My father was given 1st cycle of Lu 177 on 26/2.He was suffering from bone pain since a few days in the pelvic region.However,even after administration of Lu 177 pain is not decreasing.How long does it take for pain to subside .
Doctor has advised for RT to pelvis.After how muh time shall it be safe for him to take radiation?
The pain flare from radiation should subside within 2 weeks. That's a good question about RT to bone after Lu-177-PSMA treatment. How extensive are the pelvic metastases? Is he taking a bone-preserving agent?
Yes he is taking zoledronic acid once monthly and his right ilium and nodes had high psma intake in the scan.
Does lu 177 treatment help relieve the bone pain from cancer?
A Lu-177 cycle shall radiate the tumor cells for about eight weeks. So you cannot expect a significant difference after two days already.
Is it wise to get his pelvis radiated for pain relief?
I would wait if the Lu177 therapy provides sufficient radiation to relief the pain. If it is working well it will do that. If it turns out that this is not the case you can radiate for pain.
For how long?
While they schedule repeat Lu (and Ac) PSMA treatments 6 to 8 weeks apart it is to allow recovery of other tissues that express PSMA such as kidney, gut and salivary glands.
The half-life of Lu 177 is 6.6 days. But I believe it is the binding kinetics of the ligand to PSMA and then renal excretion that are more significant in limiting the effective duration. Radiation precautions are usually instituted for about 3 days after a treatment and then one is cleared to travel, etc. So much of the radiation burden has probably been passed by then.
Radiated tumor cells will die when they try to divide and grow. Therefore the Lu177 radiation will be beneficial for longer than 6.6 days.
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Absolutely correct GP. That is probably another reason for the spacing of the treatments.
This might be a silly question. But I am curious Why LU177 treatment can not be used in hormone sensitive prostate cancer ?
GP24,
Does it mean that other than insurance issue and payment for Lu177...there is no obstruction to getting Lu177. Do you still have to be on ADT or you donot need ADT after Lu177 ?
The decision to proceed with Lu-PSMA treatment needs to be made with a physician at the facility you choose, such as in Germany or in Australia. They will review your medical and cancer history and need to have the Ga-PSMA scan results: the complete scan data on disc, not just a report. Then they can advise you if Lu-PSMA treatment is appropriate.
Both hormonally sensitive patients as well as the castrate resistant can be treated. And there is some suggestion that earlier treatment and low-burden disease may respond better than more advanced high burden disease. But one must recognize that the response is highly individual.
For the castrate-resistant it is usual to stay on ADT as this may increase PSMA expression. Some will advise to add enzalutamide if not already on it for the same reason.
For the hormonally sensitive it may be advantageous to take interrupt ADT and allow T levels to recover, as this reverse strategy might increase PSMA expression.
This is what I am doing now, recovering T levels in anticipation of my first Lu-PSMA treatment in Australia scheduled for next month. The point is that these strategic decisions need to be made on an individual basis in consultation with the experienced treating physician.
that's good info. thanks.
I had some slight bone pain at bone mets after having first 2 shots of Lu177 but it wasn't enough for pain killers. Psa was 25 before I began, but didn't much reduce until later shots of Lu177. It takes time for Lu177 to gradually reduce bone mets, but PsMa scans showed it was working, and the slight pain you have also indicates its working. It a bit too early to get additional beam RT.
Any EBRT or IMRT will probably cause more side effects than Lu177. So deal with pain with pain killers for awhile, then pain should subside and you can quit the pain killers.
Lu177 effect is biggest while its highly radioactive, but it has a short half life so its its initial action diminishes after a week or two, and the body then easily deals with dead tissues and bone. I had 4 shots Lu177, and Psa went to about 1.6. But I also began taking Xtandi after 3rd shot to make Lu177 work better on final shot last May. Psa was 0.32 last November,
but its now rising again, so I might need more Lu177, but its too soon for it, and I have only 2 active small bone mets that could be identified and which don't cause any pain or threaten bone strength. I had countless bone and lymph node mets.
But doc giving Lu177 was worried 2 bone mets, one in femur and other in pelvis each about size of pea were not fully being killed by Lu177, and I had a sore hip, so doc said get EBRT to those 2 mets which was easy to do. One was in my bone marrow, highly dangerous, so I did have 20 Grey of the EBRT. But soreness was not from Pca mets, but from building work I did months before when I did some damage to nearby bursa around muscle. I did not need a hip joint like 2 docs said I did. bursa is still slightly not fully OK, but it is not a problem. I am now cycling 200km+ a week, feeling quite well at 72yo.
When my Psa goes up to maybe 3 by next meeting with my oncologist, he might order me to have another PsMa scan. More active mets are likely to be found, but meanwhile my Pca is under control, and more Lu177 looks likely to be able to deal with new mets, and if not, scan will tell us why not, then maybe I will need other type of therapy.
So far, so good.
Encourage your dad to have some hope that Lu177 works to give a bit more precious time. Patrick Turner.
Thanks a lot for the encouraging response.I truly agree with your opinion and shall wait for some time to see if the pain subsides.
Hi Vsahay, There are there some Pca sufferers who have far worse progression of Pca and very much worse pain, and a man in another group said he had a subcutaneous insert with slow release Fentannyl. Its maybe 2,000 times more powerful than morphine, and very dangerous to take and addictive unless tightly controlled. I was given some during an 11 day stay in hospital 2 months ago for a stomach blockage due to adhesion of small intestine to scar tissue from an op I had in 2010.
I didn't like the stuff much, because I did not have much pain, and it was administered via IV drip using a press-a-button for more if pain went high, so pain was suppressed from the surgery I had to fix problem, but I felt like I was a mindless zombie.
Pure morphine worked better. But I did not have much pain except when I tried to get out of bed after the minor surgery, so I told the nurses to get rid of Fentannyl machine.
I felt no just strangely awful feelings of withdrawal symptoms and no desire to have more F.
But had my pain been from bone mets it could have been different story and a man here got Ra223 to treat his bone mets which were very extensive, and he got the benefit from Fentannyl.
I don't know how that man is doing now. One trouble with Pca chat groups is that you get stories posted up by men or their relatives, then you read nothing about how they did later, and its probably many come here to look at what others are doing about their Pca, and if the man dies, he or his relatives see no need to talk to us again. Pca affects families real badly, as does any other cancer within a family; its often a tragedy for a number of ppl.
We are just the ordinary plain people, and all that any of us really know is our own progress through the the successive treatments that the docs serve up to us.
I am extremely lucky to have access to well meaning doctors at my local free Govt owned hospital who will not hesitate to refer me to better treatment at other private hospitals which often have the latest treatments such as Lu177.
I cycled 67km today, and feel very well, and I managed a total of 219km for the week.
That I can do this at all is a blessing by Nature, and Unusual Thing, a Wonderment Bestowed by the unidentified Greater Being than me.
Its much better than the alternative where I might have been in palliative care if Lu177 had not given me this last year of my time.
Keep well, and love your dad,
Patrick Turner.
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