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PSMA-Targeted Therapy (prostate specific membrane antigen targeted therapy)

Overview

PSMA-targeted therapy is a specialised radionuclide therapy primarily used for metastatic or advanced prostate cancer. This therapy uses radionuclides (commonly Lu-177, occasionally Ac-225) combined with a biomolecule that specifically targets the receptors on prostate cancer cells. Since PSMA radionuclide therapy is receptor-specific, it has fewer side effects than in conventional chemotherapy. PSMA therapy has been approved by the US-FDA (Food and Drug Administration) following the VISION Trial.

  • Patients are usually referred to a nuclear medicine physician for PSMA therapy when they have progressed on androgen deprivation drugs and taxane-based chemotherapy.
  • They can also be referred following progression to androgen drugs and are not candidates for taxane-based chemotherapy.

  • PSMA PET scan: to ascertain the target expression, sometimes in conjunction with FDG PET CT
  • Serum PSA
  • Performance status (ECOG)
  • Comprehensive blood work: including CBC, liver (LFT), and renal function tests (RFT)

  • Patient hydration is ensured, and IV hydration is provided if necessary.
  • Standard PSMA dosage is then slowly injected into the veins. The injection process usually takes just a few minutes.
  • PSMA-targeted therapy is usually an outpatient procedure. However, depending upon the local radiation guidelines, patient may be discharged the very next day.

PSMA radiolucent therapy is administered cyclically, usually 4-6 cycles depending upon the response following every cycle. Each cycle is administered with a gap of 6-8 weeks with multiple blood investigations, including the serum PSA and blood counts, to evaluate the treatment efficacy and side effects, if any.

The predominant benefit is symptomatic relief, translating to improved quality of life. Prostate cancer most commonly spreads to the skeleton and can cause bony pains; this can be optimally targeted by PSMA radioligand therapy. Most patients usually experience symptomatic relief in 2-4 weeks.

Some patients may experience dry mouth (xerostomia), dry eyes, fatigue, nausea, vomiting, loss of appetite, and transient reduction of blood counts, which usually recovers within a month.

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