PSA 690 after Pluvicto

[Whwalker1944]

I completed 5 infusions of Lu-177. And my PSA increased from 160-690.

Decided to stop and not administer 6 th and final dose.

Started on Erleada

[KocoPr]

im not an expert on this but we were just discussing a bounce from radiation and other treatments on another recent thread. Did your RO agree or suggest to stop?

[Whwalker1944 in reply to KocoPr]

He suggested we stop.

[KocoPr in reply to Whwalker1944]

you came to the right forum as there are some extremely knowledgeable warriors on this site.

[meowlicious99]

Hi @Whwalker1944

I am sorry Pluvicto didn't work for you.

Would you mind adding some of your case history. I think it would be very hard for people here to comment based just on the information in the post.

[Whwalker1944 in reply to meowlicious99]

My case history as follows

1. Diagnosed with PC in 1999 with Gleason of 7 and PSA of 9.

2. Prostate removed in 1999

3. 10 sessions of radiation in 1999 after surgery as PSA was above 1.0 after surgery.

4..1999-2017 PSA kept low with Lupron, then

Casodex and in 2018 went to Zytiga and PSA went from 15 to 176.

5. Started Chemo (Taxotere) in 2018 which initially dropped PSA to 76 and after 6 months of Chemo, PSA went up to 126

6. Started Lynparza in 2019 and PSA increased to 156 by late 2020.

7.stopped Lynparza and started Lu-177 in April 2022.

6. Started Lu-177 in March 2021

[meowlicious99 in reply to Whwalker1944]

Thank you. Thats quite a journey. 🙏

You might want to copy paste this into your profile so it can be referred to when ask questions or make posts here.

I have a couple of questions

Lynparza was administered concurrently with Zytiga and ADT in 2019 and you had a positive response till late 2020?

What happened between late 2020 and April 2022 . Did you get a PSMA pet before starting LU . What did it say?

[Whwalker1944 in reply to meowlicious99]

sequence was ADT followed by Zytiga(30 days) then Lynparza after Chemo but stopped when Lu-177 started.

Yes had PSMA scan which showed some mets in liver , lymph nodes and spine.

Last PSMA scan was in October which showed increased Mets in liver.

[GP24]

Pluvicto does not work well against liver mets. I would start with Cabazitaxel.

[Tall_Allen]

I'm sorry it stopped working.

prostatecancer.news/2019/12...

[Longterm101]

what other treatments have you had

[RMontana]

That is too bad as I had hoped this treatment was much more effective...I have read that its not effective for patients who have a 'low SUV' sensitivity...from what I can describe this is where, for whatever reason, our bodies dont show, or display the signals that are needed for the PSMA Pet scan to pick up 'targets.' If that makes any sense...but did they check this with you? If so then its equally more upsetting as I had thought this treatment was pretty much a sure thing for at least dropping your PSA pending other treatment if nothing else...TNX

[Whwalker1944 in reply to RMontana]

yes they checked the targets

[larry_dammit]

wow, I had great hopes for this drug, guess it’s wait and see now 😢

[meowlicious99 in reply to larry_dammit]

Haven't read too many success stories here on this forum. Perhaps people with good results aren't too motivated to come post here?

[RusLand]

Hello, warrior! I'm sorry that PSMA therapy was ineffective for you! There is a high probability that there are a lot of PSMA(-) cells in your foci that could be detected before starting therapy with PET/CT with 18F-FDG.. This is now necessarily done in the centers of excellence in order to evaluate the expected therapeutic effectiveness of the upcoming radioligand therapy using the PSMA ligand.. The smaller the PSMA(-) cells, the higher the expectation score! But in this case, I think many people would be interested to understand what was the dynamics of your PSA during the course of therapy using PSMA: before the start of the first course, after the first course, after the second, etc.? Thank you! There are studies that say that if the PSA after the first course has not dropped by more than 50%, then the effectiveness of this therapy will be very low..

[anonymoose2]

Prayers sent your way.

Everyone’s cancer is different and I’m no doctor but Lupron and Xtandi did miracles for me. That’s all I have at this point.

[max00]

Hi RusLand,

You wrote: "There are studies that say that if the PSA after the first course has not dropped by more than 50%, then the effectiveness of this therapy will be very low."

Interesting! Might you have a link to those studies?

Thanks! max00

[RusLand in reply to max00]

Hello, max00! I'm sorry, in a specific study we are talking about a 30% decrease in PSA levels 6 weeks after the first course of therapy with 177Lu-PSMA.. But personally, based on my own statistics of managing more than 20 patients in one of the medical nuclear centers of excellence using this therapy since 2016, I would still talk about a 50% reduction threshold or more after the first administration.. Here is a link to the research I mentioned above: pubmed.ncbi.nlm.nih.gov/321...

[Leader4077]

Hi

What location in your scan had the highest SUV uptake? What was your SUV there? The SUV uptake number has been discussed as very important for Pluvicto to work well. Is Radium-223 in your future?

Mike

[Whwalker1944 in reply to Leader4077]

I do not know my SUV. I will get answer at next OC meeting

[Seasid in reply to Leader4077]

He can't have Xofigo he has liver tumor. Xofigo is only indicated if your cancer is still only in your bones.