Molecular radiotherapy in prostate cancer
Molecular radiotherapy (MRT), also known as targeted radionuclide therapy or radioligand therapy, is emerging as a transformative approach in the treatment of prostate cancer, particularly in metastatic and castration-resistant cases. Unlike traditional external beam radiotherapy, MRT delivers targeted radiation internally using radioactive substances that bind to specific tumour markers, minimising damage to healthy tissue and allowing systemic treatment of both visible and microscopic disease.
Historically, agents like 89Strontium and 153Samarium were used for bone pain relief but lacked survival benefits. The ALSYMPCA trial marked a turning point, demonstrating that 223Radium, an alpha emitter, could improve both symptoms and survival, leading to its commissioning by NICE in 2016.
A major advancement came with the development of PSMA-targeted therapies. The VISION trial showed that 77Lu-PSMA-617 significantly improved survival and quality of life, although it is not yet available in the NHS. Treatment requires PSMA PET imaging for patient selection and involves multiple cycles with careful monitoring.
Challenges include workforce shortages, infrastructure limitations and environmental concerns related to radioactive waste. Despite these, ongoing research is expanding MRT’s potential, including trials like LuTectomy, SPLASH and AlphaBet, and exploring novel tracers and combination therapies.
The article concludes that MRT is not only a viable treatment option but also a rapidly evolving field offering personalised, effective care for prostate cancer patients, with promising future directions in both diagnostics and therapeutics.
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