Play the lute.

The lutetium-PSMA PET scan is gaining popularity as a way to search for occult disease in men with biochemically recurrent prostate cancer. What is PSMA? Glad you asked. It’s a membrane protein present on bad prostate cancer cells that is upregulated in high-grade tumors and in the setting of androgen deprivation. The phase 2 LuPSMA trial evaluates therapeutic Lu-177-PSMA administered every 6 weeks for up to 4 cycles in men with PSMA PET-avid metastatic castrate resistant prostate cancer (mCRPC). Over half of men had a >50% decline in PSA, with encouraging improvements in pain relief and measurable disease response. The biggest side effect was dry mouth (87%) due to salivary gland toxicity. The accompanying editorial raises the question of PSMA-radionuclide therapy in earlier stages, perhaps to identify and treat residual occult disease without the wait. Now that's music to our ears. TBL: Lu-177-PSMA radionuclide therapy appears to be effective and tolerable in men with advanced mCRPC. | Hofman, Lancet Oncol 2018