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.