“It’s given me an extension of life I would not have got otherwise, no question,” he says. His voice is croaky from a dry throat – the only side effect so far. “That’s a pretty small price to pay for life.” Mr Elderfield was part of a group of 30 men with treatment-resistant metastatic prostate cancer the treatment, known as LuPSMA, was trialled on. The proof-of-concept trial, the results of which are published today in Lancet Oncology, has been hailed as a game-changer. The best way to measure prostate cancer is a marker in the blood called PSA. The higher the level, the worse the cancer. Of the 30 men, most saw that marker halve. Some reduced it to almost-undetectable levels. Six patients who were on death’s door recovered so well treatment was stopped early.

The therapy is not a cure. The cancer will come back. But it is hoped it could significantly extend life. “It’s very exciting,” says Associate Professor Arun Azad, who heads a prostate cancer therapy lab at Monash University and was not involved in the study. “If it continues to show the very promising activity it has in this pilot, then it may well become part of the standard treatment options.” Reduced cancer activity observed in six men involved in Peter Mac’s trial. Red dots indicates sites of prostate cancer before (left side) and after (right side) treatment with LuPSMA. Credit:Peter MacCallum Cancer Centre LuPSMA is made up of two molecules. Radioactive lutetium-177 is shipped straight from NSW's 20-megawatt Lucas Heights nuclear reactor to Peter Mac, where chemists combine it with a molecule called PSMA-617, which is designed to bind to prostate cancer cells.

It is then pumped into the bloodstream, where the PSMA seeks and burrows into tumours. The attached radioactive molecule then poisons the tumour from the inside out. Lutetium only has a tiny active range – about 1mm – meaning other cells aren’t damaged. The success of the trial makes it all the more remarkable that LuPSMA has spent years sitting on a shelf. The therapy was invented in Germany in 2015, but large-scale trials were never run. Big pharma, which fund most clinical trials, were put off because it uses radiation rather than drugs. “It’s unique. It’s not a drug. Big pharma has traditionally not been in this space. They just don’t have the expertise in how to make and distribute radioactive medicines,” says Peter Mac Professor Michael Hofman, who led the trial.

“But that’s rapidly changing, because big pharma have seen the results.” Professor Hofman is now leading a 200-person national trial that will test the therapy against standard treatments. If it’s successful, LuPSMA could be available to patients within two to four years. “You know where it will finish, don’t you?," asks Barry Elderfield. Credit:Justin McManus Barry Elderfield is hoping things move quicker than that. “Without a big pharma company behind it, it’s very slow going,” he says.