Latium 177 for local reccurrence

[rococo]

Can lutium177 be used early on for local recurrence after radiation therapy.

[GP24]

I never heard that anyone did this, but it could be done. However, I would rather look into Cyberknife or focal brachytherapy. These treatments are probably covered by your health insurance. They can be used even if you had IMRT radiation before.

[cesanon in reply to GP24]

Lu177 is a global treatment.

Cyberknife or focal brachytherapy are only good for specific, identifyed tumors.

They each have a different use.

[GP24 in reply to cesanon]

It will treat the lesions you see on a PSMA PET/CT only. So it is not really global. If the only lesion you see is the local recurrence, this expensive treatment does not make much sense.

[cesanon in reply to GP24]

My understanding is lu177 goes wherever it's psma ligand will attach. That includes any psma sensitive prostate cancer cells, wherever it resides.

[GP24 in reply to cesanon]

Yes that is correct, it will remove the local recurrence. But the treatment is quite expensive for that purpose and I do not think you will find a clinic which will treat your local recurrence with Lu177.

[cesanon]

Someone said there is some evidence that early use of lu177 is effective.

[6357axbz in reply to cesanon]

There is a recent, relevant discussion on this topic, within this blog called "Early initiation of Lu-177 PSMA radioligand therapy prolongs overall survival in metastatic prostate cancer"

[cesanon in reply to 6357axbz]

If the local recurrence is outside of the prostate, it is no longer local.

Cyberknife then becomes questionable.

[GP24 in reply to cesanon]

I had an SVI invasion treated with Cyberknife. If they put in goldmarkers for the IMRT radiation Cyberknife can use these as well.

[cesanon in reply to GP24]

Once the prostate cancer goes metastatic, no one knows where all the prostate cancer cells are.

You can't target them, only large aggregations of them. That's why you need global treatments like lu177

[GP24 in reply to cesanon]

The doctors who offer Lu177 treatment will not treat you if no lesions show up on a PSMA PET/CT. They will not try to treat single cancer cells with Lu177.

[cesanon in reply to GP24]

They require the PSMA PET/CT test to confirm that you have PSMA sensitive prostate cells.

If it picks them up, and you have a doubling PSA trajectory, unless there are other confounding factors, they will treat you. And when they treat you the LU177 will seek out ALL your PSMA sensitive prostate cancer cells regardless of whether or not they show up on the scan.

Unfortunately it seeks out and kills a few other types of cells as well. Ones you would rather not be killed. But that is another story.

[GP24 in reply to cesanon]

"And when they treat you the LU177 will seek out ALL your PSMA sensitive prostate cancer cells regardless of whether or not they show up on the scan."

That is your logical thinking. Did you read that in a study or review? I did not.

[cesanon in reply to GP24]

This is info I have basically picked up here. Mostly from Tall-Allen.

Everything Tall-Allen has to say is backed up by clinical research. In this case it appears to be logical as well. Now I may not have understood him properly. But I am not invested in any position here.

But it would seem you are starting out with a proposition and then attempting to defend/prove it.

If that is so, it is very risky behavior for a cancer patient to engage in.

[rococo in reply to cesanon]

Thanks to all for the lively response. I will be looking into cyber knife. The reason why I posted it is because of the side effects some focal treatments only to have return. Lu 177 PSMA just seemed more systemic.

[tango65]

You need to consult with a Dr doing the Lu 177 PSMA treatments most probable a Dr from Germany (they have been doing this for a long time). I have not seen any paper about treating local recurrence with Lu 177 PSMA.

[immunity1]

There are plenty of papers out there showing the efficacy of LU177 based treatments on PSMA avid PC (check out Baum, Germany, Hofman, Aust and others).

On top of that there are many personal testimonies such as mine where Lu177 (x4) shrank my 7 focal soft tissue PC. No controls of course. But who wants to be a control in expts like this eg Vision. It's the same as the expts conducted in the early 1950s with radioactive Iodine. When it became clear that this treatment was effective against thyroid cancer who the hell would want to be a control taking a placebo. Nobody. The same then as it is now. 'Knowledge' is progressing faster than the randomized cohort studies can keep up with. But with Lu177 treatment it does mean 'taking a chance' and fronting up with the $ sadly.

[Claud68]

My husband had a rising psa after RP. A Ga Psma petscan showed that he has 6 mets in lymphnods. So we decided to have immediately the Lu177 therapy without any ADT. He had his first shut on March 6th, the second on April 4th and his PSA went down from 4.40 to 1.05 yesterday.

A Ga psma scan in May showed that 4 mets were disappearing or were gone and two were still present, but with much less power or energy.

My husband is Gleason 9 (4+5) with a PSA 11.20 in November 2018, before the PR. And after that, the PSA started to rise quickly since January 2019. He had no bone mets.

We went to Vienna to see the famous Prof. Shariat. He sent us to Prof. Hartenbach in Vienna for the Lu177 treatment. I think he is the only one who is convinced - as we are- to begin immediately this treatment with Lu177, before the cancer cells become resistant due a hormone therapy or a chemotherapy .

My husband will have the third shut with Lu177 on the beginning of August.

A lot of oncologists with Pca don't want to have ADT or chemotherapy for themselves and come to Vienna for this treatment.

So we think that we are maybe right to do the same.

It is just really expensive because the insurances don't pay anything.

[AlanLawrenson in reply to Claud68]

A bit surprised at you having the first 2 injections less than a month apart. In Australia, its 6 to 8 weeks apart. Also your third session is delayed until early August. I suspect, it due to travel issues.

To the main question of the PSMA ligand therapy after recurrence. It is being done.

[GP24 in reply to AlanLawrenson]

Alan,

yes, it is done after recurrence, I had it done. But to my knowledge this is not the case if you have no visible mets, just a local recurrence in the prostate bed.

[Claud68 in reply to AlanLawrenson]

Hi Allan,

My husband had on end of April a problem on his lungs and couldn't have the third treatment one month after the April 4th.

That's the reason for the delay to August.

The different hospitals in Germany ( Heidelberg and so on) and also Australia and Austria agreed for a new protocol to inject about 7.4 Mbq every 4 weeks. This showed much better results than a treatment every two months or more.

[Claud68]

Fortunately, despite this delay, his PSA continued to drop and there were no new mets in the body and still no mets in his bones. The two first treatments stopped at least a progression of any mets!

So we are very thankful for this!