Second Opinion in Munich: A Romanian Patient Consults a Top Pancreatic Surgeon

This story is about a patient from Canada who learned, like many men living with advanced prostate cancer, that treatment decisions don’t happen once. They happen again and again. Each time the disease adapts, each time a therapy reaches its limit, and each time the next step must be identified quickly and clearly.

A Long Treatment Road

Our patient is Mr. Wayne, whose diagnosis was metastatic castration-resistant prostate cancer, or mCRPC. The earlier treatment included androgen deprivation therapy (ADT), external beam radiation therapy, and brachytherapy, building a multi-layered approach that is common in prostate cancer care when the goal is control and long-term suppression.

As the disease progressed into mCRPC, Wayne pursued targeted radionuclide therapy through the SPLASH trial, receiving two sessions of Lu-177 at homecountry. Then his trial ended, with no further definitive options offered.

Disease Progression Changing the Plan

Mr. Wayne was taken off the SPLASH study due to disease progression. It’s a phrase patients learn to fear because it’s both clinical and deeply personal. The evidence that the cancer is moving faster than the therapy can hold it back.

A bone scan before his next treatment step showed progression, including worsening metastasis in the skull bone. That finding didn’t just add another data point. It added pressure. The patient needed a new option, and he needed it within a timeframe that reflected the reality of mCRPC.

Ac-225 Became the Next Step

After Lu-177, Wayne began searching for what could come next. He kept returning to the same term: Actinium-225.

In prostate cancer nuclear medicine, Actinium-225 therapy is often discussed as a potential next-line targeted radioligand approach, especially when patients have already exhausted or progressed after Lu-177-based treatment.

Wayne’s challenge was not only medical but also logistical. Access to Actinium-225 is limited, and availability differs dramatically by country, provider, and scheduling. That’s when he reached out to Airomedical.

Finding Treatment in Austria

The patient desired a provider experienced in nuclear medicine, with a structured flow for international patients and realistic timelines. Airomedical matched Mr. Wayne with a private nuclear medicine clinic in Austria. The choice spot on MINUTE Medical Vienna, under the care of Prof. Dr. med. Markus Hartenbach.

What mattered to the patient and the family was that the plan wasn’t vague. It had an address, a date, and a team, something concrete after the uncertainty of being removed from the trial.

A Critical Diagnostic Gap

One complication stood out in Wayne’s case. He did not have a fresh PSMA PET-CT scan immediately before traveling for therapy.

For PSMA-targeted radioligand therapy, imaging is not a formality. It’s the map. It confirms whether the disease expresses PSMA strongly enough, shows where the active lesions are, and helps physicians decide whether proceeding makes sense.

Rather than delay the process by sending the patient back into weeks of home imaging coordination, the team built imaging into the treatment timeline.

The patient underwent PSMA PET-CT in Vienna 1 day prior to the planned Actinium-225 treatment. That sequence was significant because it transformed uncertainty into evidence. It allowed the medical team to confirm the target profile and evaluate disease distribution in real time, right before therapy.

Actinium-225 Treatment

After imaging, Mr. Wayne proceeded with Actinium-225 therapy on an outpatient basis at MINUTE Medical Vienna. Outpatient delivery was important: it reduced complexity, helped keep the visit structured, and allowed Wayne to focus on the therapy itself rather than extended inpatient logistics in a foreign country.

In simple terms, the intent of Actinium-225 therapy is precision. The treatment is designed to deliver radiation directly to PSMA-expressing cancer cells throughout the body, including bone metastases, while trying to limit exposure to non-target tissues. The patient came to Austria because he needed a targeted next step and a team that could move from evaluation to action without delay.

For many international patients, the hardest part isn’t deciding that a therapy might help. The hardest part is making it real: finding a qualified provider, confirming feasibility, aligning documentation, organizing imaging, and turning a “maybe” into a scheduled treatment plan.