Oncology

Theranostics: A new treatment for prostate cancer patient John

How a new personalized treatment approach changed the course of John's disease.

Sameh Fahmy

Published on November 1, 2023

After John was first diagnosed with prostate cancer 15 years ago, his doctors prognosis was no more than three years. John’s endurance, along with a new personalized treatment approach, Theranostics, changed the trajectory of his disease.

Prostate cancer patient John and his wife Mary enjoying a coffee in the kitchen.

Prostate cancer patient John and his wife Mary

Prostate Cancer

Prostate cancer is the second most common cancer in men and the third leading cause of cancer death in men in the western hemisphere.(1) Doctors rely on blood tests and physical examination to detect it and use MRI and biopsy for further diagnosis. Prostate cancer often progresses slowly and might not need treatment in the early stages. In later stages, treatment options include radiotherapy, chemotherapy, and surgery.

A new alternative for John

John had been very active for most of his life. But in 2022, as a stage 4 prostate cancer patient, he could barely get out of bed. He had received chemotherapy, but the sessions soon fell into a familiar and disturbing pattern: the benefits of each round of chemotherapy would ultimately be outweighed by the side effects he experienced. Over time, he felt that the clinical trials he was eligible for were too physically demanding given his age and condition. His options became limited, and eventually he was offered hospice care.

It was during this time that he learned about Theranostics. “I was very weak when I came in to see Dr. Osborne, and we decided that this would be a good alternative,” he says. “There were six treatments, six weeks apart, and that was appealing to me because I had time in between.” Theranostic treatment offered new hope for John. It seemed like something he could tolerate, even in his severely weakened state.

prostate cancer

prostate cancer

: In theranostics, doctors use a radioactive drug, or radioligand, to identify and mark cancer cells. A second radioligand is then used to destroy the cancer cells. Both drugs share a molecular-specific target that bind to the cancer cells. The targeted approach has the potential to improve outcomes and reduce side effects. Molecular imaging is used to monitor and personalize therapy response throughout the process. The theranostics care pathway involves a series of steps from patient selection to personalized treatment, response monitoring and follow-up and survivorship monitoring.

A vast improvement

John began his treatment in April 2022. He experienced some nausea and vomiting after his first treatment, but those side effects quickly abated. The morning after his first treatment, his wife Mary was surprised to see him in the kitchen, making breakfast. “I couldn’t believe it,” she recalls. “He said, ‘Mary, would you like some breakfast?’ And I said, ‘Well, of course!’

John reflects on his Theranostics journey

From patient selection to personalized treatment

A patient is selected based on the review of multiple tests. Treatment is then personalized to the patient's specific disease state.

Dr. Osborne in conversation with prostate cancer patient John. — Based on the results of his PSMA and the fact that the hormone and chemotherapy treatments were no longer successful, John was eligible for theranostic treatment.

: A patient is selected based on the review of multiple tests. In metastatic prostate cancer, treatment response is typically evaluated using CT or bone scans. In addition to detecting disease extent in patients with metastatic castration resistant prostate cancer, PSMA-ligand PET/CT is used to confirm eligibility for theranostic treatment, since documentation of PSMA expression in metastatic sites is required prior to initiation.
Based on the results of his PSMA and the fact that the hormone and chemotherapy treatments were no longer successful, John was eligible for theranostic treatment. After discussing it with his wife Mary and with Dr. Osborne, he decided to undergo treatment.

An almost comfortable routine

John’s physicians monitored his therapy response throughout his six treatments, which soon became an almost comfortable routine. He drove himself to the hospital, greeted staff, had his blood counts checked, and underwent infusion and then post-infusion quantitative scanning.

: With theranostics, patients are injected with radioactive isotopes linked to molecules that bind specifically to tumors. A scan may be used to localize tumors within patients and also to assess how much of the radioisotope tumors take up. Once this targeting step is completed, the diagnostic isotope is replaced with a therapeutic agent that kills cancer cells by delivering radiation directly to tumors.

Because the theranostic approach uses the same ligand to monitor and treat patients, treatment is inherently personalized to the patient’s specific disease state.

Keeping track of the progress

Imaging and laboratory diagnostics play a vital role in post-therapy monitoring and follow-up. John says that in addition to increases in physical stamina—like his ability to climb stairs without becoming winded—he soon began to notice an improvement in his mental and emotional state. “It has a psychological effect on you to feel like you’re unable to do anything, and your self-worthiness gets so low,” he says.

PSMA SPECT maximum intensity projection (MIP) images acquired throughout John’s personalized treatment to assess therapy response. — PSMA SPECT maximum intensity projection (MIP) images acquired throughout John’s personalized treatment to assess therapy response. Data courtesy on file.

It can bring back functional longevity, where someone gets back to doing the things they love for the people they love,” he says. “And that’s really what we’re all in this for.
Joseph Osborne, MD, Chief of Molecular Imaging and Therapeutics

A concept gaining traction

“The concept of theranostics has been around for decades, but it’s really become actionable and exciting now because there are several prospective clinical trials showing a huge benefit,” says Joseph R. Osborne, MD, PhD, Chief of Molecular Imaging and Therapeutics, and Professor of Radiology at a leading academic institution’s hospital in New York City, USA, who oversees John’s treatment.

Osborne emphasizes that patients such as John can gain not just longevity from theranostics, but also dramatically improved overall health.

Joseph Osborne, MD, Chief of Molecular Imaging and Therapeutics, on Theranostics for prostate cancer

John is now back to everyday tasks that he simply did not have the energy for before. He has even been able to travel again. He continues to see his physicians for regular follow-up and monitoring, and he and his wife both emphasize how grateful they are.

Prostate cancer patient John (right) and his wife Mary.

Do you want to know more about theranostics?

Theranostics for personalized cancer care

By Sameh Fahmy

Sameh Fahmy, MS, is an award-winning freelance medical and technology journalist based in Athens, Georgia, USA.

(1) Gomes Marin, José Flávio et al. Theranostics in Nuclear Medicine: Emerging and Re-emerging Integrated Imaging and Therapies in the Era of Precision Oncology. Radiographics: a review publication of the Radiological Society of North America, Inc 40 6 (2020): 1715-1740