PSMA-Based Therapy of Metastasized Castrate-Resistant Prostate Cancer

  • Sarah Marie Schwarzenböck
  • Jens Kurth
  • Sascha Nitsch
  • Bernd Joachim Krause
Chapter

Abstract

Despite clinically established therapeutic regimens, mCRPC patients have a poor prognosis indicating the need for more effective therapies. In recent years, therapeutic radiolabelled PSMA-ligands have shown promising results in therapy of mCRPC patients with favourable safety and efficacy. A positive response to therapy in terms of PSA decline occurs in about 70% of patients; PSA reduction ≥50% is observed in up to 50% of patients. Pain release and improvement of quality of life are observed in a major proportion of symptomatic patients. Preliminary data show that decline of PSA values is accompanied by morphological and/or metabolic changes which can be assessed by CT, bone scintigraphy and/or 68Ga-PSMA PET/CT. The most common side effects of RLT are mild fatigue as well as mild and in most cases transient xerostomia. In the majority of studies, no acute or long-term side effects and high-grade haematological or renal toxicity were observed. Even though currently therapeutic PSMA-ligands have not yet been approved, 177Lu-PSMA RLT is a promising treatment option to be potentially offered following approved therapies in patients with mCRPC. In the future the use of PSMA-ligands labelled with alpha emitters such as 225Ac could be beneficial in patients with compromised bone marrow. Additionally, other novel theranostic agents addressing the gastrin-releasing peptide receptor (GRPR) might be promising treatment options in the future.

Keywords

Prostate cancer Radioligand therapy 177Lu-PSMA PSMA-ligands 

Notes

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sarah Marie Schwarzenböck
    • 1
  • Jens Kurth
    • 1
  • Sascha Nitsch
    • 1
  • Bernd Joachim Krause
    • 1
  1. 1.Department of Nuclear MedicineRostock University Medical CentreRostockGermany

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