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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

An education system based on hope is what South Africa needs – Dr Beryl Botman
2016-05-26

Description: Hope revised Tags: Hope revised

Dr Beryl Botman, a postdoctoral research
fellow at the IRSJ, with Dr Willy Nel research associate
at the IRSJ and lecturer at the UFS
Faculty of Education.

HOPE is tangible and concrete construct that should be rooted in the learning and training of teachers,” said Dr Beryl Botman, a postdoctoral research fellow at the Institute for Reconciliation and Social Justice (IRSJ).

She presented her research paper Educators, praxis, and hope: A philosophical analysis of post-apartheid teacher education policy, based on the theoretical ideologies of Paulo Freire’s Pedagogy of the Oppressed. She explores ways in which oppression has been justified, and how it has been overcome through a mutual process between the oppressor and the oppressed, drawing on Paolo Freire’s theories and practices. The presentation was held at the University of the Free State’s (UFS) Faculty of Education, on the Bloemfontein campus on 13 May 2016.

From oppression to hope

Hope should be an educational construct for teacher education in South Africa. Dr Botman asserts that epistemology and ontology should be inseparable, as they are pivotal to an education system that is transformational.

The recent country-wide student protests and demonstrations are an indicant that education institutions need to seek understanding of mechanisms that fuel social conflict. Dr Botman claims that vast social inequalities make the process of democratisation difficult thus hindering transformation. She states that a critical consciousness is important for all South Africans, but more so for educators; it can be used as a tool to understanding the mechanisms of social conflict.

“Self-reflection and self-critique is vital for educators, we need to understand that we do not have all the answers because we ever-evolving beings, working on understanding ourselves and the people around us,” said Dr Botman.

The notion of hope
“I am a farmer. I have no hope for a future that is different from today. This quotation comes from Paulo Freire’s work," said Dr Botman. She said that the South African context and environment is similar. She said that people cannot live for today; one should live for tomorrow if hope is to manifest itself.

South African education environment needs to adopt a progressive consciousness that is future orientated, “You need to be hopeful, if you are radical. You need to be able to envision a new society and a new world,” said Dr Botman.

“You cannot only denounce the present, you need to also announce your hopes for a new society. South Africa needs education systems built on understanding. Although change is difficult, it is necessary for transformation,” Dr Botman added.

What makes hope educational?
“Hope is a vision for a tomorrow that is different, and vital for a transformative education system. To get out of a state of despair, people need to educate their hope. Lately, the issue of white privilege has been brought to the fore. You need to educate your hope, so that you understand the reality of others but, more importantly, of yourself,” said Dr Botman.

Dr Botma added that teacher education needs to adopt a Freirean pedagogy with a strong philosophy based on hope. The agency of teachers can either be hopeful or without hope. It is vital that education promotes hope.

“Teachers need to rely on their existential experience, the experiences of others, and the experiences of the children or students they teach. An understanding of all these experience reinforces the idea that people are life-long learners, always learning and adapting to society’s needs,” said Dr Botman.

Teachers as agents of hope

Dr Botman stated that current South African education policy is directed towards transformation but it does not stipulate means to achieve this objective. Further, she argues that educators need to put greater emphasis on self-knowledge, self-reflection, and self-education. Connecting with teachers, parents, students and the community engages with their self-knowledge and reflection.

Reorientation of teacher education
Dr Botman concluded by mentioning that rethinking ontological and epistemological aspects of education is important, and should be a pivotal point of teacher education. A renewed vision of hope-orientated philosophy and pedagogy needs to be adopted by the education institutions. A praxis, which is an informed action, when a balance between theory and practice is achieved. There is a need for an inclusive exploration of education philosophies and education systems not only European and Western but also African and Eastern as well.

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