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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.

Watch video below:

News Archive

Academic delivers inaugural lecture on South African foreign policy
2007-08-06

 

In her inaugural lecture Prof. Heidi Hudson from the Department of Political Sciences, focused on the impact that Pan-Africanist sentiments have had on South Africa’s foreign policy. She also put the resulting contradictions and ambiguities into context. At her inaugural lecture were, from the left: Proff. Frederick Fourie (Rector and Vice-Chancellor of the UFS), Heidi Hudson, Engela Pretorius (Vice-Dean: Faculty of The Humanities) and Daan Wessels (Research Associate in the Department of Political Science).
Photo: Stephen Collett

Academic delivers inaugural lecture on South African foreign policy

“We are committed to full participation as an equal partner … opposed to any efforts which might seek to project South Africa as some kind of superpower on our continent. … the people of Africa share a common destiny and must therefore … address their challenges … as a united force...” (Mbeki 1998:198-199).

Prof. Heidi Hudson from the Department of Political Science referred to this statement made by president Mbeki (made at the opening of the OAU Conference of Ministers of Information in 1995) when she delivered her inaugural lecture on the topic: South African foreign policy: The politics of Pan-Africanism and pragmatism.

One of the questions she asked is: “Can the South African state deliver democracy and welfare at home while simultaneously creating a stable, rules-based African community?”

She answers: “South Africa needs to reflect more critically and honestly on the dualism inherent in its ideological assumptions regarding relations with Africa. South Africa will always be expected by some to play a leadership role in Africa. At the moment, South Africa’s desire to be liked is hampering its role as leader of the continent.”

In her lecture she highlighted the ideological underpinnings and manifestations of South Africa’s foreign policy. Throughout she alluded to the risks associated with single-mindedly following an ideologically driven foreign policy. She emphasised that domestic or national interests are the victims in this process.

Prof. Hudson offers three broad options for South Africa to consider:

  • The Predator – the selfish bully promoting South African economic interest.
  • Mr Nice Guy – the non-hegemonic partner of the African boys club, multilaterally pursuing a pivotal but not dominant role.
  • The Hegemon - South Africa driving regional integration according to its values and favouring some African countries over others, and with checks and balances by civil society.

She chooses option three of hegemony. “Politically correct research views hegemony as bad and partnership as good. This is a romanticised notion – the two are not mutually exclusive,” she said.

However, she states that there have to be prerequisites to control the exercise of power. “The promotion of a counter-hegemon, such as Nigeria, is necessary. Nigeria has been more effective in some respects than South Africa in establishing its leadership, particularly in West Africa. Also needed is that government should be checked by civil society to avoid it sinking into authoritarianism. The case of business and labour coming to an agreement over the HIV/Aids issue is a positive example which illustrates that government cannot ignore civil society. But much more needs to be done in this regard. South Africa must also be very careful in how it uses its aid and should focus potential aid and development projects more explicitly in terms of promoting political stability,” she said.

Prof. Hudson said: “It is also questionable whether Mbeki’s Afro-centrism has in fact promoted the interests of ordinary citizens across Africa. Instead, elite interests in some countries have benefited. But ultimately, the single most important cost is the damage done to the moral code and ethical principles on which the South African Constitution and democracy is founded.

“In the end we all lose out. More pragmatism and less ideology in our relations within Africa may just be what are needed,” she said.

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