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  • Therapie der Zukunft: we fight your cancer

Category: Patient testimonials

Success stories in the words of the patients

Therapy Response After Combined CyberKnife & PSMA Radioligand Therapy

anastasiaPatient testimonials

Therapy Response After Combined CyberKnife & PSMA Radioligand Therapy

3x ¹⁷⁷Lu-PSMA and 1x ¹⁶¹Tb-PSMA, at 4-Week Intervals

Mr. J. Low, 67 years old, was first diagnosed with prostate cancer in February 2011. After multiple prior treatments—including primary external beam radiation, ADT, ARPI, three cycles of immunotherapy, cryotherapy, and irreversible electroporation (IRE)—in 2024 he experienced a slow rise in PSA despite ongoing ADT, suggesting decreasing efficacy of hormone therapy.

Concerned about the long-term effects of continuous antiandrogen therapy and chemotherapy, he opted for PSMA radioligand therapy. Following a cycle of ¹⁷⁷Lu-PSMA therapy at our institution, PSMA PET/CT still showed residual PSMA expression in the prostate tumor and two very small lymph node lesions. To address this, treatment was complemented with CyberKnife radiotherapy at our partner clinic CyberKnife Salzburg and one additional session of ¹⁶¹Tb-PSMA radioligand therapy—an ideal combination for relatively localized oligometastatic disease, small metastases and possible micrometastases.

As a result, the lymph node metastases disappeared on PSMA PET/CT and local disease in the prostate was effectively and safely treated by Cyberknife despite having a history of external radiation of the prostate.

Clinical facts BEFORE

PSMA PET/CT 11/ 2024 at PSA 5,39 ng/ml showed localized PSMA-expressing tumor in the prostate and locoregional lymph node metastases after primary RT, ADT, ARPI, 3 cycles of immunotherapy, cryotherapy, IRE.

 Clinical facts AFTER

After 3x 177Lu-PSMA and 1x 161Tb-PSMA radioligand therapy sessions from November 2024 to April 2025 and CyberKnife therapy in April 2025 before the last RLT session: PSA decreased to 0,5 ng/ml with PSMA PET/CT 08/2025 not showing significantly PSMA expressing active disease anymore.

Personal testimonial:

"My husband has been battling metastatic prostate cancer for 14 years. (diagnosed at age 53). After our doctors told us there was nothing more they could do but stay on the devastating drugs, we found out about Dr. Markus Hartenbach, at Minute Medical, in Austria. Dr. Hartenbach goes above and beyond to help his patients. He and his team truly care and won't give up on you. I can't say enough about how blessed we are to have found Minute Medical. Eva goes above and beyond to help with car pick ups to and from the airport, help with hotel info and every other question we had. After treatments, my husband's scans now show NO METASTATIC CANCER!!! We are forever grateful to this team of highly dedicated doctors who work diligently to put and end to this dreaded disease. I would definitely recommend reaching out to this place, if you're dealing with prostate cancer. They are the absolute best!!!!"

“At the forefront of medicine, with outstanding human care”

anastasiaPatient testimonials

"At the forefront of medicine, with outstanding human care"

Mr. T.A., 59 years old, was first diagnosed with prostate cancer (Gleason 7b) in December 2020. Despite intensive pretreatment with irreversible electroporation and electrochemotherapy (IR-ECT) and external beam radiation to the prostate, the disease continued to progress. At the time of referral in December 2024, there was extensive metastatic spread to the skeleton (with intracranial and spinal involvement), lymph nodes throughout the abdomen and chest, as well as liver and lung metastases. The cancer was still hormone-sensitive.

Mr. T.A. refused chemotherapy due to potential side effects and opted for PSMA-targeted radioligand therapy in combination with antihormonal treatment instead, in line with the recommendations from current phase III clinical trial results (VISION, TheraP, PSMAfore). Because of the heavy tumor burden and extensive skeletal involvement, a treatment concept with one session of ²²⁵Ac-PSMA followed by two sessions of ¹⁷⁷Lu-PSMA was chosen.

Four months after the treatment series, the results were remarkable:

  • The prostate itself showed no remaining PSMA uptake.
  • Skeletal metastases almost completely regressed, with sclerotic[1] healing of former lesions.
  • The cancer in the lymph nodes throughout the chest and abdomen had almost completely disappeared, with only a tiny spot left near the lung.
  • The liver metastasis as well as the multiple lung metastases were no longer detectable.
  • Only two small PSMA-expressing bone lesions were detected.
  • The patient reported rapid pain relief, a general improvement in well-being, and the ability to resume physical activity (jogging).

Given this excellent response, an additional therapy cycle with ¹⁶¹Tb-PSMA was scheduled to consolidate the effect and target the remaining lesions as well as possible residual micrometastases.

“With MINUTE Medical and the team led by Prof. Markus Hartenbach, I have finally reached a medical destination after a long and at times very difficult journey with many stops along the way. Minute Medical stands at the forefront of applied research and medical technology, while at the same time providing truly outstanding human care and personal support – for which I can only give a 10 out of 10.

I wholeheartedly recommend MINUTE Medical to any patient facing a medical and symptomatic situation similar to the one I was in just a few months ago.”

[1] scar-like bone tissue

“I am in full remission and have no evidence of disease.”

anastasiaPatient testimonials

"As of January 2025, I am in full remission and have no evidence of disease."

"At just 50 years old, I was diagnosed with stage 4 prostate cancer in April 2024, which is very rare for someone my age.  I then entered the standard of care and was told I would have to do ADT treatment (chemical castration) for the rest of my life to essentially buy time. This would have had brutal side effects and would have been a horrible existence.

I decided that there had to be a better way. I did extensive research and networking and ultimately found the right path forward for myself. My excellent health and fitness were a very significant part of my ability to fight the disease. I started with a very complex and evolving protocol of Eastern medicine including diet, homeopathic remedies, herbs, supplements and continual physical and mental exercise.

My Western medicine treatments included cryo-immunotherapy and ¹⁷⁷Lu PSMA ligand therapy, along with a very short run of ADT. I received three sessions of ¹⁷⁷Lu-PSMA at MINUTEmedical in Vienna. Dr. Hartenbach was very supportive, explaining everything clearly and being there for me throughout the entire treatment process and beyond. The side effects were minimal and, I believe, mainly from the ADT.

The results have been no less than amazing. My massive prostate tumor and bone metastases have disappeared, and my PSA value dropped from 19 to 0.03. As of January 2025, I am in full remission and have no evidence of disease. I believe that the ¹⁷⁷Lu-PSMA treatment with Dr. Hartenbach was a huge part of my beating stage 4 cancer. I am now undergoing treatments to try and keep the cancer from ever coming back."

Brad Farmer

Check Brad's video statement on Facebook

“Exceptional Care at Minute Medical”

anastasiaPatient testimonials

"Exceptional Care at Minute Medical"

"I have been a patient at Minute Medical GmbH three times over the past seven years, and each experience has been nothing short of outstanding. Dr. Markus Hartenbach, Associate Professor of Nuclear Medicine and a true specialist in Prostate Cancer Theranostics, has consistently demonstrated exceptional expertise, professionalism, and compassionate care. From the initial consultation to diagnosis and treatment, Dr. Hartenbach and his team have provided me with the highest standard of medical care, ensuring I fully understood my condition and treatment options. Their cutting-edge diagnostic techniques and personalized approach have given me confidence and peace of mind throughout my journey. The staff at Minute Medical GmbH are equally remarkable—highly skilled, supportive, and always ready to assist. The facility is state-of-the-art, offering the latest advancements in prostate cancer imaging and therapy. I highly recommend Dr. Hartenbach and Minute Medical GmbH to anyone seeking world-class expertise in prostate cancer diagnostics and treatment. Their commitment to patient care and medical excellence is truly commendable. Thank you, Dr. Hartenbach, and the entire team, for your dedication and exceptional work!"

Shared personally by Goranko Fizulic on Google.

“Dr. Hartenbach, his team and treatment literally made a life and death difference.”

anastasiaPatient testimonials

"Dr. Hartenbach, his team and treatment literally made a life and death difference."

"Dr. Hartenbach, his team and treatment literally made a life and death difference. My prostate cancer had spread quickly after a failed immunotherapy. PSA had risen from 60 to 288. Kidney function had been compromised due to lymph involvement.Following the first treatment PSA had dropped to 7 and kidney function bounced back. Following the 3rd, PSA had gone below 1. Dr. Hartenbach has been involved with Theranostics for over a decade. I trust his deep knowledge and caring individualized approach. A heartfelt thanks to everyone at Minute Medical!"

Shared personally by Keith McIntosh on Google.

“Getting connected with Dr. Hartenbach was a blessing.”

anastasiaPatient testimonials

"Getting connected with Dr. Hartenbach was a blessing."

"Getting connected with Dr. Hartenbach was a blessing. Previous treatment did nothing to slow my prostate cancer that had metastasized into my entire skeletal system and some lymph nodes. Three treatments with Minute Medical group and my scan showed no cancer. Even my prostate had no evidence of cancer. From being mostly bed ridden on pain medication to my new self was amazing. Everyone in the clinic was compassionate and every step of the process was discussed and clearly explained. Many prayers went out for my healing and I believe Dr. Hartenbach was part of the answer to those prayers. Please don’t let any fear of this treatment stop you as it is non invasive and I only had one or two episodes of mild nausea. I’ve included photos of my before and after scans. The black areas on the current scan are not cancer but the normal expulsion of the contrast drug through my kidneys, bladder and salivary glands. My thanks goes to God and this wonderful team at Minute Medical.

Dan E."

Shared personally by Dan Eurich on Google.

Patient’s Testimonial: Full Remission after ¹⁷⁷Lu-PSMA therapy

anastasiaNews, Patient testimonials

Patient's Testimonial: Full Remission after ¹⁷⁷Lu-PSMA therapy

Here is a testimonial of one of our patients:

"I would like to announce hereby to the world that the small private clinic Minute Medical in Vienna led by Professor Markus Hartenbach, an expert in Nuclear Medicine, is nothing but a giant in helping people in need of medical attention, proving the success of day-to-day practical application of the results of the latest cutting edge scientific medical research.

Dr. Hartenbach had the courage to go against the tide of dusty, stone age “one-size-fits-all-protocols” in the treatment of metastatic prostate cancer, as a humble service to diseased men, who otherwise would have ended up going through depraving and for the human body harmful and often intolerable treatments that would result in the deterioration of the quality of life of people exposed to those treatments.

What are we talking about? The PSMA directed Lutetium-177 ligand therapy for metastatic prostate cancer, which is normally tough or impossible to access. According to my experience, most international doctors follow a “Protocol”, where affected people should rather be exposed to overall abdominal radiation, chemotherapy and years of chemical castration through hormone therapy, which often leads to the building of hormone-resistant cancer cells that cannot be treated any more and the patient is basically left to spend the rest of his life with the spreading cancer in his body. Not to mention the side effects caused by non-focussed radiation, by chemo, not to mention the hardly tolerable effects of hormone therapy.

Prof. Hartenbach is serving his patients by the motto of “individualized, tailor-made treatments”, meaning that he has the courage to apply the suitable most modern treatments at the right time to his patients. As is usual in a private clinic, however these are patients who are striving to receive this treatments at their own cost and possible peril, because they aim to maintain their lifestyle, their ability to enjoy life and their mobility despite their horrible disease, which, to my opinion, under normal “protocol” is made intolerable for the human body, slowly destroying everything in their lives that’s worth living for.

 

I’ve been writing this predominantly in third person till now, to give a somewhat objective report on the case. However, and unfortunately for me, I’m also subjected to this disease, and I went through a long process to find Prof. Hartenbach’s clinic and ask him to treat me. My name is Dr. Sandor Ambrus and I’m 70 years of age.

I can really call myself lucky to have been advised, and therefore being eternally grateful, to my wonderful and widely, as well as deeply, educated family doctor and General Practitioner who is up to date in the latest groundbreaking technologies, Dr. Andrea Szelenyi of Budapest, Hungary, who called my attention to the existence of this special therapy. I am also grateful to Prof. Stefan Förster who is heading up the Bayreuth University Clinic, who could not treat me because of the compulsory “Protocol” in public clinics, that is still controlling the medical practice in Germany. But he was kind enough to introduce me to Prof. Hartenbach and his team, who were able to “tailor-made” adapt the therapeutic approach according to my individual requirements in his above mentioned clinic “Minute Medical” to serve the ones in need with his top-notch treatment.

I had a drastic prostatectomy in January of this year (2024) in Budapest, Hungary, and was diagnosed after the surgery with further lymph nodes that were affected by metastases. I had a PSMA PET Scan that was showing the affected nodes. According to Hungarian “Protocol” – the same as the German one I was advised to go through the above-mentioned treatments, which filled me with a dread that induced sleepless nights, but even worse, horrible nightmares in the night to be awaken by the reality that was even more frightening than those scary dreams. This situation lasted till the moment I met Prof. Hartenbach who encouraged me to have the freedom of choice for my own body.

I had three Lutetium therapies in a row with a month between them. Each treatment took 15 minutes and a pleasant and educational conversation with Prof. Hartenbach regarding my health situation and the outlooks I may have. I have not experienced any side effects whatsoever then and since. After finishing the treatment, I had a repeated PSMA PET Scan that showed the complete remission of the cancer. This may obviously change with time, as you can never know with this disease, but I’m hoping that it would remain like this for a long time. In the worst case scenario that it reappears some time down the line, one can eventually repeat the treatment, depending on the circumstances at the time.

As for my current situation, I live my life to its full extent like before I was diagnosed with the disease. I’m as mobile as I have always been in the past fifty years, working in my business, having a beautiful family life and flying at least once a week within Europe and several times a year overseas. I’m driving tens of thousands of kms a year, and none of this has changed since I made up my mind to see Prof. Hartenbach.

Sincerely,

Dr. Sandor Z. Ambrus"

Transforming cancer from lethal to chronic. Therapy response after 2 cycles (6 sessions) of ¹⁷⁷Lu-PSMA therapy.

anastasiaNews, Patient testimonials

Transforming cancer from lethal to chronic. Therapy response after 2 cycles of ¹⁷⁷Lu-PSMA therapy

The case illustrates the scientific findings that the radioligand therapy 177Lu-PSMA is safe and effective and can be successfully applied more than once in case of recurrence, moving towards the goal of transforming cancer from lethal into a chronic disease like any other. It also grants the patients considerably better quality of life than the protracted ADT or chemotherapy.

72 y.o. patient William Daly was first diagnosed with prostate cancer (PC) in December 2021. Despite heavy pre-treatment with several cycles of immunotherapy, cryoablation and leukin therapy, the disease continued to progress extending to lymph nodes. Mr. Daly refused constant antihormonal therapy and chemotherapy due to side effects and opted for 177Lu-PSMA targeted radioligand therapy. The patient has undergone 2 cycles 3 infusions each of the therapy. After the first one, PC went into remission for 1,5 years.

BEFORE 1st cycle AFTER 1st cycle
PSMA PET/CT October 2021

PSA 45 ng/ml.

High PSMA-expressing lymph node metastases.

 PSMA PET/CT April 2022

PSA 0,18 ng/ml.

After 3x 177Lu-PSMA therapy sessions from December 2021 to February 2022, significant remission of the retroperitoneal and locoregional lymph node metastases. PSA decline was documented until October 2022 with a Nadir of 2,39ng/ml.
BEFORE 2nd cycle AFTER 2nd cycle
PSMA PET/CT September 2023

PSA 23,3ng/ml

Progressive retroperitoneal lymph node disease with two new bone lesions as well as progression in the prostate.  3-session cycle of 177Lu-PSMA radioligand therapy is repeated 1,5 years after the first one. A short-term complimentary ADT with Relugolix was initiated along with the RLT to increase PSMA expression.

 PSMA PET/CT April 2024

PSA 0,1 ng/ml

After 3x 177Lu-PSMA radioligand therapy sessions from December 2023 to February 2024 no activity in the metastases was detected in September 2023. The only side effect reported was short-term mild nausea and mild fatigue after the treatment. Meanwhile the patient stopped all medication and reports general well-being and regained strength.

 

Read Mr. Daly's story in his own words:

"My story began in December 2014 when I was diagnosed with prostate cancer (PC). It was identified as “intermediate risk” with a Gleason score of 7 (3+4) in 3 of the 12 biopsy samples taken. At this point it had not spread, but after an MRI, it showed an “extracapsular extension”. I chose not to have surgery and decided to do watchful waiting. I also wanted to stay away from hormone therapy.

After another MRI, it showed that the PC was very near the seminal vesicles and I engaged a doctor in Fort Lauderdale, Florida to help me with treatment. He performed a 3D mapping biopsy that showed Gleason 8 in the prostate. Then he treated the PC with focal cryoablation, and my PSA went from 9 to 0.6. This was done in October 2017.

The PSA stayed there for about 2 years before it began to gradually move up. As it happens, I was treated for a kidney stone in July of 2020 and a swollen lymph node was noted in my pelvis area. After another MRI, my doctor in Florida suggested that we go through immune therapy. His immune therapy was very successful in some of his patients – but I did not respond to it. It was at that time that we pursued the 177Lu-PSMA treatment with Dr. Hartenbach. First, I had a PSMA scan done in Houston, Texas to see if the treatment could be done at all. After approval, I made arrangements to go through the therapy with Dr. Hartenbach. My PSA was about 48 at that time. That was in the fall of 2021.

After 1 cycle (3 infusions) of the therapy, my PSA was 2.39. The follow-up PSMA scan showed a remarkable improvement. There were only a couple of places where the cancer was still in the process of dying. We were very pleased at the response. This was in the spring of 2022 and the therapy had given me 2 years of remission. After closely monitoring the PC with scheduled labs, the PSA began to move up again. When it reached 23, we felt more treatment would be beneficial.

So, in December of 2023 I started another cycle of the 177Lu-PSMA  therapy. We also added a drug called Orgovyx to the therapy. The PSMA scan was done in April after the treatment was completed in February 2024. I guess I can say that I experienced  minimal side effects from the treatment (some nausea for a couple of days and some “dry mouth”). So, all in all, I was treated with 2 cycles (6 actual infusions) by Dr. Hartenbach.

This time, the results of the treatment and scan were remarkable. The PSMA scan was clear and the report said I had a “complete response” to the therapy – my PSA is now 0.1. This couldn’t have been a better result and I was so grateful and blessed to have been working with Dr. Hartenbach and his staff. I am praying for a long - term remission.

Thanks again for Dr. Hartenbach and all his staff."

“This treatment has given me back my life.”

anastasiaNews, Patient testimonials

"This treatment has given me back my life."

Success story after 3 sessions of radioligand PSMA therapy with 1x Actinium-225 & 2x Lutetium-177

Sean Kenny was first diagnosed with prostate cancer in December 2020, when he just turned 51 y.o. Before landing in our clinic, he had undergone multiple treatments, including 6x Docetaxel, antihormonal therapy, immunotherapy and cryotherapy. He chose to pause ADT due to side effects but had to re-induct antihormonal therapy with Firmagon and Apalutamide mid-2023. The cancer was still progressing with an increasing bone involvement. Despite PSA response, pain and PSMA expression persisted. He was put on morphine medication for pain relief. His left hip was so badly damaged that it had to be replaced. After 3 years of back-and-forth Sean opted for PSMA targeted radioligand therapy (RLT) and experienced a remarkable recovery following just one 3-session cycle. Due to heavy bone infiltration, we recommended the first session be done with Actinium-225 and the two remaining - with Lutetium-177. Judge for yourself.

BEFORE

PSMA PET/CT December 2023

PSA 2 ng/ml after re-induction antihormonal and ARPI treatment. St.p. hip replacement to the left previously. Still high PSMA expressing bone metastases and pain under morphine medication.

AFTER

PSMA PET/CT April 2024

After 1x 225Ac and 2x 177Lu PSMA ligand therapy sessions from December 2023 to March 2024.

PSA 0,18 ng/ml. Minimal residual activity in the known bone lesions, most likely apoptotic cells. ALP down from 570U/l to 180U/l (norm <150).

Sean experienced pain relief 10 days after the 1st RLT session with Actinium-225 PSMA and was able to get off the morphine medication. Hemoglobin and kidney values normalized after the 2nd RLT session with Lutetium-177 PSMA. The only side effect he experienced was short-term mild nausea and mild fatigue after the treatment. At the time-point of the control PSMA PET/CT, these symptoms were gone. Sean reports general well-being and regained strength.

Here is the story in his own words:

"My story started back in December of 2020 when I was told that I had advanced prostate cancer, which had spread to my lymphatic system. This was picked up with a routine blood test when I turned 50 years of age and when they included the PSA as a blood marker. I did not have any obvious symptoms at the time and in fact I was still running 7-minute miles and was very active.

I was put on hormone treatment in January of 2021 after I came back from the Royal Marsden hospital in the UK where I got a PSMA scan (I could not get a scan in Ireland for 9 months). Later in 2021 I started a course of 6 x Chemo (Docetaxel) and then 4 weeks of RT. In early 2022 I came off the hormone treatment due to side effects (my PSA has gone to a very low figure). I got my life back again as I regained my energy, and my fatigue was a lot less.

Then in early 2023 my PSA started to slowly rise again, so we looked into travelling to the US to undergo immunotherapy and cryotherapy at a clinic. While waiting for this clinic to admit me I developed an intermittent pain in my left leg which I relayed to my oncologist during an outpatient visit. After immediate X-rays of my leg, I was told that I had an impending fracture of my femur and needed an emergency hip replacement (my pelvic bone was also diseased). My hip was replaced 2 days later, and when I was strong enough again, I went to America to undergo this procedure in the hope that it would put me into remission again. Unfortunately, this operation was not successful, and within a month of coming home the pain I was suffering in my leg area was unbearable due to the metastasis in my pelvic area. I was put straight back on hormone treatment again and was told that I would be also receiving RT again.

My good Wife Brid had been in touch with the American clinic looking to see if there were other options available. This was then when I was referred to Prof Hartenbach and the rest as they say is history. I’m off all pain medication and with the hopes of coming off both my hormone treatments in the near future. From there it will be active surveillance and fingers crossed, but certainly this treatment has given me back my life. 

Thank you, Prof. Hartenbach and team."

 

Interview with a patient

anastasiaNews, Patient testimonials
Dr. Hartenbach conducts an interview with a patient about his experience with the radioligand therapy 177Lu-PSMA. The patient A.G., 72 y.o., a molecular biologist himself, was diagnosed with metastatic prostate cancer in September 2018. After the conventional standard-of-care treatment (chemo- and antihormonal therapy) there were still residues of the primary tumour in the prostate, and lymph nodes and bone metastases. Up to date he has gone through 9 sessions (3 cycles) of 177Lu-PSMA therapy in the course of three years, initiating a new cycle once a routine control 68Ga-PSMA PET/CT detected PSMA expressing cancer lesions. The therapy has been extremely successful for A.G.: high response and hardly any side effects. Targeted radioligand therapy brings us much closer to the goal of making prostate cancer just another treatable chronic disease, at the same time preserving a decent quality of life, much like e.g. diabetes.

Prof. Markus Hartenbach (MH): Hello and welcome to Minute Medical. My name is Markus Hartenbach and today we have a special guest here who's willing to give an interview. Professor Dr. Alexander Von Gabain, renowned microbiologist, founder, entrepreneur and much more. And we really appreciate that he's giving that interview today. Hello, Alexander.

A.G.: Hello, Markus. I'm looking forward to this interview and it's a pleasure for me to support you with what I have learned during the course of my disease and its treatments.

MH: Yes, we really appreciate that, Alexander. So you are not here as an analytical scientist. You are more here now because four years, pretty much exactly 4 years ago, there was a diagnosis that you were confronted with and maybe you can talk a little bit about what it was and what were the first steps.

A.G.: Well, I have been diagnosed indeed four years ago with an advanced prostate cancer with metastases in bones and in a number of lymph nodes. And being a molecular biologist and having worked by myself in oncology, I was aware that this will change my life upside down. It is a shocking experience and in the beginning you have life fear, and as a result, you lean on colleagues who are established and renowned. And I have to say, I was getting good treatment in a university hospital. The dilemma has been that the doctors, maybe also because I am coming from the field, they rather were inclined to implement for me the standard-of-care treatments. The standard-of-care treatments is of course suppressing of testosterone, nicely named by our colleagues as castration or chemical or really physical castration or also in sequence or together with a chemotherapy. And I have gone through this and there was some achievement.

But in honesty, you could still see in my body spreads of the original tumor and also the original tumor was still in the prostate. So this was quite a learning curve. And I have to say what I have learned from this curve is standard of care therapy is important and it's good. But as soon as you are breathing out and you see it's my cancer and it's my life, you have to see what else is on the way. And I was lucky to learn by accident, but also by systematically asking around in the circles of my colleagues and friends, that there are already the next generation treatments coming up. And I always see it through the eye classes of a molecular biologist. The chemotherapy and the hormone suppression therapy I have gone through was clearly still a medicine of the 20th century, but not of the 21st century. Why? I mean, they clearly hit the tumor, but they are far from being specific.

Take chemotherapy. Of course it's blocking most fast-growing cells, so it will block the cancer, but it also has partially very severe side effects on other tissue in your body which is dividing based on dividing cells.

Suppressing the hormones in itself is OK, but I think it's not specific. It also is taking away the testosterone for other functions where they are needed in your body for natural function.

So this learning curve was basically the kickoff point to find other therapies. And interesting, I came across and this is maybe a good thing about the prostate cancer. It has the most specific diagnostic method to discover tumor or tumor metastases in the body, namely by a specific molecule which binds to a surface structure of prostate cancer cells. And if you add the label on, for example, a radio label, you can identify wherever in the body there are still spreads of your cancer. And while I was going through this procedure several times and seeing that the treatments in part improved my conditions. I said, gee, if this is so specific to discover specific residual cancer cells in your body, there must be also a therapy which is based on this specificity. And that's when I met Markus and it wasn't quite an accident.

I heard about him through many sources and Markus explained to me that science has not been resting and I think they have been making this key molecule which is binding so to say to these receptors on the surface of prostate cancer cells by adding something on, you call this a magic bullet, which gives tougher radiation. But compared to the other treatments I have gone through, it is very, very specific. It only destroys cells where you have cancer cells which bind to the ligand and the ligand in the backpack has this radioisotope which is destroying the cancer cells. So that's just the story which I would say to give in short. But now we should not go into the depths.

MH: Yes, this is our theranostics approach which is providing a diagnostic tool with a PSMA ligand PET CT and then of course the therapy with lutetium- or actinium-labeled PSMA which is directly targeting the cells. This is what you what you mentioned. Maybe you can also give an outlook on the comparison between the standard-of-care therapies you had which were successful lowering PSA also killing metastasis in your body. But from the side effect profile, you have now undergone 9 sessions of lutetium PSMA therapy over the past three years, and the last therapy you had in April 2021, which is now 1 1/2 year ago. So also in case of long-term side effects, because now you are 1 1/2 year after your last of nine sessions, maybe you can give a little outlook and comparison of these therapies.

A.G.: Yeah, before I come to this, let me stay one more time with the standard-of-care treatments I have gone through. They indeed had, I would say, nearly unbearable side effects. I have to be honest, at some time during my chemo it I was even so exhausted I could not even go downhill. So not to talk about uphill. so but if you explain this as a molecular biologist, it's clear because you are hitting so many innocent body cells, I think, which so to say, lead to your bad conditions.

So this method just described by Markus has this high specificity. And I think this is maybe the amazing thing is that um the follow-up treatment which was proposed to me by my colleagues in this academic hospital was surgery plus radiation with radio beams and they were trying to explain to me that still see several herds of cancer cells in my body that could with two methods so to say to improve my condition. And I in this situation, facing further unspecific treatments because surgery as well radiotherapy can never so precisely hit the tumor herds in the body, as I think this just described method which I have gone nine times through and I have to say, to give the plain answer, I nearly did not have any severe side effects. As a matter of fact, I was still functioning. Markus is my doctor, also my coach sometimes. He encouraged me to continue my very active professional life. So I was not, so to say, calling off my board seats in a variety of interesting academic institution and companies. And I could do this even while I was getting this treatment. And I think this for me was a hallelujah experience because I started to move into molecular biology, I think by now, nearly more than 45, 48 years ago. And I think my first teachers belonged to the pioneers who have been deciphering the DNA and finding the first protein-protein interactions and explaining how cells are functioning. And I said gee, this knowledge has now really reached the patient. It really protects you in that it really kills only and mostly cells which are really affected by the cancer or cancerous cells. There are some other tissues in the body which also are a challenge. I think this is clear, but I have to say they have not given me any handicap. And I have to say so far I can say the only real measurable side effect that you are a bit tired. But I think any type of treatment gives you a tiredness, even if you're taking antibiotics.

MH: Maybe we can focus a little bit on that because most of the patients are afraid of the described and known side effects of radioligand therapy concerning dry mouth, xerostomia, and sometimes you have the feeling that it's a little bit exaggerated in the literature about xerostomia and dry mouth. What is your experience on that after so many cycles? In the literature we only have up to six cycles described. And we have treated patients over the past decade and never seen here in Vienna real xerostomia, real dry mouth also concerning the kidneys because it is in the kidneys, the PSMA complex, these are the known and described organs also with PSMA expression. What is your experience on that?

A.G.: My experience is that I have not really suffered from, I think, the condition of dry mouth until now, nor any problems in that regard. My kidneys, they show some weaknesses, but I'm convinced they come from other treatments that I've been taking, which would be a little too long here to explain this in detail. But I can say that the real well feeling and being during the therapy and after the therapy is so residual that you can almost lead even during the therapy time, not to talk afterwards anyway, you are not impeded in functioning in your private and also in your professional life. And I think this is very important because if you have cancer, this is a very important part of life quality I think that you continue with your normal life as much as possible.

MH: And what was also very important in your approach was the combined approach. And we always want to point out that not only the radioligand therapy is a standalone therapy. In your case you started with the conventional approach. We also had to the combination over all the time with the antihormonal, also third generation antihormonal treatment. And as a last treatment we also had the carbon ion targeted radiation which is also very precise. So in the end, I think this combination was the key to success.

A.G.: Yes, and by that I like to encourage, so to say, people who come into the same severe life situation as I have been, so to say, sliding in. If you take the choice of new treatments, it's also a gain in time. And by the time before I did the radioligand therapy, there were only, as Markus has mentioned, the 1st and 2nd generation, you can say, hormone receptor blocking treatments, so to say, in the medical community. And I think some of them only you can take by taking at the same time 50 milligram of cortisone. I mean they have, they have and they had really strong side effects and I think the time gain I had with this treatment made me luckily coming into so to say qualifying for the third generation of testosterone receptor blocking agents. And I have to say I take this now as an adjuvanted treatment. And again, I say it has something to do with molecular biology. Scientists have not been sleeping. The third generation, I think, apolutamide or darolutamide, they are much more specific than the first two generations. And so they are also for me with side effects, much more tolerable. And what Markus has mentioned too, I had and I keep my fingers crossed it was still like this, still some residual tumor herds in my prostate. And we thought that it would be good also to use a technology which is really bombarding my prostate but saving as much as possible the surrounding tissue like the rectum and the urine bladder. And this is with this carbon neuron radiation. And it is the same. I mean this is now not molecular biology, but I would say it is the chemical or physical chemical specificity of the nature of the radiation is a great improvement for that type of disease because you hit the prostate much more specifically than with the classical treatments with using X-ray radiation where you almost normally also harm a bit your urine bladder and I think often very strong in your rectum.

MH: Yeah, in your case it worked greatly, and I think in many other patients as well. The data is also showing that and of course you were always very well informed, also on a scientific level. But I also want to encourage the patients, ask for different therapies, for next generation therapies and only the patient that is well informed is the patient that will receive then the best treatment. As a last question and maybe then also as an outlook, it's more a personal question. I mean what was your secret, your personal secret, how to deal with it, your disease, in the past and now also for the future? And what is it that is making you look positively into the future.

A.G.: Well, I have to say I look into the future, and I look forward, and I'm aware with my disease this needs also to some degree good luck. But I guess anyway the most important thing is that this learning curve and being guided that specific interactions of the treatment agents and the treated cells have been really entering the field and improving the treatment. And what Markus just has been stating, there's an interesting study out which is saying, and this is a good thought experiment, if you overnight would take in let's say the societies which can afford this the next generation treatments, not only for prostate cancer, also for diabetes or whatever, you would not only save the healthcare systems of the societies a lot of money, but you would prolong life substantially of the people who are affected by those diseases. So it is a calculation which has been done. And the dilemma is that often through the back door, the next generation treatments are so to say coming in. But the standard-of-care is sometimes also a bit like, I would say, an impediment or almost like a prison for the thoughts. For the doctors, for the scientists, but also for the patients. And I think what I have seen in my case, taking the specificity as a guideline (I am, of course, privileged, I can understand this) I saw more and more at least I have a path which can protect me as long as it is possible. And that really gives me a lot of strengths and I think of course not only to talk about science and molecules and my treatment, as I should say, I have a family which supports me strongly and I have also got strong support by Doctor Hartenbach. I should say in this instance I call him not only a friend but also a coach in making the right decision. Also in my personal life, encouraging me to continue to lead a normal life.

MH: Very nice words. Thank you very much Alexander for your time and maybe for the future and for next generation therapy, we also have our fibroblast-targeted imaging and possibly therapy for the future. So the story is going on and life is going on. And thanks a lot for all these words and your time.

A.G.: It was a pleasure.