With Urologic Oncology Surgeon Robert Carey, MD, PhD, FACS
When James Kruysman was diagnosed with locally advanced high-grade high-risk prostate cancer at 56 years old, the prognosis was not good. And when even standard treatments proved ineffective, a brand new targeted therapy finally made all the difference.
“Traditionally patients who present with metastatic prostate cancer have a very short life expectancy with many severe symptoms of bleeding, pain and obstruction,” says Dr. Robert Carey, Kruysman’s physician and a board-certified urologic oncology surgeon specializing in the treatment of prostate cancer. Dr. Carey outlined an AUA guideline-based multimodal treatment plan for Kruysman, moving methodically but aggressively to counter a high grade, high risk cancer. Kruysman underwent a robotic prostatectomy with an extended pelvic lymph node dissection for local control of the cancer, combined with Androgen Deprivation Therapy and Androgen Receptor Inhibitor therapy for systemic control of his metastatic disease. The combination of these treatments enabled Kruysman to be controlled for more than a decade, during which he was able to work and enjoy his family without pain, obstruction or undue suffering. “Although it is always better to not have cancer at all—or to have a simple cancer that can be easily cured—the length of time and the quality of life experienced by Kruysman are the goals of these treatments, when patients present with pre-existing metastatic disease,” says Carey. “But, eventually and consistent with the natural history of prostate cancer, Kruysman’s cancer became resistant to all of the treatments and we needed to look for another option.”
Enter Pluvicto, a PSMA-targeted radioligand therapy designed to deliver cancer-killing radiation directly to—and from within—prostate cancer cells. Here’s how it works. Around 80% of prostate cancers are made of cells with a biomarker called Prostate Specific Membrane Antigen (PSMA) on the cell surface. And one of the two key components of Pluvicto is a molecule called a PSMA-targeting ligand, meaning it seeks out cells with the PSMA biomarker and bonds to them. The second key component of Pluvicto is a cytotoxic radionuclide called Lutetium 177, which emits alpha and beta radiation and breaks down the DNA of cancer cells. Working together, Pluvicto becomes a targeted therapy that seeks out prostate cancer cells in the body, bonds with them, and then destroys them.
To Dr. Carey, the Pluvicto was something out of his past. As a young PhD student at MIT in the 1980s and as a young professor in Switzerland in the 1990s, Dr. Carey dedicated his young life to developing novel therapeutic agents to target cancer. “Radioligand therapy was something we designed on the chalkboard,” he says, “but we never had the right ligand for the right cancer at the right time.”
For Kruysman, who had been battling cancer for nearly a decade, it was another shot. “And I was all in,” he says. He would be only the fifth person at SMH to receive the new therapy.
The original plan was for six treatments with Pluvicto, meaning six separate injections. PET scans in between would let the doctors know if the therapy was working. The treatment sessions were easy enough, says Kruysman, consisting largely of getting a shot in the arm and checking in with the doctor, but there were some side effects, like dry mouth and fatigue. “You just don’t feel like doing anything,” he says. “You’re just tired.” And even though he worked full time through his treatment, he did take a few days off for each session. They were only halfway through the treatments when the PET scan came back with tremendous news: the tumor was gone.
Kruysman was floored; Dr. Carey was cautious. He recommended one more round of Pluvicto to manage any micro metastatic disease not seen on the imaging. “With cancer we remain optimistic and vigilant at the same time for follow up care,” he says.
Today, after a decade fighting prostate cancer, Kruysman is living in remission and getting back to his old self—with maybe a couple adjustments. “I feel great,” he says. “I got a lot of my
energy back. But a cancer diagnosis changes your whole outlook on life. Different things become important.” Dr. Carey, meanwhile, is looking at a brighter future for his patients. “These treatments give us options where we did not have options before,” he says. “It gives patients like James, who present with advanced disease, decades instead of years.”
Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY.