What do we know so far about the different Radioligand Therapies?
I have only really heard about Lu177 being available in the UK now.
Is AC225 available routinely in Germany?
And is 225Ac-PSMA-617 the same as AC225?
Encouraging study below.
Excuse my ignorance here.
1) Yes, 225Ac-PSMA-617 is the same as Ac-225
2) Yes, Ac-225 is available in a few places in Germany.
Ac--225 is also available in Australia and South Africa, apart from some Scandinavian countries as well. South Africa is by far the cheapest and apparently pretty good as well.
I am seriously considering going to South Africa for either Ac-225 or the combination treatment of Lu-177 and Ac-225.
Cheers and all the very best, taylor123.
Hey, thanks for that reply. Really helpful.
Have you got any contact details for the clinics that do? Germany and SA? No worries if that’s a hassle, but just in case you have them to hand 
If you do a search of this forum, taylor123, you will find the places in Germany (Bad Berka & others) and the one in Pretoria, South Africa.
Perhaps, others who have it ready could help. I know that GP24 is very knowledgeable on these issues.
Here is a list of clinics that offer Lu177 treatment in Germany:
healthunlocked.com/advanced...
and this is Prof. Sathekge in Pretoria:
Have you looked into R-223 ?? An approved treatment covered by insurance and readily available in the U.S.
Many on this site use a shorthand by writing Lu-177 when they really mean Lu-177-PSMA-617. Lu-177 is the radioactive part, PSMA-617 is the ligand that attaches to the PSMA molecule on the surface of the prostate cancer cell. There are other radioactive atoms in experimental use (e.g., Ac-225, I-131, Th-227), and other ligands (e.g., PSMA-I&T, J591, various PSMA antibodies and minibodies). Also, there are other surface proteins (e.g., PSCA, RM2, VPAC) that they can attach ligands to, and other cyto-destructive things other than radioisotopes (e.g., chemo, oncoviruses, gold nanoparticles). This strategy is also used for other cancers using different ligands (e.g., Lu-177-DOTATATE for digestive tract neuroendocrine cancers).
Super knowledgeable as always. Thanks Allen.
With all you know, if you were CRPC and other SOC treatments had failed and money was no object, what treatment would you try as a swing for the fences?
Schwah
I have no idea what I would do because I can only answer questions based on my perspective in the present moment. You would have to tell me exactly what failed, why and when and what my current status is. As you can see, I'm not good with hypotheticals.I like to focus on the concrete realities of real patients.
The R-223, available for several years now, works specifically against PC bone mets...The Radium is attracted to and binds to bones bringing its dose of radiation with it. It does not work against soft tissue mets..But against bone mets, it can be very effective. The commercial name for the treatment is Xofigo.
As for AC-225, early results have shown it's very effective against PC, it also usually destroys your salivary glands, leading to a condition called "dry mouth" which is more serious than it sounds..
None of these treatments offer a cure, (you would think so by how some people chase after them) they just buy you a little more time if you are willing to endure the side-effects..
There is no cure for this miserable disease once it becomes metastatic. Treatment usually helps in reducing pain and buying some extra time. At a huge cost for people like me who don't have insurance.
Ah yeah I have heard of xofigo. My Dad has a lung met so can’t have it however.
I seen a recent study where they were able to avoid the dry mouth side effect by reducing the subsequent doses of AC225.
For bone mets they often use Act-225 and it works well destroying these. If you take a mix of Lu-177 and Act-225 it will not destroy the salivary glands. However, if you have many cycles of this it may do so since the damage caused adds up. Also, one or two cycles of Act-225 will usually not destroy the salivary glands.
Yes, this treatment is not curative but very effective. More than a Chemo as far as I am aware.
Great answer, GP24. Thank you very much for taking time out to share your phenomenal knowledge with us on this board. I am personally obliged to you. Thank you very much indeed. Cheers !!
I’ve read a number of studies recently about treatments being moved forward in the treatment plan and working well. If one is still hormone sensitive, would it be wise to start Act-225 or Lu-177 (or both together) or for that matter even Zytiga or Xtandi before becoming resistant? If so are the radioligands a better first option. Are there good reasons not to start them sooner rather than later, aside from cost that is? I would appreciate hearing your thoughts on this GP24 as well as the opinions of other wise people on this forum. Thank you all.
Hans,
it is difficult to find a clinic which will give you a PSMA therapy while you are hormone sensitive. This is in general regarded as last resort because the treatment is not approved yet. I would get my prostate radiated and my mets radiated with Cyberknife before getting a PSMA therapy.
As an advanced patient you try to extend your life and do not plan for cure. Therefore I think this sequence will work for a longer time than if you start out with a PSMA therapy. In my case I had too many lymph node mets to have them treated with Cyberknife so I decided for a Lu177 therapy. But I asked for a PSMA PET/CT already after the first cycle and I would have avoided the second cycle if only few mets would have been left. This to avoid to get too many cycles of this unapproved treatment. However, I was very lucky and all lymph node mets which were visible with a PSMA PET/CT were gone.
If you have bone mets I would recommend a mix of Lu177 and Act225. I know a hormone-sensitive patient who got one of these cycles and had no side effects. However, they refused to give him a second cycle for the remaining mets and asked him to continue with ADT instead. So if you have a Lu177 treatment early I would try to have only very few cycles since you will need more later and the side effects add up.
GP24, thanks a lot for taking the time to answer and give advice. I do have bone mets, so a mix of Lu 177 and Act 225 does sound like a good therapy for me ... but as you counselled, not yet, because of the cumulative side effects. It's good to know that this effective therapy is available for later though. And who knows what improvements to current therapies and further new treatments are just over the horizon. I remain positive : )
Let me propose a toast "Hail to the future, cause the present sucks".... Cin-cin
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 07/17/2019 7:38 PM DST
Sono and photodynamic therapy 
5 years today from dx
Hormone Therapy & Chemo
Triplet therapy for mHSPC comes to the NHS!
