Treatment with Lutetium-PSMA for metastatic prostate cancer increasingly available at the NKI

The Netherlands Cancer Institute (NKI) is the first hospital in the Netherlands to offer Lutetium-PSMA therapy, covered by health insurance. This treatment is intended for patients with metastatic prostate cancer who have no other treatment options available to them, who are in sufficient physical condition, and whose tumors are PSMA-positive. The NKI will be using its limited capacity to start treating a part of the patient group in the Netherlands already, and will soon expand its capacity. The NKI is currently working towards making this treatment available in other centers as well.

The new Lutetium-PSMA therapy has been thoroughly tested in a large international scientific trial, of which the NKI was a part. This study showed that the patients with metastatic prostate cancer and no other treatment options who received Lutetium-PSMA therapy lived longer on average and experienced a better quality of life. Because of these results, this treatment will now be available and covered by health insurance in the Netherlands.

How does it work?
The therapy targets a specific marker of prostate cancer: the tumor cells often have a high expression of prostate-specific membrane antigen (PSMA) on their surfaces. A radioactive isotope, Lutetium-177, is attached to a small molecule created to bind to this particular antigen, the PSA-ligand. These isotopes collect in the tumor, delivering a targeted radiation dose from inside the tumor, destroying tumor cells, and shrinking or halting the growth of metastases.

Who will be eligible?
This new treatment is intended for patients with metastatic prostate cancer who no longer benefit from standard treatments like hormone therapy or chemotherapy. Among other things, the patient’s physical condition and blood values will be evaluated before the start of the treatment to ensure that they are eligible. A PSMA PET/CT scan can then reveal whether the radioactive substance is absorbed sufficiently by the cancer cells. If the patient qualifies for this treatment, they will receive an average of four Lutetium-PSMA shots over several months. These injections are delivered after a stay of at least six hours at the nuclear health department. The patient will have to follow several rules concerning the remaining radiation during the days following the therapy delivery, and several scans are made to record the absorption of the radioactive substance in the metastases.

Limited availability
Treatment with Lutetium-PSMA currently has limited availability in the Netherlands, which means that not everybody can benefit from this therapy right now. Preparing for this new therapy takes a lot of time and effort. The NKI has been able to treat its first patients and is currently working on expanding the capacity of the ward, lab, and scanners. The NKI is currently working towards making this treatment available in other locations as well, in collaboration with other hospitals.