My father had his 1st Lu infusion on 26th feb.Two weeks later his psa has risen from 21 to 32 and ALP from 171 to 195.Does this steep rise mean the Lu therapy is not working for him.Symptomatically,the excruciating pain in his hip joint has reduced remarkably.He is also continuing abiraterone.
What should we do next?
I think it is a good idea to get an FDG and a PSMA scan before getting Lu-177-PSMA therapy. It sounds like it has reduced PSMA-avid metastases but unleashed the non-avid ones.
pcnrv.blogspot.com/2019/12/...
He has had PSMA scan before infusion.Most of them were psma avid.
Maybe in more time good news. Many prayers .🙏 Hang in there.🙏
That's why BOTH an FDG and a PSMA scan are necessary. "Most" is the problem. Repopulation is a known problem with radiotherapy.
I’m sorry but I’m no expert . Maybe it goes up before it goes down . I’m glad that his hip pain is better .I have a bit of that myself.. love him much . That’s the best medicine. Don’t put the world on your shoulders . You will do what’s correct . Be strong and stay by his side . 🙏
ncbi.nlm.nih.gov/pmc/articl...
One possible treatment regimen you can tell your medical oncologist. Good luck.
Before you consider cabergoline , check his serum prolactin level. If it is high or high normal range, cabergoline can be a good idea. Sometimes when cancer becomes androgen resistant ,cancer cells start feeding on prolactin. When you lower prolactin with cabergoline, it might help.
of course the MO has the final say. But testosterone is blocked for CSPC regardless of levels. Even if prolactin is in normal ranges, it still can feed tumors since hormones have a role in their growth.
Of course this is just one more option since options will become limited as the disease progresses.
It is a very good think that the PSA has risen about 2 or 3 weeks after the Lu166 treatnent. In fact after every Lu177 treatment the dying cancer cells release all their PSA and about another two weeks later the PSA should drop under the 21 your father had before .
It will be the same after each treatment with Lu177. Good luck!
Yes ! Good news for you ! Your doctor didn't explain it?
Got the test results today itself.Haven't spoken to doctor yet.
Your reply is making me feel much more hopeful😅😅
Thanks.
My husband had also Lu177 treatments . It was the same. And after, the PSA should continue to drop for several months. I hope it will help your father and hope also that he has no sideeffects and will be well again!
After my second Lu177 in early 2019, Psa hardly moved down much from 25 before I began.
But after 3rd and 4th shots there was a bigger Psa reduction. I think your dad should continue with Zytiga,because many docs think it makes Lu177 work better.
Lu177 is not a fast working nuclide, and it often takes 2 shots before reductions of bone mets can be seen in scans, but you say dad's bone pain is getting less so its a good sign.
When I had my PsMa scans and Lu177 that followed, there was no talk about FDG scans.
12 months after beginning Lu177, Psa went to a low of 0.32. Psa is rising again but recent CT scans showed only slight activity in 2 small bone mets. There were no mets seen in soft tissues.
Docs say I had a good response with Lu177, but the fight is not over.
The issue of FDG scans seems to have become important only recently during last 12 months of research where patients had some benefit from Lu177, but Psa began to rise fast again. In November 2018, not one doctor mentioned FDG.
But now of course there is a threat to get more treatment for Pca because Covid19 virus may close down or limit what is done in all sorts of clinics.
Not one doctor has mentioned I have mets that were not PsMa avid.
I am feeling very healthy with no symptoms at all, and have been cycling across town on my bicycle and doing 200km+ a week. I am 72. But if I catch Covid19, maybe I survive because I have good fitness and health and because I have no heart or lung conditions. But if numbers of Covid19 patients fill the hospitals, Covid19 may still make me very sick and I might be left in a corner to die, because saving younger ppl is more important.
We are entering a strange time in history.
Patrick Turner.
My physician at Heidelberg told me that my first PSA might show an increase due to cancer kill releasing PSA into the blood. 3 weeks after lu177 my PSA was unchanged at 85. 2 1/2 weeks later it had decreased to 55. I’m due for my second treatment tomorrow, and then will try to find some way back to the states. Not sure I want to come back after all I’ve read in the last couple of days. Besides it is so pleasant here in Heidelberg.
At my first LU treatment in Germany last year, prof. Baum told me not to get a psa year until after 4 weeks. Because there can be a psa flare up in the first 2-3 weeks. And that’s because cancer cells are killed and releasing psa
I agree with all the other folk who have had treatment with Lu177. An elevation after the first treatment is NORMAL. My PSA began to fall after the second treatment and from then on to the 4th treatment. PSA elevation probably due to lysis (death) of cancer cells. Be encouraged!! =Rob
Lutetium treatment timeframe
Lutetium 177 PSMA radionuclide therapy for men with prostate cancer
Xtandi with lutetium?
Pluvicto (lutetium Lu 177
Decision time Lutetium or AM509
