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Pre-therapeutic dosimetry of normal organs and tissues of 177Lu-PSMA-617 prostate-specific membrane antigen (PSMA) inhibitor in patients with castration-resistant prostate cancer

  • Levent KabasakalEmail author
  • Mohammad AbuQbeitah
  • Aslan Aygün
  • Nami Yeyin
  • Meltem Ocak
  • Emre Demirci
  • Turkay Toklu
Original Article

Abstract

Purpose

177Lu-617-prostate-specific membrane antigen (PSMA) ligand seems to be a promising tracer for radionuclide therapy of progressive prostate cancer. However, there are no published data regarding the radiation dose given to the normal tissues. The aim of the present study was to estimate the pretreatment radiation doses in patients who will undergo radiometabolic therapy using a tracer amount of 177Lu-labeled PSMA ligand.

Methods

The study included seven patients with progressive prostate cancer with a mean age of 63.9 ± 3.9 years. All patients had prior PSMA positron emission tomography (PET) imaging and had intense tracer uptake at the lesions. The injected 177Lu-PSMA-617 activity ranged from 185 to 210 MBq with a mean of 192.6 ± 11.0 MBq. To evaluate bone marrow absorbed dose 2-cc blood samples were withdrawn in short variable times (3, 15, 30, 60, and 180 min and 24, 48, and 120 h) after injection. Whole-body images were obtained at 4, 24, 48, and 120 h post-injection (p.i.). The geometric mean of anterior and posterior counts was determined through region of interest (ROI) analysis. Attenuation correction was applied using PSMA PET/CT images. The OLINDA/EXM dosimetry program was used for curve fitting, residence time calculation, and absorbed dose calculations.

Results

The calculated radiation-absorbed doses for each organ showed substantial variation. The highest radiation estimated doses were calculated for parotid glands and kidneys. Calculated radiation-absorbed doses per megabecquerel were 1.17 ± 0.31 mGy for parotid glands and 0.88 ± 0.40 mGy for kidneys. The radiation dose given to the bone marrow was significantly lower than those of kidney and parotid glands (p < 0.05). The calculated radiation dose to bone marrow was 0.03 ± 0.01 mGy/MBq.

Conclusion

Our first results suggested that 177Lu-PSMA-617 therapy seems to be a safe method. The dose-limiting organ seems to be the parotid glands rather than kidneys and bone marrow. The lesion radiation doses are within acceptable ranges; however, there is a substantial individual variance so patient dosimetry seems to be mandatory.

Keywords

Prostate cancer Radionuclide treatment Prostate specific membrane antigen PSMA Lu-177-PSMA Castration resistant Radiometabolic therapy 

Notes

Compliance with ethical standards

Funding

This study was not funded

Conflicts of interest

None.

Ethical approval

The study was approved by the local Ethics Committee and was carried out in accordance with the 1964 Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Levent Kabasakal
    • 1
    Email author
  • Mohammad AbuQbeitah
    • 1
  • Aslan Aygün
    • 1
  • Nami Yeyin
    • 1
  • Meltem Ocak
    • 2
  • Emre Demirci
    • 3
  • Turkay Toklu
    • 4
  1. 1.Department of Nuclear Medicine, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  2. 2.Department of Pharmaceutical Technology, Pharmacy FacultyIstanbul UniversityIstanbulTurkey
  3. 3.Department of Nuclear MedicineSisli Etfal Training and Research HospitalIstanbulTurkey
  4. 4.Department of Nuclear MedicineYeditepe University Medical FacultyIstanbulTurkey

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