I still wonder about doing a lutium treatment before starting ADT. Would it make a difference if done first, rather than close to last?
Or should treatments be interspersed more quickly to try to kill off different cell lines? A month of chemo, a month of Zytiga?
Lu 177 PSMA treatment may be more effective if it is done before chemo. Since enzalutamide and ADT increase the PSMA expression of the cancer a short treatment of ADT plus enza before or before and concomitant with Lu 177 PSMA treatment could be more beneficial. First thing is to show the cancer expresses PSMA. You can get that info with a Ga 68 PSMA PET/CT or a DCFPyl PET/CT or with a biopsy and histochemical studies.
PSMA shows up increasingly with time. ADT boosts it temporarily, but then depresses it. It is heterogeneous within tumors and between tumors.
What does your Medical Oncologist say? He will know. Everybody in this group are different each with different scope of disease and co-mobidities.
GD
the only thing i can tell you is, my husband reached the end of his 5 year rope with Casodex just as Zytiga became FDA approved. his PSA shot up to 970 as Casodex failed him. Within a month on Zytiga it dropped to 30, then lower to 12 and hovered (+/- 5 points) around that number for 6 more years, when they switched him to Xtandi after three months of chemo failed to do anything. but, all cell lines are different. he passed after battling his super aggressive Pca 13 years after diagnosis....but, his cancer was already in his bones when they found it.
The most wonderful time of the year. 
Stay Positive and Busy doing what you most enjoy
What do you know about (unconventional) DMSO?
At what PSA did you switch treatments?
QoL's the most Wonderful time of the Year
