South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer

  • M Vorster University of Pretoria
  • J Warwick Stellenbosch University
  • I O Lawal University of Pretoria
  • P Du Toit Bloemfontein Mediclinic
  • M Vangu University of the Witwatersrand
  • N E Nyakale University of KwaZulu-Natal
  • R Steyn University of Cape Town
  • A A Gutta Sefako Makgatho Health Sciences University
  • G Hart Rondebosch Medical Centre
  • S Mutambirwa Sefako Makgatho Health Sciences University
  • A Ellmann Stellenbosch University
  • M M Sathekge University of Pretoria
Keywords: 177Lu-PSMA, RLT, metastatic castrate-resistant prostate cancer, theranostics

Abstract

Background: Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct identification and treatment of patients who are likely to benefit from receptor radioligand therapy.

Recommendations: There are a multitude of treatment modalities available for the treatment of prostate cancer and these therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and should ideally also involve a palliative/pain specialist, a dietician and a psychologist.

Conclusion: Treatment with 177Lu-PSMA has emerged as a promising systemic modality, which involves the delivery of targeted radiation therapy in the form of β-particles to sites of tumour tissue. Therapy is provided on an outpatient basis, is well tolerated with relatively few side effects and has a positive effect on overall survival and quality of life. At present, it is used mostly in the setting of advanced, castrate-resistant cancer. Patients are selected (amongst other criteria) based on the prior PSMA-based SPECT/PET/CT imaging (99mTc-,68Ga- or 18F PSMA), which should demonstrate sufficient receptor expression in order to consider PSMA-based targeted radionuclide therapy. Such imaging of an intended target prior to its therapeutic targeting is known as a theranostic approach.

Author Biographies

M Vorster, University of Pretoria

Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

J Warwick, Stellenbosch University

Department of Nuclear Medicine, Tygerberg Academic Hospital and Stellenbosch University, Stellenbosch, South Africa

I O Lawal, University of Pretoria

Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

P Du Toit, Bloemfontein Mediclinic

Nuclear Medicine, Bloemfontein Mediclinic, Bloemfontein, South Africa

M Vangu, University of the Witwatersrand

Department of Nuclear Medicine, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

N E Nyakale, University of KwaZulu-Natal

Department of Nuclear Medicine, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South 

R Steyn, University of Cape Town

Division of Nuclear Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

A A Gutta, Sefako Makgatho Health Sciences University

Department of Nuclear Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

G Hart, Rondebosch Medical Centre

Oncology, Rondebosch Medical Centre, Cape Town, South Africa

S Mutambirwa, Sefako Makgatho Health Sciences University

Department of Nuclear Medicine, Sefako Makgatho University, Pretoria, South Africa

A Ellmann, Stellenbosch University

Department of Nuclear Medicine, Tygerberg Academic Hospital and Stellenbosch University, Stellenbosch, South Africa

M M Sathekge, University of Pretoria

Department of Nuclear Medicine

University of Pretoria and Steve Biko Academic Hospital

Pretoria

Published
2019-11-04
How to Cite
Vorster, M., Warwick, J., Lawal, I., Du Toit, P., Vangu, M., Nyakale, N., Steyn, R., Gutta, A., Hart, G., Mutambirwa, S., Ellmann, A., & Sathekge, M. (2019). South African guidelines for receptor radioligand therapy (RLT) with Lu-177-PSMA in prostate cancer. South African Journal of Surgery, 57(4), 45-51. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3170
Section
Guideline