Prostate cancer is one of the most widespread malignant tumors in men. The pathology is successfully
treated in the first three stages, when the tumor can be removed or destroyed by radiation, but the disease at the metastatic stage becomes incurable. Surgery is usually not performed in such patients, and the main methods of treatment are hormonal and chemotherapy.

At a certain point this treatment stops working. 177Lu-PSMA-617 – Lutetium radiotargeted therapy,
becomes the next stage of treatment. A less common method of radiotargeted therapy is the treatment of prostate cancer with Actinium-225. It allows for a good outcome even in patients who have not responded to Lutetium therapy. In addition, the possibility of combined use of Actinium and Lutetium as part of tandem therapy is being investigated.

Principle of the method

Prostate cancer cells express a protein called prostate-specific membrane antigen (PSMA), which is not found in other tissues. PSMA is a target for the radiopharmaceutical. Once injected into the body, the drug accumulates only in tissues with high levels of PSMA because it binds to this protein. This results in a selective effect on the tumor and its metastases with minimal side effects.

Various radionuclides can be attached to ligands that target PSMA. The first such radionuclide was
Lutetium-177, which was synthesized in Germany in 2010, and its efficacy was first confirmed in trials in 2015. The good results were subsequently confirmed in a large study involving 13 university hospitals in Germany.

In recent years, Actinium-225 has been used instead of Lutetium. It destroys cancer cells with alpha
radiation.

Advantages and disadvantages of Actinium-225

Lutetium-177 is still considered the mainstay of radiotargeted therapy for castration-resistant prostate
cancer. However, Actinium is also used in certain situations, usually in patients with advanced cancer who have not responded to Lutetium treatment or when the efficacy of 177Lu-PSMA-617 has decreased after several courses (cancer progression has resumed).

Advantages of Actinium-225 over Lutetium-177:

● More pronounced effect due to alpha radiation causing double-strand breaks in DNA strands
● Less toxic effect on bone marrow and hematopoietic function due to shorter recovery time
● Works even in cases where the cancer is progressing against the background of Lutetium therapy

However, it is worth considering the disadvantages of this method:

● Limited evidence base compared to Lutetium
● Higher incidence of side effects, especially dry mouth

Who is a candidate for Actinium therapy

Radiotargeted therapy with Actinium is considered a novel treatment. The technique is indicated for
patients with metastatic castration-resistant prostate cancer (MCRPC) who:

● Have received Lutetium radiotargeted therapy but have not responded to it
● Have responded to Lutetium radiotargeted therapy, but have stopped responding after several
courses of treatment
● As part of tandem therapy: when Actinium and Lutetium are used in reduced doses

In summary, Actinium therapy is one of the last treatment options. It is used when chemotherapy, hormone therapy, radiotargeted therapy with Lutetium, and possibly targeted therapy (in the case of BRCA mutations, which occur in 28% of patients with metastatic prostate cancer) have already been tried. In addition, the choice of treatment tactics takes into account the location of the metastases. In the presence of predominantly bone metastases and pain syndrome, radionuclide therapy with Radium-223 is preferred, and in the presence of predominantly organ metastases, radiotargeted therapy with Lutetium or Actinium is performed.

If you want to undergo innovative treatment in Germany, visit Booking Health website. Our team will find a clinic for you and organize your trip.

With the success of the iGaming market in Ontario, Alberta is looking to it as a blueprint for its own plans in that arena. Despite this, there will likely be differences in the way the two provinces regulate this industry.  These potential differences will likely be based on the strategies laid out by Dale Nally, Alberta’s Minister of Service and Red Tape Reduction.

The manner in which Alberta eventually decides to handle its iGaming regulations will be crucial to maintaining a healthy balance for the industry there. Many other regions have begun seeing the drawbacks of over-regulation in this field. As a result, many new-age casinos operating offshore have been gaining popularity over traditional ones that are often stifled by restrictions. 

This is because restrictions place more onerous burdens on operators and cause lengthy delays with everything from sign-up procedures to payout times. However, offshore casinos have become a revelation for players tied down by these restrictions. For example, crypto casinos and the perks found at sites like an instant payout casino have seen the number of players from regions like the US, UK, Asia, Europe, and even Canada soaring in recent years.

Instant payout casinos in particular have grown very popular in recent years as they offer players same-day access to their winnings. This phenomenon has been playing out amid ever-tightening regulations on iGaming sites being deployed in many prominent markets. 

While reasonable regulations have their benefits, many players feel that most jurisdictions are over-regulating the industry now and players have begun to respond by flocking to offshore sites. Instant payout casinos offer a perfect refuge since platforms like these feature fewer restrictions, more expansive gaming libraries, more privacy, and more generous bonuses.  

While Alberta is drawing heavily from Ontario’s regulatory guidelines, it also wants to retain some aspects that will distinguish it too. Minister Nally has indicated that Alberta will seek a less onerous regulatory regime than Ontario. However, as it is with Ontario, there won’t be a limit imposed on the number of iGaming operators permitted. These would also not require any partnerships with land-based casinos. 

This approach is expected to foster a competitive online betting environment. As such, huge operators are expected to set up shop there and operate freely alongside the government-run Play Alberta—which currently holds a monopoly.

Nally’s ministry has already been busy working on these new regulations and is set to keep being so as it will also be directly responsible for overseeing iGaming regulations and their enforcement. This ensures a separate regulatory body need not be created. It also addresses concerns raised by operators that Alberta’s Gaming, Liquor, and Cannabis Commission (AGLC) would have a conflict of interest if it managed the new regime as the AGLC is a market operator since it runs the Play Alberta platform.

All in all, Alberta’s approach currently does look good and at least considers the need for making it as simple as possible for new entrants to gain access to the market. Alberta’s method to  “conduct and manage” gambling activities is in direct contrast with Ontario’s, where iGaming Ontario (iGO) is simply a subsidiary of the Alcohol and Gaming Commission of Ontario (AGCO).

The revenue-sharing model will also be looked at. Currently, Ontario operators are taxed 20% with the province making $790 million of them last year—with more expansion on the horizon. On that note, Alberta has hinted that it may seek a higher percentage. With other things like consults with indigenous communities and other stakeholders, and setting up transition periods for “grey” market operators, there is more work to be done. However, for now, the future of the iGaming industry in Alberta looks good indeed.