My husbands local oncologist called him a Pioneer in his treatments, to go down paths unknown and help those that will follow in the future. Knowing this will help someone else in the future is encouraging.
Update - my husband had 6 Lut-177 treatments beginning January 2019 in the vision trial and finished in August 2019. PSA was 34 in December 2018 and he reached compete resolution of all tumors and an undetectable PSA in October 2019. A remarkable response to the treatment. But now short lived
A small recurrence has now been found on the C-11 pet scan a few weeks ago, February 2020, his PSA was only .29 and Dr. Kwon said its a best case scenario for a recurrence . It is all contained in the prostate gland now and today it was confirmed by an MRI. Bone Scan and CT scans at the end of December were all clear.
The recommended treatment now is consolidated radiation to the prostate bed for 5-6 weeks. At this point we are trying to decide if we do this at Mayo Clinic or his local cancer center, not familiar with Lut-177 treatment. They also gave him the option of having Spaceoar gel to protect the colon. But, this could also protect possible unseen cancer cells that may be in that area.
Your thoughts on the next step would be appreciated.
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CJ4J
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Thank you for your thoughts, we asked if he could have any more Lut177 treatments, and they said if a Dr was willing to do it in Germany or Australia. So, maybe this could be an option.
Congratulations on the excellent response, and thanks for being a pioneer. It is certainly a mistake to think that what one can see on a scan is all there is. Two large randomized clinical trials have proven that debulking the prostate after there are multiple metastases does not affect outcomes, and may increase side effects:
The Lu-177-PSMA treatment has eliminated the cancer that is PSMA-avid, but has selected for cancer that is not PSMA-avid. Systemic therapy with jevtana would be a better next step, imho:
If the carboplatin treatment was effective, it is likely that a PARP inhibitor could work too. That is especially true if a metastasis-biopsy shows BRCA mutation.
Thank you Allen for your honest opinion, I read both of the blogs. We will discuss this with Dr.s next week. We know he is in uncharted territory and not like someone who was newly diagnosed. He had no response to the Carboplatin treatment. He was also tested 2 weeks ago and doesn't have any BRCA mutations.
Thanks for being a pioneer. Keep in mind that the trial that TA posted regarding debulking the prostate notes that the trial was done using older radiation equipment and is not on par with the radiation treatments used today.
I had my prostate debulked over 5 years ago using IMRT and I have experienced no side effects to speak of from radiation. Those I had were mild a short lived. I had a couple of excellent MO’s including Snuffy Myers tell me it was one of the best things I could have done in dealing with my G9 metastatic PCa.
I had a dose of radiation equal to or greater than 80 gray, which trials have found to extend survival in men with a Gleason score of 8-10.
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Crossroads - ADT or wait for psma pet/LU 177? Meeting with oncologist to discuss tomorrow 
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