The uniqueness of this treatment is that the radioactive substance can be specifically directed to tumor cells that have prostate-specific membrane antigen (PSMA) on their surface. The radiopharmaceutical preparation attached to this target allows radiation to affect tumor cells and disease foci, including those that may still be invisible in conventional imaging studies, according to a press release from Santaros Clinics.
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The medical director of Santaros Clinics, VU Associate Professor Donata Ringaitienė, says that every new treatment option primarily means more opportunities for the patient – especially when we talk about a complex and advanced disease: “The start of radioligand therapy at Santaros Clinics is an important step that allows us to offer patients a modern treatment precisely targeted at tumor cells. However, such medical possibilities do not arise by themselves – they are created by people, their competence, teamwork, and the ability to combine knowledge from different fields into one treatment process. I am proud of our team of specialists who not only implemented a new treatment method but also created a safe and high-quality treatment system for the patient.”
When prostate cancer becomes resistant to hormone therapy
Treatment of prostate cancer often begins with drugs that suppress the effect of hormones, as the growth of prostate cancer cells is stimulated by male sex hormones. For a certain period, such treatment can effectively control the disease.
However, in some patients, the disease eventually becomes resistant to hormone suppression. This means that even with reduced levels of male hormones in the body, the tumor continues to grow and spread. This stage of the disease is called castration-resistant prostate cancer.
“Castration-resistant” in this case does not mean that treatment is no longer applied or that there are no treatment options left. It describes the disease characteristic – the tumor becomes resistant to hormone suppression. Other treatment methods may be applied to such patients, including chemotherapy and radioligand therapy.
Radioligand therapy specifically becomes another treatment option for patients whose disease progresses despite previously applied treatments. The effectiveness and safety of this treatment in patients with metastatic castration-resistant prostate cancer are supported by clinical trials.
The radioactive substance is delivered exactly where it is needed
Radioligand therapy can be simply explained as a kind of “internal radiotherapy”: “A radiopharmaceutical preparation is injected into the patient’s vein, one part of which recognizes a specific tumor cell target, and the other – the radioactive isotope lutetium-177 (¹⁷⁷Lu) – emits ionizing radiation that damages tumor cells and causes their death,” explains the head of the Radiation Safety Service, VU Associate Professor Dr. Birutė Gricienė. “Since the radioisotope is directed to the tumor through a specific receptor, the energy it emits mainly affects the areas where tumor cells are present.”
In this case, the target is PSMA receptors located on the surface of prostate cancer cells. The preparation binds to them, and its radioactive part, mainly beta radiation, damages the tumor cells. Thus, the treatment is directed at disease foci while striving to preserve healthy tissues as much as possible.
Another important feature of this method is that the journey of the preparation in the body can be seen. This means that nuclear medicine specialists can assess where it accumulates and how it distributes in the body. Thus, diagnostic and treatment possibilities are closely linked in this case.
“Today, it is important for the patient not only that we can offer an innovative treatment method. Equally important is that behind this treatment lies a whole system ensuring its accuracy and safety. Radioligand therapy is not just a new drug or a new therapeutic procedure. It is new competencies, infrastructure, and close collaboration among specialists from different fields,” says the head of the Nuclear Medicine Department at the Radiology and Nuclear Medicine Center, radiologist Dr. Renata Komiagienė.
Lutetium – the chosen radioisotope for treatment
The radioisotope lutetium-177 (¹⁷⁷Lu) is used in radioligand therapy. “The beta radiation it emits has enough energy to damage tumor cells and cause their death,” explains the head of the Radiation Safety Service, VU Associate Professor Dr. Birutė Gricienė. “Since the radioisotope is directed to the tumor through a specific receptor, the energy it emits mainly affects the areas where tumor cells are present.”
Lutetium is a radioactive isotope of the chemical element lutetium, used not as a separate “drug” but as part of a radiopharmaceutical preparation. It is combined with a molecule capable of recognizing a specific tumor target. This combination allows the radioactive substance to be delivered to the required location.
It is also important that the goal of treatment is not always to completely destroy the tumor. When the disease is very advanced, treatment can also help with symptom control – for example, reducing pain and improving the patient’s quality of life.
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Treatment begins with patient selection
Although radioligand therapy is innovative, it is not prescribed to every patient with prostate cancer. One of the most important stages of the entire process is careful patient selection.
Before treatment, the patient’s overall condition, disease spread, previously applied treatments, laboratory test results, kidney and bone marrow function must be evaluated. This allows assessing not only the expected benefit of treatment but also possible risks: “Kidney function is especially important because part of the preparation that does not enter the tumor tissue is eliminated from the body through urine. Therefore, before treatment, it is necessary to ensure that the kidneys can safely eliminate the radiopharmaceutical preparation,” explains radiologist Dr. Komiagienė on the importance of patient selection.
Before treatment, the patient is provided with detailed information about how the procedure will proceed, what effects can be expected, what precautions need to be followed, and how to behave after treatment, which lasts about 2 hours, i.e., while the medication is being infused. Radiation safety recommendations are explained to the patient so that they can safely return to their usual environment. “Since the half-life of this isotope is about 7 days, the patient remains radioactive for some time after the procedure. The patient is advised, as much as possible, to sleep in a separate room for at least 7 days, avoid concerts and other events with many people, not be near pregnant women and children, and is instructed on personal hygiene. In clinical practice, this treatment is well tolerated – adverse effects are observed only in rare cases,” lists practical advice radiologist Dr. Komiagienė. It is also important that the goal of treatment is not always to completely destroy the tumor. When the disease is very advanced, treatment can also help with symptom control – for example, reducing pain and improving the patient’s quality of life.
The preparation is delivered by commercial flight and infused the next day. Before that, the patient is examined and prepared for the procedure.
Patient story: “I wanted to be treated because I believed it would help”
Jonas from Utena agreed to share his story. He is already over 80 years old. When asked how he feels after the procedure, he says that first of all, his mood is much better, looking forward to even better times ahead. The disease has troubled Jonas for 20 years: “In 2006, surgery was performed, after which the condition improved. Later, the disease returned, chemotherapy was prescribed, which took place during the COVID-19 pandemic. After that, health improved briefly, but around New Year’s, it began to worsen again,” the patient Jonas recounts his disease history. He considers it a fortunate coincidence that circumstances allowed him to receive this treatment: “I am happy and believe that this treatment will help, and God will grant me a few more years to live on this earth.” Jonas is very grateful to the entire medical team for the great care and support he felt throughout.
Behind one procedure – a whole team of specialists
Radioligand therapy is not just the injection of a radiopharmaceutical preparation. It is a complex process that combines the competencies of nuclear medicine, oncology, urology, medical physics, radiation safety specialists, radiopharmacists, and radiology technologists: the doctor evaluates treatment indications, the patient’s condition, and selects the treatment strategy. Radiology technologists ensure the proper preparation and injection of the radiopharmaceutical preparation. “In nuclear medicine therapy, the role of the medical physicist is invisible to the patient but very important throughout the treatment process. Our task is to help doctors assess the radiation dose received by tumor foci and critical organs and to ensure control of the radiopharmaceutical preparation’s activity and proper patient dosimetry,” says the head of the Radiation Safety Service, VU Associate Professor Dr. B. Gricienė.
Dosimetry is not limited to assessing the activity of the radiopharmaceutical preparation. “To accurately determine the radiation dose received by the patient, it is important to properly calibrate imaging equipment and activity measurement devices. This allows analyzing and assessing the radiation energy absorbed in different tissues. It is especially important to evaluate the doses received by critical organs where radiopharmaceutical preparations may accumulate, such as kidneys, bone marrow, and other critical organs, and, if necessary, optimize the administered radiopharmaceutical activity or reduce the number of treatment cycles,” says medical physics expert Dr. Kirill Skovorodko.
Radiation safety begins even before the procedure
Since a radioactive isotope is used for treatment, radiation safety is an integral part of the entire process. It begins even before the patient arrives for the procedure – evaluating the receipt, preparation, use of the radiopharmaceutical preparation, patient care after injection, staff exposure, and radioactive waste management.
Before starting such therapy, it is necessary to evaluate the premises and radiation safety solutions. At Santaros Clinics, a radiation safety expert assessment of the premises was conducted, and activities with the radioactive isotope lutetium were authorized. The permit to carry out activities with radioactive substances is issued by the Radiation Safety Center, which is the institution responsible for state radiation safety supervision and control and advises institutions on radiation safety issues.
An innovation created by more than one person
The start of radioligand therapy at Santaros Clinics is not only the application of a new treatment method. It is the result of new competencies, technological infrastructure, and the work of specialists from different fields.
“The essence of this treatment is not just the use of a radioactive substance. It is a precisely planned and controlled process in which every team member is important. The doctor decides on treatment indications and patient care, the medical physicist ensures dosimetry accuracy, the radiology technologist prepares and injects the radiopharmaceutical preparation to the patient, and radiation safety specialists help ensure safe working conditions. The combination of these competencies allows radioligand therapy to be applied responsibly and safely,” emphasizes radiologist Dr. R. Komiagienė.
Santaros Clinics aims to continue expanding the possibilities of modern nuclear medicine and to implement innovative treatment methods based on scientific and clinical research data. For the patient, this means not only another treatment option but also the opportunity to receive treatment that meets the advances of modern medicine closer to home.
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