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San Radiology & Nuclear Medicine

Theranostics

Theranostics is a personalised approach to treating cancer using both therapy and diagnostics. PET-CT (diagnostic imaging) is used to identify if target receptors are present on cancer cells, and precision radiation treatment is used to target those receptors. In basic terms, we specifically treat what we see, limiting damage to surrounding healthy tissues. Whilst in the future theranostics is likely to extend to many types of cancer, the global experience and success to-date in the treatment of men with castrate resistant metastatic prostate cancer has made it the forerunner.

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About our Theranostics service

Our service commenced in March 2021 with the commissioning of a dedicated theranostics area within the imaging department which enabled our dedicated team to treat up to three patients at any one time in a safe and comfortable environment. The introduction of theranostics further enhances our commitment to offer patients the latest in both technology and treatment.

Our first therapy is for men with advanced prostate cancer called Lutetium-177 Prostate Specific Membrane Antigen ("Lutetium-PSMA") therapy. This therapy is used when the disease has spread, and other treatments have failed or been poorly tolerated.

Lutetium-PSMA Therapy
Lutetium-PSMA therapy aims to reduce the size and number of tumours, as well as ease symptoms. In some patients, it appears able to lead to long term remission. PSMA is a type of protein found inside prostate cells but is highly overexpressed on the membrane (or surface) of prostate cancer cells which we target for imaging and treatment. We can see tiny amounts of prostate cancer in the early stages of the disease and, of course, we can easily detect prostate cancer when it has spread to other parts of the body which is where Lutetium (177Lu) fits in. Lutetium emits beta radiation which can kill cells and when it is combined with PSMA, you have a radioactive molecule that delivers targeted radiation/radiotherapy to prostate cancer cells.

Our two (2) key points of difference are:

  1. All patients referred for Lutetium-PSMA will be reviewed at a multidisciplinary (cross-speciality) team meeting, prior to and during any course of treatment; and
  2. Care is provided by a dedicated wholistic team combining oncology, urology, radiology and nuclear medicine, who will look after all theranostics patients at every time point throughout their treatment journey.

Your treatment journey
We understand that it is important you are informed and feel safe and supported throughout your treatment journey. Before any treatment you will need to attend an appointment with our Nuclear Medicine Physician who will explain in detail the potential benefits of Lutetium-PSMA therapy, as well as any potential risks and side effects. As part of this appointment our Theranostics team will also show you the treatment room.

In order to determine and confirm your eligibility for treatment, you will be required to have a PSMA PET (+/-CT) scan and specific blood tests. Our Nuclear Medicine Physician will review results and discuss with your referring doctor and our multidisciplinary team before confirming any treatment plan with you.

A tissue marker is a very small object that is inserted into the breast either at the time of a biopsy, or to mark a previously diagnosed abnormality. There are a number of different types of markers available and the radiologist uses the marker clip most suitable for your particular requirements. There are different materials used in the various markers that are available and the markers come in a variety of shapes. Different shapes are useful if there are multiple areas to be marked in the same breast.

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Frequently Asked Questions

Our team is available to answer any questions or address any concerns you may have. Some common questions asked by our patients include:

How do I obtain a referral for Lutetium-PSMA therapy?

You can obtain a referral letter from a doctor involved in your care such as an Oncologist, Urologist or your GP. Your referral letter should be emailed or faxed to our team. Once your referral has been reviewed, and if not already, your case will be discussed at a multidisciplinary team meeting. Following this meeting our team, or your referrer, will contact you.

What do I need to do if I am referred for Lutetium-PSMA therapy?

You will have an initial consultation with a Nuclear Medicine Specialist who will explain the treatment in detail with you and answer any questions you may have. You will also be provided written information to review. You will need to have had a baseline PSMA PET-CT within 3 months of planned therapy. You will also need blood tests including full blood count, renal function tests and PSA. To proceed with therapy, you will need normal kidney and bone marrow function.

What can I expect on a Lutetium-PSMA treatment day?

You should be prepared to stay in our department for up to 6 hours on each treatment day, although each treatment will usually last approximately 4 hours. A Nuclear Medicine Physician, Nuclear Medicine Technologist and Theranostics Nurse will look after you throughout your treatment. The Nuclear Medicine Physician will deliver your treatment via an injection, usually in your arm, and monitor you regularly throughout the day. Our team will ensure you are comfortable and well hydrated throughout your treatment. The day after treatment, you will be required to attend Nuclear Medicine for a scan of the Lutetium-PSMA which will take approximately 1 hour.

Are there any side effects from Lutetium-PSMA therapy?

As well as the prostate gland and cancer cells, PSMA is found in the salivary glands, lacrimal glands, kidneys and small intestine. The adverse effects to these areas, however, is minimal and temporary. Side effects can include dry mouth, dry eyes, nausea, tiredness and a brief decline in blood cell production. Blood tests are performed intermittently to ensure the radiation is not damaging healthy tissue. The blood tests will be reviewed by our treating Physician and your referrer and will also be discussed with you.

What is the cost of Lutetium-PSMA therapy?

There is an out-of-pocket expense for patients as Lutetium-PSMA therapy is not covered by Medicare or Private Health Insurers at this point in time. Access to Lutetium-PSMA therapy is authorised via the Therapeutic Goods Administration Special Access Scheme (www.tga.gov.au/form/special-access-scheme); a scheme for compassionate access to medicines/treatments before our team manage your registration.

Further Information

Contact our San Radiology and Nuclear Medicine team by phone on (02) 9480 9850 or email theranostics@sah.org.au.

Appointments can be made by phoning (02) 9480 9840.

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Resources

Patient Information:

What is Theranostics?
(Courtesy of Charles Sturt University)

San Doctor (Summer 2020/21):

PSMA Theranostics: