First-hand radionuclide PSMA experience in Heidelberg, Germany

by Rick Davis | Feb 5, 2020 | Prostate Cancer

Radionuclide technology to manage rather than screen advanced prostate cancer is an intriguing treatment alternative that has not yet been FDA approved in the US, although we are hopeful it will happen in 2020. There are privately paid as well as trial opportunities overseas, mainly in Germany and Australia but also in S. Africa. The guiding agent is attracted to PSMA, a protein often but not always expressed by prostate cells; the radionuclide is most often lutetium (Lu177) or actinium (Ac225) and sometimes a combination of both.

AnCan has supported several men who underwent this treatment, both in in trials in the US as well as in Oz and Germany. Most recently a long time particpant, whose PSA was increasing after several treatment modes including Xtandi and docetaxel + carboplatin, made the decision to enter Lu177 PSMA treatment in Germany. Here is his report after the first session in Heidelberg; he is now back stateside. This report also appeared on Health Unlocked. (rd)

I am sitting in my hospital room in Heidelberg hospital and thought I would send this update.

To get an appointment at Heidelberg, one needs to go to www. Ukhd.org and fill out the online application. You will need to scan many of your records into your computer and then upload them on the application. It is also very important to upload all the images from your Psma scan, otherwise you will only receive the Vision trial dose of Lu177. They will not be able to dose adjust based on your scan, and you will probably not receive Ac225.

Within 24 hours of sending my application, I received an email that said I had been accepted for treatment with an appointment date in 2 weeks. I was given an IO number to be used for correspondence and questions (international office).

I booked airfare from JFK to Frankfurt. Only $650 round trip. (Round trip from Norfolk was twice that amount) so I had my appointment with Dr Drake on Tuesday, and flew out that afternoon. Flight was 7 hours. Arrived Frankfurt at 5 am. There is a train station at the airport where you can buy tickets to Heidelberg with a transfer in Mannheim. Train ride was 1 hour. Took a cab to the hotel. It could not have been easier.

We are staying at a cute, clean, well appointed boutique hotel called Rafaela, run by a very nice woman named Maria. Only $100 per night. Walking distance to old town. And Heidelberg is a beautiful charming city on a river with a castle. Wonderful restaurants. Lots to see and do. There is a bus stop 1 block from the hotel that takes 5 minutes and drops you right outside the Kopfklinik. Alternatively you can walk the 20-30 minutes.

Today I arrived at the clinic at 8:15 for inpatient registration. It was a breeze despite a slight language barrier. Then up to nuclear medicine on the 4th floor. There nurse Tomas told us the rules regarding radiation safety. Visitors are limited and must remain behind a 4 foot protective wall. My clothes upon discharge must be placed in a protective bag until washed at home.

The doctor starts your IV and draws your blood. (BTW, you do not see Dr Haberkorn.) He answers your questions and you sign the consent. At 12:30 he injected a combination of Lu/Ac at a dose of 7.4 and 2.0 Mbq. Direct push, no discomfort. Three hours later you go for a scan to determine the radioligand uptake by the tumor. My tumors were intensely PSMA avid, and fortunately because of this I had a great uptake of radiation by the tumors. I’m highly radioactive, and the doctor said this was a very good sign, and bodes well for a successful treatment. I will remain in the hospital for 2 days

Follow up will consist of a PSA every 3 weeks. He warned my PSA may rise due to tumor kill. Also routine bloods every 2 weeks. My next appointment is in approximately 7 weeks on March 17. Doctor said I would most likely get 3-4 treatments. Cost of first treatment is 9800 euros.

I am pleased with my choice so far. Heidelberg oozes positive energy. The hospital seems to be very organized, efficient, and the staff are friendly, well trained, and speak English.