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18 August 2021 | Story André Damons | Photo André Damons
Dr Osayande Evbuomwan is a Senior Lecturer and medical specialist in nuclear medicine in the Department of Nuclear Medicine, Faculty of Health Sciences, at the University of the Free State (UFS).
The University of the Free State (UFS) Department of Nuclear Medicine has, for the first time, started using Lutetium 177 PSMA (Lu-177 PSMA) therapy for the treatment of metastatic castrate-resistant prostate cancer (MCRPC) – an advanced stage of prostate cancer.

The UFS and the Free State province are now joining other South African universities, such as the University of Pretoria, the University of the Witwatersrand, and other provinces in using this method to treat MCRPC patients. 

Dr Osayande Evbuomwan, a Senior Lecturer and medical specialist in the Department of Nuclear Medicine, Faculty of Health Sciences, says they have started treating their first MCRP patient (first cycle) with peptide receptor radionuclide therapy (PRRT) on 15 July. It is the first time that Lutetium 177 PSMA – a type of PRRT used for treating patients with MCRPC – has been used in the Free State. This method is used on MCRPC patients who are not eligible for chemotherapy or have failed first- or second-line chemotherapy.

Expertise and funds are now available for this treatment

Dr Evbuomwan was trained and exposed to this therapy at the University of the Witwatersrand during his registrar training in nuclear medicine. When he joined the UFS in 2019, he – with the always available help of the Head of Department, Dr Gerrit Engelbrecht – pushed for the therapy to be used in the department. 

“We in the Department of Nuclear Medicine are happy that expertise is now available and that some funds have been released for this treatment to commence. The index patient is very sick with MCRPC and was too sick to qualify for first-line chemotherapy. Each patient will need about four-six cycles for complete treatment. The patient is being treated in the Department of Nuclear Medicine at the Universitas Academic Hospital and Annex.” 

“We are hoping that he will be able to complete at least four cycles and respond well to the treatment. We believe that the ability to administer this treatment now is good news for the Free State, as the people of the Free State also deserve to be exposed to this level of treatment. We are hoping that the government will continue to provide more funds for more of these patients to be treated in our facility,” says Dr Evbuomwan.

It was budgeted to treat five patients (20 cycles), with each cycle (just the Lu-177 PSMA) costing more than R50 000. 

A googled image from the internet of a case before, during, and after completing the full course of therapy. The first image is before
treatment and the last image is after completing treatment, while the images in between are during treatment. (Source: Google) 

Prostate cancer one of the leading causes of morbidity and mortality

Dr Evbuomwan says prostate cancer is one of the leading causes of morbidity and mortality in the world, including South Africa. When it progresses to the advanced stage of MCRPC, the prognosis becomes bad. 

Dr Evbuomwan explains that there are various conventional systemic therapies, including first- and second-line chemotherapy that could be used to treat patients at this bad stage. However, not all patients are fit for chemotherapy. The few who are fit, according to Dr Evbuomwan, usually end up failing the first-line chemotherapy, which has a lot of undesirable side effects and require long-stay hospital admissions. 

Only a few centres are able to offer second-line chemotherapy. So many of these patients end up suffering from prolonged bone pains before eventually dying from the disease.

PRRT is a targeted nuclear medicine therapy that offers the opportunity to deliver very high levels of radiation specifically to cancer cells, because these cancer cells express specific receptors to which certain peptides can bind. This specificity to cancer cells offers the advantage of providing lower doses of radiation and damage to normal organs and tissues, a characteristic that conventional therapies do not offer, explains Dr Evbuomwan.  

According to him, Lutetium 177 PSMA (Lu-177 PSMA) is a type of PRRT used for treating patients with MCRPC, who are not eligible for chemotherapy or have failed first-line chemotherapy. Numerous research studies around the world have proven that this treatment improves quality of life, slows down disease progression, and improves overall survival, with little or very tolerable side effects in most patients. 

The University of Pretoria is one of the pioneers of this treatment in the world, having done a lot of research with it since 2017. Other provinces such as the Western Cape and KwaZulu-Natal have also recently become involved with the therapy. This therapy is expensive and requires a lot of expertise. It also involves the input of a multidisciplinary team (MDT), which must at least include a nuclear medicine physician, a radiation oncologist, and a urologist. The Departments of Urology and Radiation Oncology at the UFS were also instrumental in the initiation of the therapy and form part of the MDT team at the UFS in the management of these patients.

Treatment puts department, university, and hospital on the map

Dr Evbuomwan says the ability to administer this treatment puts the department, the UFS, and the hospital on the map, alongside other top universities within and outside the country. “It also creates an avenue for us to gather data for research purposes and for publications. We are now able to offer a promising, safe, and highly efficacious therapy for patients with MCRPC in the Free State. Some of these patients no longer need to travel to other provinces to get the treatment.”

There are plans to expand the treatment to more patients – and hospital management, who were present at the first treatment, are excited and looking forward to the outcome of this current treatment.

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News Archive

Africa's Black Rhino conservation strategy must change
2017-07-10

 Description: Black Rhino Tags: conservation strategy, black rhino, Nature Scientific Reports, National Zoological Gardens of South Africa, extinction, decline in genetic diversity, Prof Antoinette Kotze, Research and Scientific Services, Dr Desire Dalton 

The black rhino is on the brink of extinction. The study that was 
published in the Nature Scientific Reports reveals that the
species has lost an astonishing 69% of its genetic variation. 
Photo: iStock

The conservation strategy of the black rhino in Africa needs to change in order to protect the species from extinction, a group of international researchers has found. The study that was published in the Nature Scientific Reports reveals that the species has lost an astonishing 69% of its genetic variation. 

South African researchers took part 
The researchers, which included local researchers from the National Zoological Gardens of South Africa (NZG), have highlighted the fact that this means the black rhino is on the brink of extinction. "We have found that there is a decline in genetic diversity, with 44 of 64 genetic lineages no longer existing," said Prof Antoinette Kotze, the Manager of Research and Scientific Services at the Zoo in Pretoria. She is also affiliate Professor in the Department of Genetics at the University of the Free State and has been involved in rhino research in South Africa since the early 2000s.  

DNA from museums and the wild 
The study compared DNA from specimens in museums around the world, which originated in the different regions of Africa, to the DNA of live wild animals. The DNA was extracted from the skin of museum specimen and from tissue and faecal samples from animals in the wild. The research used the mitochondrial genome.

"The rhino poaching ‘pandemic’
needs to be defeated, because
it puts further strain on the genetic
diversity of the black rhino.”


Ability to adapt 
Dr Desire Dalton, one of the collaborators in the paper and a senior researcher at the NZG, said the loss of genetic diversity may compromise the rhinos’ ability to adapt to climate change. The study further underlined that two distinct populations now exists on either side of the Zambezi River. Dr Dalton said these definite populations need to be managed separately in order to conserve their genetic diversity. The study found that although the data suggests that the future is bleak for the black rhinoceros, the researchers did identify populations of priority for conservation, which might offer a better chance of preventing the species from total extinction. However, it stressed that the rhino poaching ‘pandemic’ needs to be defeated, because it puts further strain on the genetic diversity of the black rhino. 

Extinct in many African countries 
The research report further said that black rhino had been hunted and poached to extinction in many parts of Africa, such as Nigeria, Chad, Cameroon, Sudan, and Ethiopia. These rhino are now only found in five African countries. They are Tanzania, Zimbabwe, Kenya, Namibia, and South Africa, where the majority of the animals can be found. 

 

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