At Turku University Hospital, Finland, a new theranostics type of treatment using nuclear medicine has been taken in use to improve the quality of life for prostate cancer patients. The StarGuide™ SPECT/CT system from GE HealthCare plays an important role in treatment management, significantly reducing scan times and increasing image quality, especially compared to conventional dual-head cameras.
In the last few years, the use of Lu-PSMA treatments to prolong the life span and improve the quality of life for late-stage prostate cancer patients has shown promising results in several places. This has also been the case at Turku University Hospital in Finland, where the treatment started at the beginning of 2024.
177Lu-PSMA-I&T therapy is a Prostate-specific membrane antigen-targeted type of therapy that uses the 177 Lutetium isotope to target and destroy PSMA, a protein on the outside of prostate cancer cells.
“Since 177Lu-PSMA-I&T targeted radionuclide therapy became available, we have wanted to introduce the treatment to patients here at Turku Hospital, and after careful planning and preparation, we were able to treat the first patients in February 2024. 10 months on, we have treated 20 patients, and our overall conclusion from this initial period is very positive. The majority of the patients have tolerated treatment well. Dry mouth, nausea, and fatigue are the most common adverse event. We have seen some responses too,” says Kalle Mattila, Oncologist at Turku University Hospital.
“If we compare the StarGuide system to our conventional systems, when acquiring 177Lu-PSMA exams we are able to reduce the scan time by more than 50 % while at the same time getting a better image quality.1"
Tommi Noponen, Medical Physicist and Adj. Prof. at Turku University Hospital
“Having said that, though, it’s important to emphasize that 177Lu-PSMA therapy is not a cure for prostate cancer and is not an option for all patients. We have been able to improve patients’ quality of life and prolong their survival by several months, which is indeed positive. But at the moment, the treatment is indicated for patients with metastatic castration-resistant prostate cancer that no longer responds to traditional hormone treatments or chemotherapy.”
Following the effect of treatment using high-quality SPECT/CT images
An important prerequisite is the ability to precisely follow the patients’ response to the treatment. This is where the images provided by the StarGuide SPECT/CT system are used to distinguish patients responding positively to the Lutetium-PSMA therapy from the ones with a more moderate response. Tommi Noponen, Medical Physicist and Adj. Prof. at Turku University Hospital, explains:
“As is the case in diagnostics in general, having the ability to obtain the best data and the best images plays a crucial role. If we compare the StarGuide system to our conventional systems, when acquiring 177Lu-PSMA exams we are able to reduce the scan time by more than 50 % while at the same time getting a better image quality. I find the StarGuide to be a much more sensitive system due to the ring-shaped design with 12 detector heads2, and when required we can utilize the system capabilities to reduce the scan time while still getting better images than our conventional system can produce.”
Besides saving time in the clinic, Tommi Noponen points out that the faster scans, in addition the narrower detector heads in the system, mean that many patients will suffer less from claustrophobia while being imaged in the StarGuide.
It takes 30-60 seconds to administer the Lutetium injection. After that, patients remain in the treatment room for 3-4 hours in isolation until the radiation levels are lowered. SPECT/CT images helps determining how the patients respond.
Close cooperation between oncology and nuclear medicine departments
The close cooperation between the hospital’s Department of Nuclear Medicine and the Oncology Department is a key reason for the successful start of the Lu-PSMA treatment at Turku University Hospital.
“No doubt, the cooperation and dialogue we have had from the very beginning, through the planning phase and that we still have on a daily basis today between our colleagues in Oncology and ourselves in the nuclear medicine department plays a vital role in securing a successful introduction of a new treatment such as the 177Lu-PSMA,” Tommi Noponen continues.
“This form of treatment requires special arrangements due to the use of radioactive drugs, and the treatment is given in a specially equipped isolation room. However, in our experience, the 177Lu-PSMA therapy site can be launched with a quite reasonable investment in a normal oncology outpatient day ward. The staff needs special training in radiation safety, but previous radiation work experience is not necessary. Also, the radiation safety actions are straightforward, and radiation exposure to the environment from a 177Lu-PSMA patient is moderate.”
The staff at the Department of Nuclear Medicine, Turku University Hospital.
Patients arrive for treatment in the morning and leave again in the afternoon
The term theranostics, deriving from the combination therapeutics and diagnostics in one workflow, describes a type of treatment in which one radioactive drug is used to identify (diagnose) and a second radioactive drug to treat the cancer cells. At Turku University Hospital, patients can arrive for treatment in the morning and leave again in the afternoon. Kalle Mattila describes the standard procedure:
“Actually, it’s quite simple. It takes 30‒60 seconds to administer the Lutetium injection. After that, we keep the patients in the treatment room for 3‒4 hours in isolation until the radiation levels are below the required limits. It’s easy for the patients and staff as well. The patients get an injection four to six times at six-week intervals. In between, we do SPECT/CT imaging to monitor the response, calculate dosimetry results and determine how the patients are benefiting.”
Still on a learning curve
One learning is that patients whose prostate cancer is progressing rapidly seem to benefit less from the treatment than patients whose cancer is progressing at a slower pace, says Kalle Mattila.
“In some ways, we are still on a learning curve with this kind of treatment and for every patient, we learn more about how to identify and choose the ones who are benefiting the most.”
“At present, this type of treatment is for men with metastatic castration-resistant disease, but if we look at the future perspectives, we might see several other radionuclide-targeted therapies. I think this will be an interesting new tool for oncologists in many different cancer subtypes. Maybe we’ll get combination therapies with radionuclides and some other treatments like immunotherapy or other kinds of targeted therapies. This is something we look forward to and hope will happen.”
References:
1. This statement by GE HealthCare’s customer reflects their own opinion and the results observed in their specific settings. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, etc.), there can be no guarantee that other customers will achieve the same outcomes.
2. A higher planar and volume sensitivity compared to NM/CT 870 DR and NM/CT 870 CZT. StarGuide’s planar sensitivity was measured for each of its 12 detectors and adapted from NEMA NU 1-2018. NM/CT 870 DR used LEHR/LEHRS collimators and NM/CT 870 CZT used the WEHR collimator for both planar and SPECT measurements.
3. StarGuide has improved SPECT* resolution compared to NM/CT 870 CZT and NM/CT 870 DR. The improved SPECT resolution enables sharp images for better visualization of fine anatomical details, which is important to help enable physicians to detect diseases at earlier stage. (*StarGuide SPECT reconstruction with scatter used the system’s factory NEMA NU 1-2018 resolution protocol which uses the same method (BSREM with Clarity 3D) as its clinical bone protocol. NM/CT 870 DR and NM/CT 870 CZT SPECT reconstruction used Evolution for Bone (OSEM). NM/CT 870 DR used LEHR/LEHRS collimators and NM/CT 870 CZT used the WEHR collimator.)
4. Based on Song et al (DOI 10.1007/s00259-023-06176-6). Results may vary since the scan time depends on the clinical task, patient size, anatomical location and sites’ clinical practice. A radiologist should determine the appropriate scan time for the particular clinical task.
5. Clarify DL improves StarGuide’s image quality performance measured by Structures Similarity (SSIM) – up to 38% improvement, Mean Squared Error (MSE) - up to 91% improvement, and Peak Signal-to-Noise Ratio (PSNR) - up to 37% improvement, as compared to GE bone SPECT factory reconstruction presets*. Improved image quality performance may help increase diagnostic confidence.(*Demonstrated using digital phantom simulations with inserted lesions of known size, location, and contrast, for AC and NC images=.
6. In 127 exams rated by total of 9 physicians, in 85% of the exams, Clarify DL’s image noise level was rated as better than the existing factory reconstruction preset images* (*As demonstrated in clinical evaluation, where each exam was reconstructed with both Clarify DL and the existing factory reconstruction preset and evaluated by 3 of the physicians.)
© 2025 GE HealthCare. StarGuide is a trademark of GE HealthCare. GE is a trademark of General Electric Company used under trademark license. JB32400XX.
January 2025. Turku University Hospital does not have any contractual relationship beyond the fact of being end user of a GE HealthCare medical device.
