Royal Jubilee one of two BC hospitals offering new treatment for late-stage prostate cancer

The BC Cancer Foundation began offering Pluvicto—an innovative and life-extending form of radiotherapy—in June, starting only at RJH and at a clinic in Burnaby.

It’s not a cure, but it can extend the lives of those fighting complicated late-stage prostate cancers. With more than 4K people in BC diagnosed with prostate cancer each year, any progress is positive.

“What's important to understand is how common and how big of a problem prostate cancer is,” Dr. Abraham Alexander, a radiation oncologist who specializes in prostate cancer treatment at BC Cancer in Victoria, told Capital Daily.

“It's the most commonly diagnosed cancer in men. It's also the third-most common cause of cancer death in men as well. So it's a big, really, really big problem.”

Finding and destroying prostate cancer cells

Pluvicto was approved by Health Canada in 2022 to target treatment-resistant prostate cancers when all other options have been exhausted.

“It's actually a really neat treatment,” Alexander said. “It's what we call a radiopharmaceutical.”

Prostate cancer cells have a unique protein—a receptor called PSMA (prostate-specific membrane antigen)—on their surface that makes them identifiable, even when the cancer spreads outside of the prostate.

“This receptor is fairly specific to prostate cancer cells,” Alexander said. “It's not in very many other types of cells, and it's not highly expressed in regular prostate cells.”

Pluvicto seeks out these receptors, zeroing in on the prostate cancer cells and leaving healthy cells alone. The medication binds to the PSMA and delivers radiation therapy directly inside the cell.

Side effects aren’t as severe as other approaches

The side effects aren’t nearly as bad as those experienced during chemotherapy, which causes hair loss and leaves patients feeling nauseous and fatigued. The most notable complication found so far is dry mouth caused by a salivary gland tissue that expresses PSMA. It can also reduce blood cell count, the long-term effects of which are being closely monitored.

“It’s definitely much more straightforward [than chemo] because it's so specific,” Alexander said. “It mostly acts on the prostate cancer cell… it’s a much, much easier treatment than chemotherapy.”

The treatment option will be available soon at Vancouver General Hospital, and hospitals in the Fraser Valley will see it later this year. RJH was selected as a location for the treatment because it has a protected room, allowing for the proper radiation precautions, Alexander said.

Because those needing Pluvicto must receive it onsite at RJH, the drug manufacturer is offering a travel assistance program to alleviate costs for those travelling from up-Island or elsewhere..

The treatment—costing up to $130K for six sessions—will also be covered by BC Cancer’s Compassionate Access Program.

This wasn’t a guarantee mere months ago, when negotiations for public coverage stalled in November between the drug company Novartis and the pan-Canadian Pharmaceutical Alliance (pCPA), which negotiates drug prices for provincial health plans. But in December, they reached an agreement, and in May, the Provincial Health Service Authority confirmed BC Cancer would cover the treatment for those who need it.

A blueprint for future cancer treatments

​​ For now, Pluvicto is only able to target late-stage prostate cancer. But as it’s studied more over the next few years, Alexander says it could become available to those with earlier stages of the disease.

It could also serve as a template for treating other types of cancer. Currently, the only cancer cells that have identifiable markers are prostate and rare neuroendocrine cancers. But Alexander says he’s sure every cancer has a marker.

“The truth is, we haven't identified them for all cancers,” Alexander said. “Certainly other cancers do have specific markers on their surface as well that could potentially be exploited.”

Alexander says efforts are being made to identify these, but it will take time to understand the variations.

For now, 24 patients throughout the province—including five being treated at RJH—are in the process of receiving this treatment. As it becomes a more standard treatment, Alexander says BC could treat around 300 late-stage prostate cancer patients a year using Pluvicto.

“We're really fortunate to have this new treatment that's effective for people who have run out of treatment options, which is great for hope,” Alexander said. “I think in the future, we're definitely going to see this drug being brought earlier on in treatment of prostate cancer and a similar paradigm used for other cancers in the future as well.

“So this is a great new step forward.”