BACKGROUND : Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the
world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European
counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown
to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim
of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct
identification and treatment of patients who are likely to benefit from receptor radioligand therapy.
RECOMMENDATIONS : There are a multitude of treatment modalities available for the treatment of prostate cancer and these
therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary
approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time
points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and
should ideally also involve a palliative/pain specialist, a dietician and a psychologist.
CONCLUSION : Treatment with 177Lu-PSMA has emerged as a promising systemic modality, which involves the delivery of
targeted radiation therapy in the form of β-particles to sites of tumour tissue. Therapy is provided on an outpatient basis, is
well tolerated with relatively few side effects and has a positive effect on overall survival and quality of life. At present, it
is used mostly in the setting of advanced, castrate-resistant cancer. Patients are selected (amongst other criteria) based on
the prior PSMA-based SPECT/PET/CT imaging (99mTc-,68Ga- or 18F-PSMA), which should demonstrate sufficient receptor
expression in order to consider PSMA-based targeted radionuclide therapy. Such imaging of an intended target prior to its
therapeutic targeting is known as a theranostic approach.