Before your first Lutetium therapy cycle.

Step 1: The eligibility scan

This is the most important pre-treatment test. It uses the same targeting molecule as your therapy, paired with a different isotope (Gallium-68 or Fluorine-18) that emits PET-imaging signals. The scan shows whether your cancer cells will pick up the therapy.

For prostate cancer (Lu-177 PSMA therapy candidates)

• Test: PSMA PET (Ga-68 PSMA or F-18 PSMA, e.g., Pylarify, Locametz)
• Duration: 60–90 minutes total (uptake + scan)
• Preparation: Usually no special preparation; some centers ask you to be well-hydrated.
• Cost in India: approximately $300–$650 USD depending on tracer and center

For NETs (Lu-177 DOTATATE therapy candidates)

• Test: Ga-68 DOTATATE PET (also called Ga-68 DOTANOC or DOTATOC)
• Duration: 60–90 minutes
• Preparation: Hold long-acting somatostatin (octreotide LAR) for 4 weeks if possible; short-acting fine until day before.
• Cost in India: approximately $250–$550 USD

Step 2: Pre-treatment blood work

Standard tests within 14–21 days of cycle 1:

• Complete blood count (CBC) — hemoglobin, white cells, platelets
• Kidney function — serum creatinine and eGFR
• Liver function tests — AST, ALT, alkaline phosphatase, bilirubin
• Tumor markers — PSA for prostate, chromogranin A and 5-HIAA for NETs
• Pregnancy test — for women of childbearing age

Step 3: Multidisciplinary review

At reputable centers, your case is presented at a tumor board or multidisciplinary meeting before treatment begins. The team includes:

• Medical oncologist or urologist (for prostate cancer)
• Endocrinologist or oncologist (for NETs)
• Nuclear medicine physician
• Radiation safety officer
• Sometimes: radiologist, palliative care physician, oncology nurse

This team confirms you're a good candidate, plans the treatment schedule, and anticipates any complications.

Step 4: Logistics

Insurance pre-authorization

For Indian Mediclaim, submit pre-authorization to your TPA at least 1–2 weeks before cycle 1. Required documents typically include: scan report, oncologist note, expected treatment plan with costs. Your hospital's TPA desk usually handles this.

Scheduling

Cycles are usually scheduled in advance — 6 cycles for Lu-177 PSMA therapy (6 weeks apart) or 4 for Lu-177 DOTATATE therapy (8 weeks apart). Block these dates in your calendar; rescheduling can be difficult once a center's drug delivery is locked in.

For international patients

• Apply for medical visa (India: M-visa) at least 4–6 weeks before
• Book accommodations near the treatment center
• Arrange travel insurance covering pre-existing condition
• Identify a caregiver who can be with you for the first few days after each cycle

The day before your first cycle

• Hydrate well — start drinking extra water 24 hours before.
• Eat normally — no fasting required.
• Continue your usual medications unless told otherwise.
• For Lu-177 DOTATATE therapy: hold short-acting octreotide on treatment day morning if used.
• Bring: all recent reports, current medication list, ID, insurance documents.
• Wear: comfortable, loose clothing. Avoid metal zippers near the IV site.
• Bring with you: phone charger, a book or tablet for the 4-hour wait (Lu-177 DOTATATE therapy), a snack and water for after.
• Arrange transport: someone to drive you home, even if you feel fine. Some patients feel fatigued.

Emotional preparation

Most patients describe the period before cycle 1 as the most anxious phase of the whole journey. The fear is mostly fear of the unknown — once you know what to expect, things get easier.