LU 177 better if you did not take any ADT or CHEMO prior

[Samdres]

Hello all,

After reading a lot of information and post over here, does someone got LU 177 prior to any other treatment (ADT / CHEMO ) and see better results ? would you recommend it ?

thanks

Sam

[Fairwind]

Lu-177 is a new therapy and most everyone in the States who has been treated with it has received it in a clinical trial setting. As far as I know, These trials have been conducted on advanced PC patients and most of this group has had a full range of prior treatments including ADT and chemo..Very few if any patients in this country have received this treatment at an early stage (before ADT) in their treatment. Even in Germany, where a handful of private clinics and hospitals have been treating patients who can afford it with Lu-177 / PSMA617, those patients are likely to have been in the advanced / stage 4 category.

So how would Lu-177 work at an early stage ?? Who knows...If a special scan shows your cancer has a high PSMA component, it should work great, but no better than ADT..Nobody is claiming that Lu-177 CURED them of prostate cancer..It's just one of many treatments that (but not in all) cases can extend your life considerably. This must be balanced with its cost and side-effect potential...The long-term side-effects of ADT are pretty well known. The long term side-effects of Lu-177 are still pretty much unknown and are subject to a lot of conjecture..Most of the men who volunteered for the trials were at the point they had nothing to lose.. A big dose of radiation (Lu-177) is bound to have some serious long term side effects..

[Samdres in reply to Fairwind]

thanks for your quick reply.

[paige20180 in reply to Fairwind]

My husband is having his first dose of Lu177 today at Fortis memorial with Dr. Sen. He is still ADT sensitive with four lesions. Three are on his spine and 1 on his rib. We will let everyone know how it goes.

[tango65]

ADT initially could increase the expression of PSMA and the Lu 177 PSMA treatment could have better results. It seems Lu 177 PSMA is more effective in patients treated with enzalutamide or abiraterone. Lu 177 PSMA may be less effective if the patients had prior chemo treatment.

jnm.snmjournals.org/content...

[paige20180 in reply to tango65]

I think a question would be the difference between hormone sensitive and resistant as more men have LU177 that are hormone sensitive. I'm a little worried about the one 50 mg enzalutamide my husband took 5 days prior to his Lu177. His PSA went down from 2.7 two weeks ago to 1.64 and his testosterone went way up from 40 to 200. I hope the PSMA is going to suck up Lu177 like a sponge today.

[tango65 in reply to paige20180]

My PSA went from 10 to 0.8 during the ADT plus casodex before going to Germany. When I got there we discussed about this situation. They decided to do a Ga 68 PSMA PET/CT that showed about same PSMA expression than the one done when my PSA was 10. One course of treatment made all my lymph nodes metastases PSMA negative according to other Ga68 study done 5 weeks after the treatment .

The treatment with Lu 177 PSMA is well tolerated. I had fatigue for about 12 hours, and some edema that resolved with 1 dose of lasix.

I wish you the best of luck!!!

[paige20180 in reply to tango65]

Thanks Tango. That’s when Dr Sen did today Was repeat the PSMA since Charlies PSA went down from Casodex and the lesions looked the same so we pressed with his first Lu-177 treatment. We are having dinner and he feels great.

[tango65 in reply to paige20180]

Glad to know he is doing well. What is your impresson of the hospital and the doctors in India?

Best of luck!!

[paige20180 in reply to tango65]

The hospital is a little rustic compared to the US but you can afford to be treated here so I think you come to India or overseas knowing the money goes into the treatment and not lobby or in room dining. The hospital is as I expected. The doctor Dr Sen and her staff are incredibly attentive. I was concerned I had altered Charlie's PSMA by him taking 1 50mg Casodex 5 days ago. He had a drop in PSA That worried me the PSMA might be suppressed. The information is still not 100% how a hormone sensitive man will do starting ADT right before LU177. So she did a PSMA to make absolutely sure his PSMA was still super sensitive at no cost to have the "evidence" he was still PSMA avid. She wants this treatment to be successful just like us. She sat down with us and compared his PSMA August 20th next to the one today. The scans were just alike so we pressed with his first treatment. That was beyond impressive to me. Her staff did not leave the hospital until our hotel picked us up. Charlie feels great. We had an amazing Indian meal selected by the chef at the Westin. I am so happy to see him having zero side effects and eating a nice meal in great spirits. We go in tomorrow at 4pm for scan and have a final PSMA Thursday morning before we leave for home.

We do not know yet if the treatment worked, but no side effects so far. We feel nurtured and cared for. The Indian people are wonderful. We have been taken care of from the minute we walked off the plane and the hospital had us met and ushered through immigration. I'll be sure to let everyone know more as things unfold. I sure hope I get to report the four lesions were successfully treated.

We are here because of my conversations with Fuzzyman77 so we are not the first to come here. He's been a huge wealth of information.

Thanks!

[tango65 in reply to paige20180]

Great, thanks for sharing your experience. I could manage in Munich thanks to a friend ( a physician) who lives there and she helped us to navigate the hospital and the local bureaucracy. The doctors in Munich recommended to wait 4-5 weeks to repeat the PSA and see if ithe treatment had some positive effect. They usually do 2 treatments and then repeat the Ga 68 PSMA PET/CT. Glad to know he is doing well and enjoying the local food.

Best of luck!!

[GP24]

I know a patient who was diagnosed with lymph node and bone mets spread over his body. He decided to start with a Lu177 treatment. After two cycles the mets were gone from a PSMA PET/CT but some tumor left in the prostate. So he had surgery. However, new mets appeared and he had to have ADT and Chemo etc. I lost contact so I do not know if he is still alive.

[klaas40]

Four years after a HIFU (April 2014) of my Gleason 9 T3a, I got a GaPSMA scan (May 2018) that showed a number of “tiny” bone and soft tissue mets. In those four years my PSA doubling time was 2 years, with a rise from 0,8 one month after HIFU to 3,3 in May 2018.

No further treatment, except doing strenuous exercise (30 MET/week) until yesterday and two LuPSMA treatments in Sept and November last year.

Since then, PSA constant around 3,0 and no increase in number and volume of my “tiny” metastases.

Not any side effects yet, so, according to my urologist (and myself) no reason for any other treatment (yet).

I will turn 79 next month and feel very healthy.

[Godblessus]

I think so...

[Godblessus]

First treatment went from psa 16 to 2.1...

[Godblessus]

Went to Germany... I never had any other treatment