"Detecting Cancer and Targeting It On the Spot"—The Current State of "Theranostics" Transforming Prostate Cancer Treatment

Locating where cancer is in the body and delivering radiation to that specific spot.

What once sounded like science fiction is now a reality being delivered to patients.

At the Cross Cancer Institute in Edmonton, Alberta, Canada, a prostate cancer treatment combining PSMA PET imaging and the radiopharmaceutical Pluvicto is gaining attention.

The key feature is not just administering a new drug.

It involves confirming through imaging which patients are likely to benefit from the treatment, targeting the same markers to deliver the therapeutic agent, and verifying post-administration that the drug reached its intended destination.

This approach, which integrates diagnosis and treatment, is known as "theranostics" and is becoming a symbol of personalized cancer medicine.

One patient benefiting from this is 63-year-old Ron Allman.

The Meaning of "Still Being Here"

Allman's battle with prostate cancer began about eight years ago.

Initially thought to be detected at a relatively early stage, his PSA levels—a key indicator of prostate cancer status—later rose, revealing a more aggressive disease than anticipated.

Drug treatments were effective for about four years but eventually became less effective. He continued with various medications and treatments, ultimately progressing to stage 4.

His doctor then proposed a treatment involving PSMA PET to identify lesions followed by Pluvicto administration.

After treatment, Allman's PSA levels dropped to their lowest in three years.

For him, the significance lies beyond mere changes in test numbers.

Having lost his grandfather to prostate cancer in the 1970s, Allman attributes his continued life eight years post-diagnosis to the new drugs and treatments that have emerged in recent years.

The term "advances in cancer treatment" can sometimes sound abstract.

However, for patients, the existence of "another treatment to try" itself signifies time.

Even if one treatment ceases to be effective, it can lead to another drug with a different mechanism, with the possibility of new treatments emerging in the meantime.

Medical advancements in treating advanced cancer impact patients' lives by connecting these "next options."

What is PSMA?

Understanding the term "PSMA" is crucial for comprehending this treatment.

PSMA, or Prostate-Specific Membrane Antigen, is a protein abundantly present on the surface of many prostate cancer cells.

The key point is not just viewing PSMA as a characteristic but utilizing it as a "marker."

First, a substance that binds to PSMA is combined with a radioactive material that can be tracked through imaging tests.

When administered to a patient and a PET scan is conducted, lesions with high PSMA expression can be captured in images.

This allows doctors to confirm whether the patient's cancer has PSMA as a target and where lesions have spread throughout the body.

It not only potentially identifies lesions that were difficult to assess with conventional imaging but also provides a basis for choosing the next treatment.

This is where the "treatment" part of theranostics begins.

Delivering Radiation to Cancer Cell Markers

Pluvicto is a radiopharmaceutical combining the radioactive isotope Lutetium-177 with a molecule that binds to PSMA.

When administered into the bloodstream, it targets and accumulates in prostate cancer cells with high PSMA expression, releasing radiation there.

The concept is akin to delivering treatment based on the "address" attached to cancer cells rather than uniformly attacking the entire body.

Of course, it doesn't act exclusively on cancer cells. However, by utilizing target molecules, the aim is for more precise treatment.

This is known as "radioligand therapy" or "targeted radionuclide therapy."

A distinctive feature of the Cross Cancer Institute's approach is the ability to verify through imaging where the administered radiation has actually reached after treatment.

Doctors review images the day after treatment to see if the therapeutic agent has accumulated in the anticipated lesions.

If the distribution isn't as expected, the information can be used to revise the next treatment plan.

It's not just "administer and wait for results."

Diagnose, treat, verify the actual delivery location, and make the next decision based on that information.

This cycle is a major feature of theranostics.

The Term "Personalized Medicine" Becomes Concrete

In recent cancer medicine, the term "personalized medicine" is frequently used.

However, in reality, even for the same type of cancer, genetic mutations, protein expression, metastasis locations, and past treatment histories vary among patients.

Therefore, a treatment highly effective for one patient may not work the same way for another.

The combination of PSMA PET and Pluvicto is very straightforward in this context.

First, confirm the presence of a "target" before treatment.

Select patients with sufficient targets and deliver treatment to those targets.

It's the idea of narrowing down treatment candidates using imaging information rather than using the same drug for everyone.

However, being PSMA-positive doesn't necessarily guarantee significant effects.

Cancer isn't uniform even within a single patient's body. There may be a mix of lesions with strong PSMA expression and those without.

Therefore, it's dangerous to perceive "targeted therapy" as a panacea just by hearing the term.

Precautions Unique to Treatments Involving Internal Radiation

Pluvicto is significantly different from typical oral medications.

Because it involves administering radioactive substances into the patient's body, radiation protection precautions are necessary for a certain period post-treatment.

Doctors at the Cross Cancer Institute explain that since patients themselves temporarily emit radiation after administration, actions to reduce exposure to those around them are crucial.

Specific lifestyle restrictions and precautions vary depending on the dosage, facility policies, and patient conditions, requiring instructions from the medical team.

This also means that it's not a treatment that can be immediately implemented at any hospital just by introducing the latest technology.

Facilities for safely manufacturing, transporting, and managing radiopharmaceuticals, specialists in nuclear medicine, pharmacists, technicians, nurses, and systems to explain safety measures to patients are all necessary.

It's a type of medicine that cannot exist with just the "drug" alone.

Supporting PET Facilities Across the Province from Edmonton

Theranostics has been conducted at the Cross Cancer Institute since the late 1980s.

According to the original article, PSMA treatment using lutetium has since become standard medical practice and will be publicly funded in Alberta starting March 2025.

Equally important is the infrastructure for supplying radiopharmaceuticals.

The Edmonton Radiopharmaceutical Centre, located a few blocks from the Cross Cancer Institute, supplies radioactive isotopes needed for PET scans using cyclotrons and other equipment.

As of the original article, isotopes are being sent from here to seven PET scan facilities across the province.

A new facility is also planned in Calgary, with future prospects for further distribution of the supply system within the province.

While cutting-edge treatments often highlight a single renowned doctor or a groundbreaking drug, the reality of healthcare is supported by such massive infrastructure.

A $35 Million Investment in Clinical Trials

Another crucial element in elevating treatments to standard medical practice is clinical trials.

In July 2026, the Alberta Cancer Foundation announced a $35 million investment over the next five years to support cancer clinical trials in Alberta.

The initiative includes the Clinical Trials Unit at the Cross Cancer Institute, aiming to accelerate research on CAR T-cell therapy and new immunotherapies.

According to the foundation, over 200 cancer clinical trials are active in Alberta.

Clinical trials play a role in verifying whether new treatments are truly effective, whether their safety is acceptable, and whether they are superior to conventional treatments.

Simultaneously, they can serve as an entry point for patients to access treatments before they become standard.

The early implementation of PSMA-related treatments at the Cross Cancer Institute is backed by an environment where research facilities, administration, donations, healthcare professionals, and patients are interconnected.

Pluvicto Moves from "Experimental Drug" to the Next Stage

The situation surrounding Pluvicto is rapidly changing globally.

In the United States, it was approved in 2022 for PSMA-positive metastatic castration-resistant prostate cancer, and the range of eligible patients has gradually expanded since then.

Furthermore, on July 31, 2026, the U.S. Food and Drug Administration approved Pluvicto for use in combination with androgen receptor pathway inhibitors for PSMA-positive metastatic hormone-sensitive prostate cancer.

This indicates a shift from being an option only after exhausting all other treatments to being used at an earlier stage.

However, the approval status in the U.S. and the conditions under which it can be received within Canada's public healthcare system are not the same.

The Canadian Cancer Society also notes that the availability and public insurance coverage of treatments using Lutetium-177 may vary by region.

The existence of a groundbreaking drug and the reality of patients being able to receive it are separate issues.

"Hope" and "Anxiety" Are Simultaneously Discussed on Social Media

Looking at social media reactions to Pluvicto reveals how patients and their families perceive this treatment.

In the Reddit community for prostate cancer patients and families, posts repeatedly appear from people with family members starting treatment, seeking to know the experiences of those who have undergone it.

This gathers a different type of information than medical papers.

For example, there are reports from patients whose PSA levels significantly dropped after treatment.

Another post describes experiencing nausea, fatigue, and dry mouth after multiple doses, with some symptoms easing over time.

Family members reading these posts express reactions like "I want to hold onto hope as my father is about to start treatment."

The high expectations for new treatments are evident.

On the other hand, not all experiences are positive.

There are accounts of severe fatigue, nausea, loss of appetite, and significant dry mouth, making it difficult to continue treatment.

Even with the same Pluvicto treatment, there are people who found it "relatively tolerable" and those who found it "extremely difficult."

Regarding PSMA PET, there are cases where patients express strong anxiety about potentially receiving bad results before the test, receiving encouragement from other patients.

While advanced imaging provides doctors with crucial information, it also confronts patients with the extent of their disease.

Progress in technology doesn't eliminate anxiety.

Rather, as information becomes more precise, patients need support to understand it and make decisions about their next treatment.

Social Media Experiences Are Not "Proof of Effectiveness"

It's important to note that treatment experiences shared on social media cannot be directly treated as evidence of treatment effectiveness.

Posts about significant PSA drops or severe side effects are individual experiences.

Each patient differs in disease progression, metastasis sites, past medications, age, physical strength, and concurrent treatments.

Moreover, inaccurate medical information can be posted on social media.

Therefore, these should be read as materials to understand "what patients hope for and what they fear," and medical judgments should be based on information from clinical trials and medical institutions.

The important point revealed by social media isn't just "whether it works."

How severe are the side effects?

Where are the facilities that offer the treatment?

What about insurance and public coverage?

Is there a need to distance oneself from family?

How much of a normal life can be maintained while undergoing treatment?

Patients are also seeking information directly connected to their daily lives.

Not Just "Curing Cancer" but "Connecting Time"

When discussing the latest treatments for advanced prostate cancer, using the term "miracle treatment" is not appropriate.

Pluvicto is not effective for all patients, may cause side effects, and might not be suitable for some based on their condition.

Nonetheless, the emergence of drugs with new mechanisms of action is significant.

There are patients like Allman who can transition to new options after one treatment becomes ineffective and then move on to the next.

Each treatment generates time, during which the next treatment emerges.

The shift from cancer being a "disease resolved