Lutetium-177 PSMA treatment

Could this treatment help me?

Your team reviews a PSMA scan using positron emission tomography (PET) to see whether the cancer has enough of the target. They also consider whether some important disease sites appear different or lack PSMA uptake. Sometimes a scan using fluorodeoxyglucose (FDG), a radioactive tracer similar to glucose, a sugar used for energy, adds useful information; it is not required for everyone.

Blood tests, earlier treatment, symptoms and your general fitness are considered together. Tell the team about difficulty passing urine, a blocked urinary tract, kidney disease, urinary leakage or a urinary catheter (a tube that drains urine). These do not all automatically rule out treatment, but they may change preparation or care.

Ask which exact medicine is proposed and whether its use is approved and available locally. Suitability is not defined simply by having tried every other treatment.

Preparing for treatment

• Ask which exact medicine is proposed, how many treatment sessions or cycles are planned and what would lead to a pause or change.
• Obtain a medicines plan. Hormone-suppressing treatment is commonly continued; do not stop injections or tablets yourself.
• Ask when blood tests are needed and whether food or fasting instructions apply.
• Discuss fluid restrictions so the amount you drink is suitable for your heart and kidneys.
• Explain your home circumstances: children, a pregnant household member, shared bedroom, shared toilet and anyone who helps with personal care.
• Discuss fertility (the ability to have children), contraception (preventing pregnancy) and any plans to father a child before treatment begins.
• Arrange transport and any required time away from close-contact work.

On treatment day

Staff check your health, blood results and treatment plan. The medicine is given into a vein. You may receive fluid and anti-sickness treatment as needed.

For one commonly used lutetium-177 PSMA medicine, treatment is usually planned every six weeks for up to six doses. Your schedule may differ, or be paused or stopped because of response, side effects or other clinical reasons.

You may have imaging after treatment to check where the medicine has gone. This is not necessarily another PET scan, and your team assesses the response over time. Discharge depends on the centre's clinical and radiation-safety checks.

Side effects and when to call

Possible effects include tiredness, nausea, reduced appetite and a dry mouth. The team can discuss mouth care and ways to keep eating comfortably. Blood counts can fall, increasing the risk of infection, anaemia (a low level of red blood cells, which carry oxygen) or bleeding. Kidney function can also be affected, which is why scheduled blood tests matter.

Contact the treatment team immediately for fever, shivering or suddenly feeling very unwell. Also report unusual bruising or bleeding, marked weakness, breathlessness, much less urine or persistent vomiting without waiting for your next appointment. If you cannot reach the team and need urgent help, seek urgent medical care.

You do not need to work out the cause before asking for help.

Fertility and longer-term risks are part of the consent discussion. Ask how your previous treatments influence your own risks.

Going home and follow-up

You will need temporary precautions because some radioactivity remains in the body and some leaves in urine and other body fluids. These are manageable when planned ahead. The team should give dates and times for close contact, sleeping arrangements, sex, toilet hygiene, laundry, work and travel.

Different activities may have different end dates. Sleeping beside someone is not the same as briefly passing them in a room. Children and pregnant people may need longer restrictions. The period for contraception may also be longer than the period for limiting close contact. Your centre must issue instructions for your exact medicine and discharge assessment.

Drink within your medical limits and pass urine regularly. During the advised precaution period, sitting to pass urine can reduce splashes. Wash your hands well and follow the centre's directions for flushing and cleaning. A caregiver handling urine, soiled linen or pads used for urinary leakage needs the team's glove and disposal instructions. Do not flush wipes, pads or medical supplies. Ask for help before treatment if these arrangements are difficult.

Checking how treatment is helping

Blood tests may be needed between cycles as well as before another dose. Your team follows symptoms, prostate-specific antigen (PSA), a marker measured in the blood, and imaging over time. A single PSA result or a scan taken immediately after treatment does not tell the whole story.

Before leaving, know the next blood-test date, review date and urgent contact number. Report new symptoms between visits; you do not have to wait for a planned appointment.

Questions you may have