Radiopharmaceuticals That Target Psma
Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.
Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.
This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.
This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.
Possible side effects
Some of the more common side effects of this drug include:
This drug can lower blood cell counts:
- A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
- A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
- A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.
This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.
Other Questions About Radiation Therapy
Who can I contact if I have concerns about my treatment?
Many hospitals and clinics have a staff social worker who can help you during your treatment. Check with your doctor to see if this is available to you.
The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation, and they can give you information about resources. They can also discuss housing or transportation needs if you need.
People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can give you a list of support groups if youâre interested. Your social worker can offer more information about finding support, and you can look online for support group resources.
What about follow-up care?
After your radiation therapy sessions are complete, youâll visit your doctor for regular follow-up exams and tests. Your doctor will tell you how often to schedule your follow-up appointments.
You can also ask your doctor for a survivorship care plan. This outlines things like:
- The treatment you received
- What side effects you may get in the short and long term
- Who should be following you for testing and care
American Cancer Society: âRadiation Therapy for Prostate Cancer,â âRadiation Therapy Side Effects,â âCancer Therapy,â âEating Well During Treatment.â
OncoLink: âRadiation Therapy: Which type is right for me?â
Memorial Sloan Kettering: âWhat Is Brachytherapy?â
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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Patient Selection And Technical Description
Successful implementation of HDR brachytherapy for prostate cancer begins with appropriate patient selection. Anatomic factors lending to successful HDR treatment are as follows: prostate volume of approximately 20-60 cc a central/straight urethral position that can be adequately avoided during transperineal needle implant absence of significant benign prostatic hypertrophy/median lobe or transurethral resection of the prostate defect at the prostate base adequate spacing between the prostate and rectum and adequate pubic arch width to avoid interference with needle placement. Clinical factors include general risks of both anesthesia and elective surgical procedures . Careful attention must be paid to baseline urinary function. Brachytherapy is not a good treatment option for patients with significant baseline obstructive uropathy. Risks for significant obstructive complications of brachytherapy increase substantially in such patients, and our practice typically will exclude patients with a baseline American Urologic Association symptom score > 15 if already on medication, or > 20 if previously untreated for obstructive symptoms.3 Any of these factors are relative contraindications to performing HDR brachytherapy and the treating physician should consider them on a patient-by-patient basis, weighing risks and benefits.
Is Proton Therapy Safer Than Traditional Radiation
Traditional radiation therapy delivers radiation to the tumor and to healthy tissues around the tumor. With proton therapy , the majority of the radiation is delivered to the tumor.
A type of radiation treatment called proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.
Traditional radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.
Plus, proton therapy is more expensive than traditional radiation, and not all insurance companies cover the cost of the treatment, given the limited evidence of its benefits. Nevertheless, 31 hospitals across the country have spent millions of dollars building proton therapy centers, and many advertise the potential, but unproven, advantages of the treatment.
In the new study, patients treated with proton therapy were much less likely to experience severe side effects than patients treated with traditional radiation therapy. There was no difference in how long the patients lived, however. The results were published December 26 in JAMA Oncology.
These results support the whole rationale for proton therapy, said the studys lead investigator, Brian Baumann, M.D., of the Washington University School of Medicine in St. Louis and the University of Pennsylvania.
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Surgery For Prostate Cancer
A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinciÂ® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.
The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.
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Entrance And Exit Dose Defined
Entrance dose: The dose of radiation that inadvertently makes contact with normal cells before it reaches the cancerous tissue.
Exit dose: Imagine the radiation hitting the tumor, but then continuing on beyond it, taking out normal cells in its path.
The primary difference between proton therapy and Cyberknife is that protons do not have an exit dose, says Dr. Cavanaugh. Both modalities deliver entrance and target dose.
Many insurers have been unimpressed with the differences in outcomes with proton therapy and have declined to pay.
For many patients I prefer HDR brachytherapy to both proton and Cyberknife therapy. HDR stands for high dose rate.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy causes similar side effects to external beam radiotherapy. If you have brachytherapy on its own, some side effects may be less severe. If you have it with external beam radiotherapy, they may be more severe.
Brachytherapy causes similar side effects to external beam radiotherapy. Having brachytherapy with external beam radiotherapy may make some side effects more severe. Some side effects may take several weeks to develop and may last for longer.
What Are The Results Of Using Proton Therapy In Patients
For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.
For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.
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Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a persons quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
A PSA test every 3 to 6 months
A DRE at least once every year
Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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How Does Brachytherapy Compare With Other Forms Of Radiation Treatments
When used appropriately, brachytherapy has been shown to be as effective as conventional external beam radiation therapy and surgery for many cancers. It is best used in patients whose cancer has not spread, or metastasized. In many cases, brachytherapy is combined with external-beam radiation therapy, including stereotactic body radiation therapy, to get the best results.
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects dont appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
Sore Skin In The Treatment Area
Your skin may be sore on the inside and outside of your genitals and the area around your bottom . It can help to use a moisturiser on the outside everyday.
While you are having radiotherapy, do not:
- use hair removal cream.
If you want to use these products, wait until radiotherapy has finished and your skin is no longer red or sore.
Be extra careful to protect the skin in the area where youve had radiotherapy for at least the first year afterwards. Dont use sunbeds and use high factor sunscreen if part or all of the area will be exposed for example, if you are wearing a bikini.
This sore skin may also cause pain when you wee. Let your healthcare team know about your symptoms as soon as possible, so they can help.
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Problems With Your Bowels And Back Passage
Your bowel movements might be looser or more frequent than before your treatment. You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help.
You might find that you need to avoid high fibre foods as it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Inflammation of the back passage is another possible long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Talk to your doctor or specialist nurse if you have any of these side effects. They will be able to refer you to a specialist team that can help you to find ways of controlling the effects.
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How Brachytherapy Works
Brachytherapy works by preventing cancer cells from actively replicating. Unlike normal cells, which have a set replication cycle and a limited lifespan, cancer cells divide erratically and are essentially immortal .
While normal cells can be damaged by radiation, they have the ability to repair themselves and continue multiplying normally after treatment is stopped. Cancer cells are far less able to do so.
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Frequent Or Loose Poo
Your bowel movements might be looser or more frequent than before your treatment.
You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel, might also help. Your doctor or nurse can prescribe these for you. Talk to your doctor before taking these.
You might find that you need to avoid high fibre foods. Although we normally think a high fibre diet is the most healthy, it might worsen long term diarrhoea. Some people find it best to avoid high fibre vegetables, beans and pulses .
Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes:
- specialist nurses
Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
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Radiation Therapy Side Effects
Because the prostate is close to several vital structures, radiation therapy can disrupt normal urinary, bowel, and sexual functioning.Short-term ComplicationsYou may experience some temporary urinary symptoms, such as waking up in the night and needing to urinate, needing to urinate more often during …
What Is A Radiation Oncologist
If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the persons overall health and well-being through the process.
With advanced cancer, a patient may also be referred to a medical oncologist. This specialized doctor uses medicines such as chemotherapy and hormone therapy to treat cancers. Its common for several medical specialists to work together on a treatment plantheyre known as a cancer care team.
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