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PSMA (prostate-specific membrane antigen) -targeted radiopharmaceutical therapy could be more effective and better tolerated than current chemotherapy in patients with metastatic castration-resistant prostate cancer (mCRPC), according to a recent trial.
The Australian study published in the Lancet, compared Lutetium-177 [177Lu]Lu-PSMA-617 (intravenously every six weeks for up to six cycles) with cabazitaxel (20 mg/m2 intravenously every three weeks for up to ten cycles) in 183 men with mCRPC.
PSA responses were more frequent among men in the [177Lu]Lu-PSMA-617 group than in the cabazitaxel group (65 vs 37 PSA responses; 66% vs 37% by intention to treat; difference 29% (95% CI 16–42; p<0·0001; and 66% vs 44% by treatment received; difference 23% [9–37]; p=0·0016). More serious adverse events occurred in 33% of men in the [177Lu]Lu-PSMA-617 group versus 53% of men in the cabazitaxel group.
The treatment of patients with mCRPC has mostly involved androgen receptor-targeted therapies and cytotoxic chemotherapy for over a decade. [177Lu]Lu-PSMA-617 is a radiolabelled small molecule that delivers β radiation to cells expressing PSMA and thus offers a new approach to treatment.
A commentary in the same issue of the journal notes that completion of the study is a considerable accomplishment, given the absence of a pharmaceutical industry sponsor. It is rare for a trial to be done in which the synthesis of the drug is done by the participating academic institutions and the funding largely provided by charities including Movember, it says.
Prostate cancer has returned, considering experimental therapy (if I can get it).
Highly effective targeted therapy for metastatic prostate cancer, using 177Lu-PSMA Radioligand 
Is Lu177 just a recourse for when other metastatic prostate Cancer options are exhausted?
Apalutamide for Metastatic Castration-Sensitive Prostate Cancer
Revisiting Intermittent Therapy in Metastatic Prostate Cancer
