Radiopharmaceuticals for Advanced Prostate Cancer
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Dan Childs, M.D., Oncologist: For a long time, we thought advanced prostate cancer was incurable. But now we see some men who have come in with metastatic prostate cancer. We treat all of the sites that we can see on the PET scan. Eventually, we take them off all hormone therapy, and we're not seeing signs of their cancer grow for a long time. That makes me really hopeful for curing men with advanced prostate cancer.
Jacob Orme, M.D., Ph.D, Oncologist: Advanced prostate cancer means that that cancer, even though it comes from the prostate, is moved somewhere else. That can be in the bones, which is a real common place for it to go, but it can be in the lungs and the liver and other parts of the body. But if this cancer is moved somewhere else, we have to do something that's going to take care of it from head to toe. And so we move then in advanced prostate cancer from things that are local treatments like surgery, radiation, cryoablation into things that are going to work throughout the body.
Dr. Childs: Fortunately, right now, we have more life-prolonging therapies for prostate cancer than ever before. We can use chemotherapies that have been available for a number of years. We can use hormone therapies which help shrink or slow the growth of the cancer. We can use a new kind of therapy called radiopharmaceuticals. This has been a really important innovation within the last decade.
Dr. Orme: The way that lutetium PSMA works right now, it's this bit of molecular velcro that sticks to the PSA on the surface of the cancer cell and radioactive lutetium. And so you inject it into the bloodstream, it goes all over, and it sticks to the surface of those cancer cells and delivers that radiation specifically to those cancer cells. It's an amazing process, and we've seen some pretty fantastic results from that.
When we do these advanced scans, where we're doing a molecular scan, and you can see where this cancer is, that's incredibly helpful for us to know as medical oncologists because we want to know the extent of where things are and that helps us to know how to treat them.
Dr. Childs: We also have the ability to take pictures the day after treatment and understand whether the medication is going to the location we desire it to go to.
Geoffrey Johnson, M.D., Ph.D., Nuclear Specialist, Radiologist: Why does a patient who has advanced prostate cancer like this kind of theragnostic or radio pharmaceutical therapy? Overwhelmingly, it's the low side effects. Because we were able to design the drugs and we were able to see exactly where they went, we know they're not radiating or at least very minimally radiating anything else. So the guys are on the golf course talking to their buddies and they're saying things, and we have this in our data, I feel better taking this therapy than before I had it.
We're able to find the cancer. We're able to track the tumors as they go through therapy in ways that pretty much almost no one else can do to really guide the therapy. And even to say, if the therapy is not working in some of the tumors, but it's working in others, we can actually see that on our imaging, and we can then bring in other therapies like external beam radiation to treat the ones that aren't responding. As a physician or as a nurse or as somebody helping in the care of these patients, it's really rewarding.
Mayo Clinic is proud that all of our three major sites are qualified as comprehensive radiopharmaceutical therapy Centers of Excellence. So we come in with a team — we've got urologists, radiation oncologists, medical oncologists, nuke med physicians, any other physicians that that particular patient needs. I think that's Mayo's specialty — our team approach.
Dr. Childs: With any anti-cancer therapy that you're giving, including radio pharmaceuticals, you want to make sure that you have the infrastructure in place. You want to make sure you have a team of well-trained physicians, well-trained nurses, and well-trained technicians. Mayo Clinic laid the groundwork for this treatment many months and even years prior to its approval so that once it was available for men with prostate cancer, we were ready to go and ready to support our patients.
Dr. Johnson: I would say that if you come to the Mayo Clinic, it would be our commitment that you leave feeling like we're working as a team. We're all coming together for your best interest first.
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