapy.
  • Use a condom when having sex to prevent your partner from becoming pregnant (it is dangerous because of the effects of radiation) – this recommendation is valid for six months.
  • Do not expose your partner to pre-seminal fluid and semen, as it may contain radioactive particles.

What Questions Should I Ask My Doctor?

If you are feeling overwhelmed by your diagnosis, here are some questions that you can ask your doctor. 

  • How do I know if I am a candidate for Radium-223 Therapy (Xofigo)?
  • Is it an outpatient procedure? Why?
  • How many therapy sessions with Radium-223 Therapy (Xofigo) do I need?
  • What happens if I don’t follow through with all the Radium-223 Therapy (Xofigo) sessions?
  • Is it mandatory to stop other methods of therapy like chemotherapy?
  • Should I stop taking dietary supplements that contain calcium?
  • Should I take any security measures with my family and partner?
  • Can I have sex?
  • What do I do if I have blood in my urine?
  • Is it mandatory to have blood tests before each session?
  • Could I end up being sterile?
Prostate Cancer, Cancer, Theranostics, Prostate Cancer Treatment, Nuclear Medicine

What Is Prostate Cancer?

Prostate cancer is one of the most common cancers in men. Statistically, it is known that 1 out of every ten men will be diagnosed with this disease.

In the United States, the diagnosis is usually in the initial stages, but it does not represent all cases, especially in Latin America, whose diagnosis is late. That is, cancer has metastasised to other organs and tissues.

The most affected population is the one between 65 years of age and older (representing 60% of cases), according to epidemiological data from the American Cancer Society (ACS).

The prostate is a small gland located below the urinary bladder and surrounding the urethra (pelvic cavity). This gland is regulated by the testosterone hormone and is responsible for producing seminal fluid or semen.

Cancer occurs when abnormal growth occurs in the prostate gland, and in many cases, it usually spreads to the surrounding tissues.

What Are the Different Types of Prostate Cancer?

The prostate cancer with the highest incidence of cases is called Adenocarcinoma, which develops from glandular cells (they produce the prostate fluid that binds to semen).

Although it is not the only type, there are others whose percentage of appearance is minimal. Among them, we have:

  • Small cell carcinomas
  • Neuroendocrine tumours (other than small cell carcinomas)
  • Transitional cell carcinomas
  • Sarcomas

Prostate cancer can also be classified according to its growth:

  • Aggressive or fast-growing: The tumour grows rapidly and usually spreads to neighbouring organs quickly.
  • Non-aggressive or slow-growing: the tumour does not grow, or its growth is very slow.

What Causes Prostate Cancer?

Doctors and scientists still do not know the causes that trigger prostate cancer. It is known that family history (a family member with cancer), exposure to radiation, or certain chemical compounds can influence the development of this pathology.

Other risk factors that have already been mentioned are advanced age, obesity, race, especially African ethnicity, which are risk factors for developing.

Age is undoubtedly a relevant factor since it occurs more frequently in men over 65 years of age and with a 14: 1 ratio in men between 60 and 69 years of age.

What Are the Symptoms of Prostate Cancer?

The symptoms of prostate cancer are not always perceptible by the subject since many can go years without knowing that they have such a disease. This event occurs commonly in those patients with slow-growing prostate cancer.

In general, the men who develop symptoms are those whose cancer has advanced in extension and/or size. Among these symptoms, we have:

  • Urinary problems: the frequent desire to urinate, slow urination stream, blood in the urine (hematuria).
  • Sexual issues: sexual dysfunction (impotence), bleeding after ejaculation.
  • Pelvic, back, or chest pain due to the spread of cancer to bone tissue, affecting these areas.
  • Numbness or loss of sensation in the legs and bladder due to the spread of cancer to the spinal cord.

The first symptoms to appear are urinary symptoms. However, some of these symptoms are associated with other pathologies such as benign prostatic hyperplasia and prostatitis.

It is important to note that if some of these symptoms occur – especially hematuria – a specialist doctor should be consulted immediately. Early diagnosis is the key to a speedy recovery.

How Is Prostate Cancer Diagnosed?

The diagnosis of prostate cancer is usually according to the individual’s preference, given that it does not generate symptoms in most cases, and its diagnosis is advantageous.

Sometimes, specific antigen tests produce a false positive, which leads to unnecessary treatments. Routine annual exams and a preventive check-up in the population at risk described above are keys to a more accurate diagnosis.

The doctor will perform a physical examination, and it will review your medical history in detail, emphasising the family history, but may also perform one of the following tests:

Lab tests

Digital rectal exam: The doctor will insert a gloved finger into your rectum to evaluate the presence of lumps, lumps, or an out-of-normal growth of the prostate.

Prostate-Specific Antigen (PSA) Test: This is a test that detects your blood levels.

Biopsy

Prostate biopsy: 

The specialist will extract a small sample of the prostate gland. This test is linked to a Gleason scale. When the score is less than 6, it means it does not have signs of cancer, and if the value is equal to or greater than 7, it may be a sign of cancer.

The PSA tests and biopsy are evaluated by a specialist doctor, who will determine the state and severity of the disease.

Imaging tests

Magnetic resonance (MRI): 

It creates a detailed image of the soft tissues, especially a very clear image of the prostate and neighbouring tissues. It is useful to determine the incision point in case of surgery.

Computed tomography: 

Although it is not a study of choice, it is used in cases where metastases to bone or surrounding organs are suspected – such as screening after chemotherapy or radiotherapy – to see the size of the prostate and determine if the treatment is being effective.

Bone scan: 

Generally speaking – if the prostate cancer has spread – it does so towards the bone tissue, and this scan allows detection of possible areas of metastasis. To corroborate this diagnosis, resonance and/or tomography should be used.

PET/CT:

This is advanced hybrid imaging that utilises radiotracers to detect specific metabolic pathways or cells. In respect to prostate cancer, a ligand called prostate-specific membrane antigen (PSMA) is typically used to detect prostate cancer cells. This form of imaging can be considered the current gold standard of prostate cancer staging.  

What Are the Treatment Options Available for Prostate Cancer?

Your doctor will recommend the best therapeutic options, according to your age and stage of the disease. In some cases, it begins with active surveillance in the absence of symptoms.

In case of preexisting symptoms, the therapeutic alternatives for the treatment of prostate cancer are the following:

1) Radiation

Radiation therapy is one of the therapeutic options used to treat prostate cancer. The most common type is the external beam of radiation, which goes to specific points on the body.

Its primary purpose is to reduce the size of the tumour and cancer cells, which is why half of the patients receive this type of treatment. Its use can be before or after a surgical intervention or in combination with other therapies.

Each radiotherapy session lasts from 10-30 minutes on average, and its frequency being approximately five a week for ten weeks. This may vary depending on the size of the cancer and the specialist’s criteria.

Here are some of the possible side effects of radiation therapy:

  • Involvement of healthy cells that will eventually recover
  • Burning, dry, itchy, and peeling skin condition
  • Diarrhoea
  • Earache
  • Dry mouth
  • Mouth ulcers
  • Throat pain
  • Nausea
  • Difficult to swallow
  • Difficult to urinate, pain, and urinary urgency
  • Sexual dysfunction
  • Joint problems
  • Oedema of the tissues or lymphedema (accumulation of fluids in the lymph nodes)

Most of these effects disappear after two months. In case of persistence, consult your doctor.

2) Chemotherapy

It is a chemical pharmacotherapy procedure whose purpose is to destroy rapidly growing cells, prevent their spread to other regions. In other words, to prevent metastasis, reduce the size of the tumour and reduce the symptoms caused by cancer. Chemotherapy is usually combined with radiation therapy, surgery, or other treatments.

One of the disadvantages of this type of treatment is that other rapidly growing cells can be affected, such as blood cells, skin, hair, and epithelial lining.

Although chemotherapy is beneficial, it generates the following side effects:

  • Presence of bruising and excessive bleeding
  • Diarrhoea
  • Dry mouth
  • Mouth ulcers
  • Fatigue
  • Fever
  • Hair loss
  • Loss of appetite
  • Nausea and vomiting
  • Weight loss
  • Pain from nerve damage
  • Infections
  • Anaemia
  • Constipation
  • Neuropathy
  • Lymphedema
  • Memory and concentration problems
  • Skin and nail changes
  • Insomnia
  • Sexual changes, such as impotence and low sexual desire
  • Fertility changes

These effects are reversed at the end of the treatment, although in some cases, you may see some organ involvement (heart, kidneys, lungs, reproductive organs, and nerves).

3) Targeted Therapy

It is a cancer treatment that uses drugs to destroy cancer cells, causing minor damage to normal cells. Each targeted therapy works differently but has the same goal, which is to destroy cancer. 

Among the most widely used drugs, we have rucaparib (rubraca) and olaparib (Lynparza), which treat metastatic castration-resistant prostate cancer. These help repair cellular DNA damage. The medic will be the one who determines if this type of treatment is necessary.

Targeted therapy has the following side effects:

  • Nausea and vomiting
  • Diarrhoea or constipation
  • Tiredness
  • Loss of appetite
  • Low red blood cell count (anaemia)
  • Skin lesions
  • Abnormalities in blood tests for the liver
  • Low platelet count
  • Cough and shortness of breath
  • Rare cases of blood clots in the legs and lungs

4) Immunotherapy

Immunotherapy is nothing more than a treatment that stimulates the immune system of men with prostate cancer to attack cancer cells. The vaccine is called Sipuleucel-T (Provenge).

This vaccine treats patients with advanced cancer who do not respond to hormone therapy and have little or few symptoms. It is created specifically for each man from his white blood cells in combination with proteins.

The vaccine does not cure cancer, but it does increase survival rates. Once again, it will be the doctor, the one person who determines if you are a suitable candidate for this treatment.

The side effects of immunotherapy are as follows:

  • Fever
  • Shaking chills
  • Tiredness
  • Headache, back, and joint pain
  • Nausea
  • In some cases, breathing problems and hypertension

5) Surgery

Known as radical or partial prostatectomy, where the entire prostate gland (radical) or only a segment of it (partial) is removed. The prostatectomy for both cases can be open, which generates a larger scar at the level of the lower abdomen or of the laparoscopic type, which would be through small incisions.

General or regional (spinal) anaesthesia is usually used, which numbs the lower body.

Patients often choose laparoscopic surgery or robot-assisted prostatectomy since recovery is faster and has fewer side effects. Other types of surgery are laser and endoscopic, and – in both – a probe is inserted through the opening of the penis.

Transurethral Resection of the Prostate and Transurethral Incision of the Prostate (TUIP) is another procedure to cut enlarged prostate segments, which are removed through the bladder.

These are some side effects of the different types of surgery:

  • Blood in the urine
  • Urinary irritation
  • Difficulty holding urine
  • Urinary tract infections
  • Inflammation of the prostate
  • Reaction to anaesthesia
  • Infection of the surgical site
  • Impotence or erectile dysfunction, transient, rarely permanent (only if the nerves are injured)
  • Transient sexual dysfunction, that is, difficulty obtaining orgasms
  • Lymphedema in the leg or genital area

6) Theranostics

In relation to this type of treatment, we will mention two options aimed at prostate cancer:

  1. Radio-223 (Xofigo) Therapy: This drug works like targeted radiation therapy, used when cancer has spread to the bone and helps prevent symptoms of the disease.
  2. Prostate-Specific Membrane Antigen (PSMA) Therapy with Lutetium-177: Like all theranostics therapies, it is a nuclear medicine radionuclide treatment. This allows for very specific and targeted radiation therapy.

These are some side effects of the theranostic treatment of radio-223 therapy (Xofigo):

  • Decrease in red, white blood cells and platelets
  • Patients with low-grade myelosuppression are the most common.
  • Nausea and vomiting
  • Diarrhoea
  • General weakness

Side effects of prostate-specific membrane antigen (PSMA) therapy with lutetium-177:

  • Decrease in red, white blood cells and platelets (transitory event)
  • Nausea and fatigue
  • 10-20% of patients experience decreased salivation

Who Will Benefit From Treatment With Radium-223 (Xofigo) Therapy?

 

It is a targeted radioactive therapy that is ideal for patients with metastatic castration-resistant prostate cancer (mCRCP) that has metastasised to bone and generates symptoms in the patient without visceral metastases and biochemical progression.

Who Will Benefit From Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy?

Lutetium-177 PSMA therapy (“Lu177 PSMA therapy”) is a treatment for those individuals who cannot tolerate chemotherapy, have bone marrow involvement, or have mCRPC.

This therapy has shown a significant improvement in these types of patients, thanks to the fact that it acts as a radiation therapy directed at cancer cells.

What Are Some Questions I Should Be Asking My Doctor When Considering Treatment Options for Prostate Cancer?

  1. How far has the prostate cancer spread? Do I have metastases?
  2. Is my prostate cancer fast-growing?
  3. What is my best treatment option?
  4. Can I be left with sexual impotence?
  5. What is my real life expectancy after treatment?
  6. Would a prostatectomy be the best option to avoid metastasis?
  7. Do you know of any trials with less invasive alternative treatments?