Since the 4th treatment, Ray has had no drugs(had Orchidectomy 10 years ago) at all. Scan on 29th October, lymph nodes and residual growths in bones showing further reduction in size. PSA dropping still, lowest since 2007 at 3.74(levelling out now). I wondered if anyone had had similar drops?
Thanks, Carol
"how long before the effects wear off?"
From what I heard, you should expect new lesions to appear in twelve months or sooner. This causes the PSA value to rise. I would expect the treated mets not to grow again.
Why would the "treated mets" not grow again ?
Only "new mets" appear again in twelve months or sooner ?
Thank you for any reply.
The Lu177 treatment radiates tumor cells. If you radiate cells, you can destroy them or you are only partially successfull. I think the Lu177 treatment was successful if the mets disappear from the PSMA PET/CT. These mets will not grow again. For the ones which just shrink, they may grow again, but I think just slowly.
However, the ones you did not see on the first PSMA PET/CT before the Lu177 treatment, because they were too small, they will grow to a visible size. Usually these had not enough PSMA expression for the ligands to attach to them and so they escaped. This is a hypotheses, nobody saw how this happens under the microscope.
Thank you. PSMA scan in June was amazing when compared to the original one from December. So is it viable to do this treatment again when PSA rises?
Yes, you can repeat the treatment. However, it does not work just as well as the first treatment then. You had 4 cycles already so you have to expect more side effects when you repeat the treatment. I would try to make a long break before starting with another treatment. No need to start again when just a few mets appear.
Thank you, GP24, that makes sense.
Much obliged to you, as always.
Cheers and all the very best,
Carlos.
Before my Lu177 treatment began last Nov, I had Psa 25 and lots of mets in lymph nodes and bones, some were pea sized. I had 4 Lu177 shots. Right after No 3, I began Xtandi, because it makes Lu177 more effective. Psa was already going down but its now 0.32, and docs are well pleased. Research at Peter Mac in Melbourne by a Dr Hoffman suggests that if Pca returns and PsMa scan shows enough PsMa avidity, then another Lu177 shot or maybe Lu177 + Ac225 will give good result, and it may be repeated again, so extension to time alive could easily be many years, and not the mean time of 14 months. Now this figure is gained over countless patient histories but many were end stage patients with very high Psa at start, and the higher the Psa at beginning, the more it takes to kill all that Pca. I had Lu177 when Psa was only 25, not a much worse 250.
Mutated forms of Pca may exist which do not have PsMa avidity. These cannot be killed by Lu177, and they become a threat and they sometimes explain why some men don't get an ideal response from Lu177.
After my follow-up PsMa scan months after 4th Lu177 shot I was told I have nothing to worry about, and mutant Pca did not show up in scan. I feel good, and have returned to being able to cycle 220km a week, not bad for an old man of 72.
I have no idea if I will be sick again by this time next year, but so far, so good, and I have only occasional dry mouth side effect. More Lu177 will increase damage to saliva glands, and maybe affect tear glands but mine are not affected so far. Ac225 has more killing power on Pca that has PsMa avidity, but has more certain effects on both these glands.
But it seems it will take a long time for my Pca to become a threat again, last time Psa was 0.32 was some time in 2014. I was diagnosed in 2009, Gleason 9, inoperable, given EBRT and ADT so I have survived say 14 years, if I assume it began 4 years before diagnosis in say 2005.
If Lu177 had not worked like it seems it has, I'd be in palliative care, because chemo failed.
Patrick Turner.
Thank you very much.
Lu-177 very nearly killed me and I will NEVER EVER go close to either Lu-177 or Ac-225 or a combination thereof EVER AGAIN.
Cheers !!!
You are the first case I have read about where a man concludes Lu177 is an intolerable therapy. Pca and many other cancers do not respond the same way with same treatment for all people. The research numbers show this clearly, but chemo raised my Psa, allowed Pca to continue in my bones, and just what effect it had in soft tissues will never be known. Systemic Pca treatment is supposed kill reduce Psa by either suppressing and slowing its growth, ie, ADT, or kill cancer cells, ie, chemo, and beam radiation can only treat small target areas, while nuclide like Lu177 is systemic, but targeted. For me, Lu177 has given me a QOL that can continue and if it had not worked I'd be on palliative care.
Side effects have been minimal, and tolerable, but for others this may not be the case.
Patrick Turner.
Hi Patrick. My brother was considered a 'model' patient by the private TA group in Oz. Four treatments with the last in late February, saw everything good with just minimum saliva dryness. PSa was 2 when he went to NA for 5 weeks in Sept/Oct. On his return, he looked drawn and found that his PSA had gone to 100. Now 315 and he is in considerable pain from bone metastasis. TA said no more Lu. MO giving him Docetaxel from 21st Nov.
It has been gutting how quickly he has gone from great QOL to today.
Clearly, Peptide Ligand Therapy is a good 'holding pattern' treatment, but it needs combining with other therapies to have long term efficacy in most men.
I cannot see how your brother was a model patient. He may have had PsMa Ga68 scan that showed he was, but he may have had a high amount of Pca that had low or zero PsMa expression so SUV for Lu177 was low for that variety of Pca, so it was not targeted by Lu177 doses so that Pca continued to grow.
Professor Hoffman talks about this in his recent video on latest trials and research at Peter Mac.
So far, seems like I don't have your brother's problem.
Nobody knows if they are going to be a model patient or not before any particular treatment. They might know after treatment if all goes well.
Chemo failed for me, so I was not a model patient. Same for the EBRT I had as primary treatment for inoperable Gleason 9 in 2009.
Patrick Turner.
Carol,
I completer 6 LU177 injections ending in early May. The major side effects have subsided significantly. I did have new mets to my 5th left anterior rib and right hip by late August that we treated with SBRT.
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