ENLutetium-177 PSMA therapy treats metastatic prostate cancer from inside: a medicine carrying a radioactive substance seeks out tumour cells; in Germany nuclear medicine departments give it. Families usually hear of it at a hard moment: hormone therapy has stopped working, chemotherapy has been given, and in their search for options lutetium-177 PSMA therapy in Germany keeps coming up.
The name points to the target: PSMA is a protein on the surface of prostate cancer cells, to which a radioactive substance is attached. This page explains the principle, who it is for, how it runs, side effects and organisation; every stage of the disease is covered on the page on prostate cancer treatment in Germany.
How lutetium-177 PSMA therapy works
The therapy irradiates the tumour from within. A small «key» molecule injected into a vein travels through the body and finds PSMA on tumour cells wherever they are — in bone, lymph nodes or organs. It carries radioactive lutetium-177, whose radiation reaches only a very short distance, so the tumour cell is irradiated from inside.
Hence «radioligand therapy»: a ligand binds precisely to its target, and «radio» refers to its radioactive load. The method follows the «see first, then treat» principle known as theranostics: the same protein is first shown on a PSMA PET scan, and treatment only makes sense if the tumour takes up the tracer. PSMA PET as a test for metastases is covered on the page on prostate cancer diagnosis.
A lutetium-177-PSMA medicine is approved in the European Union for a defined group of patients. Variants with another radioactive substance, actinium-225, are still used only in clinical trials and individual cases; no actinium-based medicine is approved in the EU.
Who PSMA treatment is for
PSMA treatment is mainly for men with metastatic castration-resistant prostate cancer: a tumour that keeps growing although testosterone has been suppressed. It is considered after newer hormone drugs and chemotherapy, provided the PSMA PET shows uptake. The EU approval for this group rests on the VISION trial, which compared standard care plus lutetium-177 therapy with standard care alone.
Earlier use, before chemotherapy, is discussed in clinical trials and by tumour board decision. The current German S3 guideline on prostate cancer says that a man in good general condition whose disease progresses after docetaxel and a newer hormone drug should be offered further chemotherapy or lutetium-177-PSMA. If chemotherapy cannot be given, lutetium-177-PSMA can be offered after the newer hormone drugs alone; EU approval does not cover this, so the decision is individual.
Treatment does not fit if the tumour takes up no PSMA, blood counts are markedly low or kidney function is severely impaired; the nuclear medicine physician and the oncologist decide. Prostate cancer immunotherapy is a different approach: it works through the immune system rather than radiation.
How treatment runs
Treatment runs in cycles and starts with preparation: a recent PSMA PET, blood and kidney tests and a consultation with the nuclear medicine physician.
Each cycle is an intravenous infusion in the nuclear medicine department, after which radiation protection rules require a stay in a special room until radiation levels fall, usually a few days. The doctor sets the number of cycles and the intervals according to the product information and tolerance.
Between cycles PSA and blood tests are checked, and scans are repeated after a while, usually with PSMA PET. If the tumour keeps growing or the treatment is poorly tolerated, it is stopped.
Side effects and where treatment is given
Common and usually manageable side effects are dry mouth, tiredness and nausea; dry mouth occurs because the salivary glands also carry PSMA. More important are falling blood counts and effects on the kidneys, hence the tests between cycles. For the first days at home the patient protects others from radiation: he keeps his distance, especially from children and pregnant women, sleeps alone, drinks plenty, flushes the toilet twice and washes his hands twice. The department gives the exact rules on discharge.
In Germany, PSMA therapy is given by nuclear medicine departments of university and large city hospitals. Examples are the Department of Nuclear Medicine at Charité Hospital Berlin, directed by Prof. Winfried Brenner; the Department of Nuclear Medicine at Klinikum Stuttgart, headed by Prof. Christoph Rischpler; and the nuclear medicine departments of Augsburg and Ulm university hospitals. Whether a department offers PSMA therapy and has capacity is confirmed by the hospital itself.
The decision is always shared: the urologist or oncologist leads the case, and the nuclear medicine physician is responsible for the radioligand treatment.
Frequently asked questions
Can lutetium-177 PSMA therapy cure prostate cancer?
No, it cannot cure prostate cancer that has spread. Its aim is to hold the disease back: in some men PSA falls markedly, metastases become fewer and smaller, and tumour-related pain eases. Tests and scans between cycles show whether it helps; if there is no benefit, treatment is stopped.
Can I have lutetium-177 PSMA therapy before chemotherapy?
Sometimes, but it is not the usual route. In the EU the medicine is approved for men whose disease progresses after newer hormone drugs and chemotherapy. If chemotherapy is unsuitable, the German guideline allows earlier lutetium-177 treatment, but outside the approved indication, and a tumour board decides. A clinical trial is another possibility.
How long will I need to stay in Germany?
That depends on the hospital’s schedule. Each cycle involves preparation, the infusion and a few days in a special room, and several weeks pass between cycles. Some patients therefore stay for the whole course, while others travel in for each cycle. Where to have blood tests in between is agreed with the nuclear medicine department.
How AlenMed arranges PSMA treatment in Germany
AlenMed starts with the documents: the histology report, the treatment history with hormone drugs and chemotherapy, the PSA trend, a recent PSMA PET or at least a CT and a bone scan, and blood and kidney tests. They are translated and sent with a request to nuclear medicine departments of partner hospitals.
The hospital replies whether the patient qualifies, whether a new PSMA PET is needed on site and what the cycle schedule is, and sends a cost estimate. AlenMed then arranges the visa invitation, accommodation between cycles or a travel plan for each cycle, and an interpreter. The page on prostate cancer treatment costs explains what the bill is made of. AlenMed’s office is in Munich; partner hospitals are all over Germany.
This material is for reference only and is not an offer. Whether PSMA therapy is indicated is decided by a doctor after an in-person assessment.
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