Lu-177 PSMA Therapy - Lutetium PSMA Treatment
Lu-177 PSMA therapy is a radioligand treatment for advanced prostate cancer that carries lutetium-177 radiation directly to cancer cells carrying PSMA. Given as a drip every six weeks for up to six cycles, it extended survival after hormone therapy and chemotherapy and doubled disease control before chemotherapy. Our nuclear medicine team confirms suitability with a PSMA PET/CT scan, gives each cycle over a short stay and follows you once you are back home.
About This Department
Lu-177 PSMA therapy carries radiation straight to prostate cancer cells wherever they have spread. The same target that lights up on the PSMA scan becomes the treatment.
Lu-177 PSMA therapy, or lutetium PSMA treatment, is a radioligand therapy for advanced prostate cancer in which a molecule that binds to PSMA, a protein found in large amounts on prostate cancer cells, is joined to lutetium-177, a radioactive metal whose short-range beta radiation damages the cancer cells and those next to them. Patients receive it as a drip every six weeks, for up to six cycles. In the VISION trial of 831 men with metastatic castration-resistant prostate cancer that had progressed after hormone therapy and chemotherapy, adding Lu-177 PSMA-617 to standard care extended median survival from 11.3 to 15.3 months (Sartor and colleagues, New England Journal of Medicine, 2021). Doctors now also use it before chemotherapy. A PSMA PET/CT scan first confirms that the cancer carries enough PSMA. This page explains how the treatment works, who qualifies, the trial results, the scans before treatment, a treatment day, radiation safety at home, side effects, monitoring, and how patients from abroad arrange treatment at Biruni Hospital in Istanbul.
What Lu-177 PSMA therapy is
| Part | What it is | Role |
|---|---|---|
| PSMA-617 or PSMA I and T | Small molecule ligand | Finds and binds PSMA on cancer cells |
| Lutetium-177 | Radioactive metal | Delivers beta radiation to the cancer |
| Gamma rays from lutetium-177 | Small side emission | Allow imaging after each dose |
Doctors call the approach theranostics, because one target serves first to diagnose, with a PSMA PET scan, and then to treat.
Who qualifies
The treatment is for men whose prostate cancer has spread and keeps growing despite hormone therapy, called metastatic castration-resistant prostate cancer.
| Requirement | Why | How it is checked |
|---|---|---|
| Spread prostate cancer growing on hormone therapy | The approved setting | Rising PSA, new lesions on scans |
| At least one new hormone tablet already tried | Abiraterone, enzalutamide, apalutamide or darolutamide | Treatment history |
| PSMA-positive disease on PET | The drug needs the target | PSMA PET/CT |
| Adequate blood counts and kidney function | Bone marrow and kidneys receive some radiation | Blood tests |
| Situation | Reason | Alternative |
|---|---|---|
| Large tumors without PSMA uptake | Radiation would miss them | Chemotherapy or other treatment |
| Very low blood counts, extensive marrow disease | Risk of marrow suppression | Treatment adjusted or deferred |
| Poor kidney function | Drug cleared by kidneys | Individual assessment |
| Spinal cord compression | Needs local treatment first | Radiotherapy or surgery, then reassessment |
Results after chemotherapy
Lutetium-177-PSMA-617 plus standard care significantly prolonged both imaging-based progression-free survival, median 8.7 against 3.4 months, and overall survival, median 15.3 against 11.3 months (Sartor and colleagues, 2021).
Compared with chemotherapy
Lu-PSMA-617 compared with cabazitaxel led to a higher PSA response, 66 against 37 percent, and fewer grade 3 or 4 adverse events, 33 against 53 percent (Hofman and colleagues, Lancet, 2021).
| Measure | Lu-177 PSMA with standard care | Standard care alone |
|---|---|---|
| Median survival | 15.3 months | 11.3 months |
| Median time before scans showed progression | 8.7 months | 3.4 months |
| Serious side effects, grade 3 or higher | 52.7 percent | 38.0 percent |
| Measure | Lu-177 PSMA | Cabazitaxel |
|---|---|---|
| PSA fall of half or more | 66 percent | 37 percent |
| Serious side effects, grade 3 or 4 | 33 percent | 53 percent |
Before chemotherapy
| Measure | Lu-177 PSMA | Switch to another hormone tablet |
|---|---|---|
| Median time before scans showed progression | 11.6 months | 5.6 months |
| Serious side effects, grade 3 to 5 | 36 percent | 48 percent |
| Crossed over to Lu-177 PSMA later | Not applicable | 57 percent |
For patients with PSMA-positive metastatic castration-resistant prostate cancer being considered for a change of androgen receptor pathway inhibitor, Lu-PSMA-617 may be an effective treatment alternative (Morris and colleagues, Lancet, 2024).
Scans before treatment
| Test | Purpose | Timing |
|---|---|---|
| PSMA PET/CT | Confirms the target, baseline for response | Within weeks before cycle 1 |
| Blood counts, kidney and liver tests | Safety | Days before each cycle |
| PSA | Baseline and trend | Before each cycle |
The treatment cycle
Each cycle is a single infusion. Six weeks later comes the next, up to six cycles in total.
| Time | Step | Note |
|---|---|---|
| Day 0 | Blood tests, consultation | Confirms safe to proceed |
| Day 1 | Infusion, rest in a shielded room | Several hours to overnight |
| Day 2 | Post-treatment scan, discharge | Written radiation precautions |
| Weeks 2 to 6 | Blood tests every two weeks | Watch blood counts and kidneys |
Radiation safety at home
After each dose
The radiation from lutetium-177 falls by half every 6.7 days, and most of the dose leaves the body in urine within the first two days.
- Drink plenty of water and empty the bladder often for the first days.
- Wash hands well after using the toilet.
- Carry the treatment card when traveling, since airport detectors may register the radioactivity.
| Precaution | Usual duration | Note |
|---|---|---|
| Keep distance from children and pregnant women | About one week | Brief contact is fine |
| Sleep in a separate bed | About three to seven days | Varies by dose and country rules |
| Avoid sexual contact, use condoms | About one week, condoms for longer | Protects partners |
Side effects
| Side effect | How often | What helps |
|---|---|---|
| Dry mouth | Common, usually mild | Sips of water, sugar-free gum, saliva substitutes |
| Tiredness | Common in the first weeks | Rest, gentle activity |
| Nausea | Common on treatment days | Anti-sickness medicine |
| Low blood counts, especially platelets and anemia | Serious in a minority | Blood tests, transfusion, dose delay |
| Kidney changes | Uncommon | Hydration and monitoring |
Will I lose my hair or feel as unwell as on chemotherapy?
Monitoring response
Realistic expectations
Lu-177 PSMA extends life and eases symptoms. Cure remains rare.
The men who gain most have high, uniform PSMA uptake and few deposits that lack it. For them, PSA can fall to very low levels and stay down for many months, with bone pain easing and energy returning. Others respond for a shorter time. When the cancer grows again, further treatment is still possible, including chemotherapy, other radioligand agents in trials, and in some cases more Lu-177 PSMA after a break. The team sets out what to expect, plainly, before the first cycle.
For patients from abroad
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Six cycles over about seven months means six trips, or a longer stay for patients who prefer to remain in Istanbul.
Traveling home
Keep the card close. Store it with your passport for the first weeks after each cycle, since some airports use radiation detectors at security.
Cost
Treatment is priced per cycle, and most men receive four to six.
What is included
| Item | Included | Priced separately |
|---|---|---|
| Treatment | The radiopharmaceutical, infusion, shielded room stay | Extra nights for medical reasons |
| Imaging | Post-treatment scan | PSMA PET/CT before and after treatment |
| Tests and review | Blood tests on treatment days, nuclear medicine review | Transfusions or management of complications |
References
- Sartor O, de Bono J, Chi KN, et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021;385(12):1091-1103.
- Hofman MS, Emmett L, Sandhu S, et al. [177Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP). A randomised, open-label, phase 2 trial. Lancet. 2021;397(10276):797-804.
- Morris MJ, Castellano D, Herrmann K, et al. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore). A phase 3, randomised, controlled trial. Lancet. 2024;404(10459):1227-1239.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Burçak YILMAZ, Nuclear Medicine.
Medically reviewed by
Prof. Dr. Burçak YILMAZ
Nuclear Medicine
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