Prostate cancer, is curable when detected well in time. Survival is often over decades. With newer treatment options coming in, there is now hope for last stage prostate cancer.
Nicknamed magic bullet therapy, now targeted alpha therapy offers hope for even metastasized, castration resistant prostate cancer( mCRPC and has changed the way metastatic prostate cancer can now be treated.
How does Magic Bullet Therapy work for Prostate Cancer ?
Prostate-specific membrane antigen radiology ( PSMA-RLT) with 177 Lu, holds great potential as the Prostate Specific Member antigen peptide binds itself specifically to prostate cancer cells but not to normal healthy cells. With a range of 0.1mm, this method allows selective irradiation, killing cancerous cells with minimal damage to healthy tissue.
The Alpha emitters work by inducing clusters of DNA damage such as double- stranded breaks and cellular cell modifications which leads to destruction of cancerous cells due to cell cycle arrest.
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As we continue our conversation on Precision Medicine for cancer, a popular therapy used to treat NET tumours or Neuro Endocrine Tumours is PRRT or Peptide Receptor Radionuclide therapy. Neuroendocrine tumours are a rare form of cancer and originate from Neuro endocrine cells in the body and hence the name.They are different from adenocarcinoma’s and often do not do not respond well to chemotherapy, the 1st line of treatment for most cancers.
By administering radioactive protein lutetium octreotate, it is possible to treat NET tumours or neuro endocrine carcinoma with precision and offset progression of disease.
In PRRT a peptide or a cell targeting protein is combined with a small amount of radio active nuclide creating what is called as a radio peptide. The radio peptide when injected into the patients blood stream travels and binds to a neuro endocrine tumour, delivering a high dose of radiation to the tumours. This also limits damage to the nearby healthy tissue and hence lesser and milder side effects than chemotherapy.
What kind of cancers can be treated by PRRT?
Along with Neuroendocrine tumours, carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung a form of lung cancer, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach cancer , intestine cancer and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radio iodine are often treated with PRRT.
Patients with following conditions are often proposed for PRRT
When neuro endocrine tumours are not responsive to other lines of cancer treatment
When surgical removal of tumours is not possible at current stage, PRRT may be used to reduce size of the tumours.
PRRT is also a treatment option for last stage inoperable cancers when metastasis has set in.
The main aim of PRRT is then to slow down progression of disease, offer relief and prolong life.
However, not all neuroendocrine tumours respond to PRRT. First an OctreoScan is done. If the patient is found to have a positive OctreoScan and meets other requirements, PRRT is proposed.
What happens during PRRT ?
For patients having a positive octreoscan, to start with an amino acid solution is delivered to protect the kidneys.
As most net tumours have a lot of a specific type of surface receptor, a protein called somatostatin. Octreotide, is a lab version of somastostatin. During PRRT, a dose of radio nuclides such as Lutetium, Yttrium are often combined with octreotide and injected into the blood stream.
Molecular imaging and scans follow to see whether the radio peptide has latched on of the tumour sites correctly.
The entire session usually lasts for about 4 hrs and is often done as an out patient procedure.
The main goals of PRRT hence are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.
Advantages of PRRT ?
PRRT along with other molecular therapies or targeted therapies offer excellent results as they are tailor made keeping in mind molecular properties of the tumour and also biologic characteristics of the patient.
PRRT is offered in Germany , USA, UK and other developed countries at a significant cost, In India, a single session of PRRT costs approx USD 6300.
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Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated. CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.
Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.
Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.
CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.
CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.
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Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.
The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on use of CyberKnife as treatment option can be arrived. To connect to the best hospitals in India, offering CyberKnife, and to know if CyberKnife is a treatment option for your medical condition, send us an email on firstname.lastname@example.org or Consult Now.
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