Advanced Prostate Cancer and Lutetium-177 Therapy

A recent study shows that a novel treatment for advanced prostate cancer called Lutetium-177-PSMA-617 may be helpful.


  • Prostate Specific Membrane Antigen (PSMA) is found on the surface of prostate cancer cells and in lower amounts in some normal cells.
  • About 10% of prostate cancer cells do not express PSMA.
  • PSMA is also found in much smaller amounts in normal amounts in the small intestine, part of the kidneys, and salivary glands.
  • Up to 20% of men with advanced prostate cancer are not eligible for Lut 177 due to low PSMA expression on prostate cancer cells.


  • PSMA PET Scan is a newer type of PET Scan and seems to be best in capturing small prostate cancer cells in the body.
  • This type of PET detects prostate cancer cells with PSMA on the surface
  • PSMA PET scans are not widely available yet in the United States.
  • PSMA PET scant is required to treat prostate cancer patients with Lutetium 177.

Here is an overview of PET Scans for Prostate Cancer.


  • Men with prostate cancer with bone metastasis (or cancer that has spread to the bone) respond less than prostate cancer that has spread to the lymph nodes or other soft tissue.
  • Side effects to Lut 177 include dry mouth, as one would expect since there is PSMA protein in salivary glands. The other is fatigue in about 25% of the patients and some nausea. 

Lutetium-177-PSMA-617 on Advanced Prostate Cancer – RECENT STUDY RESULTS (06/2021)

The most recent study looking at the effects of Lutetium-177-PSMA-617 among a large group of men with advanced prostate cancer who failed standard chemotherapy for advanced prostate cancer showed the following:

  • PSA was more likely to drop
  • Tumor shrinkage was higher in the group treated with Lutetium-177-PSMA-617
  • Reduction in prostate cancer progression was up to 60%
  • The most common side effect was dry mouth and nausea


Years before this latest study was published I learned about Lut-177 from research out of Germany and Australia and I thought it was a decent treatment for advanced prostate cancer. 

I recommended multiple patients overseas for it. Some did well others not as much. 

The main reason why some did not do well because they did not have PSMA expression on cancer cells. If there is no PSMA, Lut-177 will not work.

Also, only about three institutions in the United States have the PSMA PET scan which is required for Lut-177 therapy. Even if one goes to one of the institutions for a PSMA PET scan, it is not yet covered by Medicare or any health insurance.  

Because of all mentioned Lutetium-177-PSMA-617 will not be available in the US for some time despite showing impressive efficacy in men with advanced prostate cancer.

Lastly, as usual, men who follow aggressive lifestyle interventions even with advanced prostate cancer and when including medical treatments tend to do better.

In my experience, aggressive lifestyle interventions include diet, exercise, good sleep, and some targeted nutraceuticals. 

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