Gallium-68 PSMA PET-CT
This is currently the most effective imaging technology for assessing the spread of prostate cancer to other organs or tissues. A prostate-specific agent called PSMA is combined with the radioisotope gallium-68 and injected into the patient intravenously, after which PET-CT imaging is carried out. Gallium-68 PSMA binds to certain molecules specific to prostate cancer cells and makes it possible to visualise cancerous tissue. This method does not expose patients to very high doses of radiation.
How is the Gallium-68 PSMA PET-CT scan carried out?
The scan must be planned the day before, so an appointment is made. After the intravenous injection of the agent, a waiting period of 45 to 60 minutes is observed. Once the patient is in the scanner, imaging lasts about 20 minutes, during which time the patient must not move. The whole process can take 2 to 3 hours in the Nuclear Medicine department. Patients are advised to drink plenty of water before and after the scan. As some radiation remains in the body for a while after the scan (8 to 12 hours), you should keep away from pregnant women and especially from children.
Gallium-68 DOTA-TATE PET-CT
This is the most advanced technology available for diagnosing neuroendocrine tumours. On the surface of neuroendocrine tumour cells there is a particular receptor (receptor protein) called "somatostatin". DOTA-TATE is a peptide compound able to bind to these receptors. Combined with a radioactive agent called "Gallium-68" and injected into the patient, it makes it possible to visualise, with great precision on the PET-CT scanner, tissue containing tumour cells. This method does not expose patients to very high doses of radiation.
LUTETIUM-PSMA therapy
Lutetium-PSMA therapy (177Lu-PSMA) is a radionuclide treatment increasingly used in patients with advanced prostate cancer. The aim of this therapy is to reduce the size of the tumour and stop the growth of tumour cells. In this setting, it is possible both to control the progression of the disease and to relieve the symptoms of advanced stages, such as pain and widespread bone fatigue. This therapy is generally used when the disease is progressing or spreading, or when the patient cannot tolerate the side effects of other treatments such as chemotherapy.
Is LUTETIUM-PSMA therapy safe?
The radiation used in this therapy is intended to destroy cancer cells. The PSMA injected into the body travels to the tumour and targets the cancer cells. Besides prostate cancer cells, PSMA is also present in tissues such as the salivary glands, the tear glands and the kidneys. These tissues can therefore also be exposed to radiation. However, this effect remains small and, because PSMA binds directly to cancer cells, it does not cause the devastating side effects of chemotherapy. In some patients, side effects such as dry mouth, temporary fatigue or a temporary fall in blood counts may be seen. These effects can be monitored with blood tests carried out at regular intervals in the period following therapy. In addition, patients who may be susceptible to side effects can be identified through tests before the treatment decision is made. Individualised treatment strategies, tailored to each patient and supported by test results and dosimetry studies, ensure that side effects are kept to the lowest possible level.
LUTETIUM-DOTA-TATE therapy
Lutetium-octreotide therapy [Lutetium-DOTA-TATE (177Lu-DOTA-TATE)] is a treatment increasingly used in patients with advanced neuroendocrine cancer. Its other name is "peptide receptor radionuclide therapy" (PRRT). The aim of this therapy is to reduce the size of the tumour and stop the growth of tumour cells. In this setting, it is possible both to control the progression of the disease and to relieve the symptoms of advanced stages, such as pain and widespread bone fatigue. This therapy is generally used when the disease is progressing or spreading, or when the patient cannot tolerate the side effects of other treatments.
Is LUTETIUM-DOTA-TATE therapy safe?
The radiation used in lutetium-octreotide therapy is intended to destroy cancer cells. Once injected into the body, the smart molecules targeting somatostatin receptors travel to the tumour while targeting the cancer cells. Besides cancer cells, somatostatin receptors are present in many different organs. These tissues can therefore also be exposed to radiation. However, this effect remains small and, because the smart molecules attach directly to cancer cells, they do not cause any of the devastating side effects of chemotherapy. In some patients, side effects such as a temporary fall in blood counts may be seen. These effects can be monitored with blood tests carried out at regular intervals in the period following therapy. In addition, patients who may be susceptible to side effects can be identified through tests before the treatment decision is made. Individualised treatment strategies, tailored to the patient and supported by test results and dosimetry studies, ensure that side effects are kept to the lowest possible level.
Radium therapy
Radium therapy is a form of treatment used in patients whose prostate cancer has metastasised to the skeletal system and bones. The aim of this therapy is to destroy the cancer cells present in the bones, thereby reducing or even eliminating the tumours. In addition to its therapeutic effect, it is also used to relieve the pain caused by bone metastases.
Is radium therapy safe?
Because the energy level of the radiation used in radium therapy is very high, its destructive power is also very high. However, by its nature, this alpha-type radiation can only travel very short distances. Here, a short distance means a length equivalent to the size of 2 to 10 cells. Because of the characteristics of this alpha radiation, it destroys the cancer cells present in the bone without affecting normal healthy cells. Side effects after therapy are rare and generally take the form of a temporary fall in blood counts. For this reason, patients must be checked at regular intervals after treatment.
Actinium therapy
Ac-225 PSMA is the name of the radioactive agent injected into the patient as part of targeted alpha therapy for prostate cancer. It is a form of therapy that can be used in patients with advanced metastatic prostate cancer. The aim of this therapy is to reduce the size of the tumour, stop the growth of tumour cells and destroy them. In the treatment of prostate cancer, radionuclide therapies are preferred when the disease is progressing or spreading, when other treatments such as chemotherapy are ineffective, or when the patient cannot tolerate the side effects of those therapies. As a rule, the first choice for patients in whom radionuclide therapy has been decided on is Lutetium PSMA. Lutetium-PSMA is a treatment method applied to thousands of patients, both in Turkey and worldwide. Reduction of symptoms, longer life expectancy and improved quality of life are among the main goals of Lutetium-PSMA therapy. However, despite Lutetium-PSMA therapy, some patients may not respond to treatment, or the response of the disease to the therapy may be insufficient. The disease may continue to progress despite treatment. The medical literature has shown that targeted alpha therapies with Actinium-225-PSMA give better results in this group of patients.
Is actinium therapy safe?
The radiation used in actinium therapy (AC-225) is intended to destroy cancer cells. The PSMA injected into the body travels to the tumour and targets the cancer cells. Besides prostate cancer cells, PSMA is also present in tissues such as the salivary glands, the tear glands and the kidneys. These tissues can therefore also be exposed to radiation. However, this effect remains very small and, because PSMA binds directly to cancer cells, it does not cause any of the devastating side effects of chemotherapy. In some patients, side effects such as dry mouth, temporary fatigue or a temporary fall in blood counts may be seen. These effects can be monitored with blood tests and examinations carried out at regular intervals in the period following therapy.
Kezban Berberoğlu
M.D.
Diagnostic Services – Pathology
Kezban Berberoğlu
M.D.
Diagnostic Services – Pathology
Education and career
• Trakya University Faculty of Medicine
• İstanbul University Faculty of Medicine
• Johns Hopkins School of Medicine, Baltimore, USA
Areas of expertise and medical interests
• Nuclear oncology
• Nuclear cardiology
• Member of the Turkish Society of Nuclear Medicine
Research and publications
• 2 international publications
• 12 national publications