Before starting therapy, you’ll have a PSMA PET-CT scan – a very precise diagnostic test. It uses a radioactive tracer that shows where prostate cancer has spread to other parts of your body that often can’t be seen on other imaging scans.

The tracer is a combination of a special carrier molecule and a radioactive substance called either ⁶⁸Gallium or ¹⁸Flourine. The carrier molecule is attracted to a substance called prostate specific membrane antigen (PSMA). PSMA is a type of protein found in high concentrations on the surface of prostate cancer cells, including those that have spread to other parts of your body.

This means the carrier molecule takes the radioactive substance directly to cancerous prostate cancer cells – even in the smallest tumours. The radioactive substance shows up on the PET-CT scan to reveal where these tumours are and help the Theranostics team plan your personalised treatment. The radioactive substance doesn’t stay in your body for long and is eliminated naturally.

If your PSMA PET-CT scan identified PSMA positive lesions potentially amenable to Lutetium-177 PSMA therapy, the case will be discussed by a Multi-Disciplinary Team (MDT) and if approved, you'll start your treatment within a few weeks. Lutetium-177 PSMA therapy is usually given every five to eight weeks typically over six cycles as an outpatient in our purpose-built Theranostics suites in Windsor or Surrey.

1. Each cycle works in a similar way to the PET-CT scan. This time, another radioactive substance that can destroy cancer cells, called ¹⁷⁷Lutetium, is attached to the carrier molecule that is attracted to PSMA.
2. When this is injected into your bloodstream, the carrier molecule ‘locks’ onto PSMA on the surface of prostate cancer cells, delivering the ¹⁷⁷Lutetium straight to its target. This sends a localised radiation dose to destroy the tumour, avoiding damage to healthy tissues in your body.
3. You’ll have an appointment with your consultant and a blood test before each cycle of your therapy, to check how well things are going.
4. After every two cycles, you’ll have a PET-CT scan to check how the cancer is responding to treatment and whether it’s appropriate to continue or consider other treatment options. Your treatment will be personalised according to your response and symptoms.

At the end of the sixth cycle, you’ll have another PSMA PET-CT scan to assess how well the treatment worked and what you can expect from it. You’ll be given a discharge summary for your referring doctor. You’ll need to have blood tests regularly after your treatment which does not need to be done at the Windsor or Surrey centre. Your consultant will advise how often you should have them.

As with all cancer treatments, you may experience side effects. These could include:

• A dry mouth
• Nausea
• Loss of appetite
• Tiredness

You may also have reduced production of blood cells for a while. This is because bone marrow – which produces blood cells – can also take up some of the ¹⁷⁷Lutetium. If you’ve already had chemotherapy and radiotherapy, your bone marrow may be more sensitive to the effects of radiation. Your doctor will discuss this with you before your treatment begins. After treatment, you’ll need to have regular blood tests to keep track of any changes to your blood.

The Theranostics team will be available during and after treatment should you have any questions and will continue to follow up on your health and wellbeing by phone or email.

¹⁷⁷Lutetium PSMA therapy may be suitable for you if you have prostate cancer that has spread elsewhere in your body and other treatments haven’t worked or you’re unable to tolerate them. The PSMA PET-CT scan must also show that you’re suitable for the treatment. The scan will show whether the special carrier molecule selectively targets the prostate cancer cells and not healthy cells.

Your consultant will discuss your prostate cancer, treatments to date and overall health with you in detail before advising if this is right for you.