Lu177 versus Actinium in Germany or in India. I need advice.

[Nesrine]

I dont know if you remember me. But my husband took Lu177 for 4 times. In the beginning the PSA decreased. And the scans looked good. After the third treatment the PSA started to rise again doubling, even after 4th treatment.

Due to lockdown we didn't hv any other option and we took arbitrone. The PSA doubled. We wanted to try the two new meds approved by the FDA. But we need to do a BRCA1 and BRCA2 test. It came out negative.

So, now our only option is Actinium. I tried to convince the Doctor to follow the Protocol of Germany, where they combined lu with Actinium. He refused.

Anyway we booked our first treatment for mid of July.

We should be leaving India to Egypt in August. And this means we have at least two other treatments to undergo.

The Actinium treatment in India for only the Hospital one day and medicine is around 6500 USD. The Insurance company refused to pay anything.

My question is should we continue the treatment in India, which means flying to India twice from Egypt, or is Germany more better treatment? As in Germany they combine treatments.

In all cases I am the one who will cover the costs, so I also seek cost efficiency. How much is it in Germany?

Any suggestions please?

[LearnAll]

I can not give exact answer to your question as you will have to decide where to get treatment. I do know a few things about Oncologists in India.

Almost all Oncologists in top hospitals follow American or British protocols and hardly any one follows German protocols.

If you go to medical library in India, over 90% books and journals are either American or British. You rarely see a German Journal as rarely any doctor reads German Language.

The cost in India will be certainly lower. My Ga68 PSMA PET CT was being done for $300 which costs $2800 in USA. So take all factors into account and decide accordingly.

[Nesrine in reply to LearnAll]

Are you in India?

[LearnAll in reply to Nesrine]

No. I live in USA for last 35 years. I visit every 1 to 2 years.

[Tall_Allen]

Is his remaining cancer still PSMA-avid?

[Nesrine in reply to Tall_Allen]

What does that mean?

[Tall_Allen in reply to Nesrine]

Lu-177-PSMA and Ac-225-PSMA are only effective against cancer cells that express a protein called PSMA. Not all prostate cancer cells express it. If the cells that express it are already killed off and only cells that don't express it are left, then taking a PSMA-targeted therapy may be more harmful than it is helpful. The fact that his cancer is increasing rapidly after the last two treatments may indicate that the therapy has already killed off all the cells that express PSMA ("PSMA-avid") and the other cancer cells have taken over. Eliminating their competition has given them room to grow.

The way to know if this has occurred is to get a PSMA PET scan. It is available for purchase at UCLA:

healthunlocked.com/advanced...

[Nesrine in reply to Tall_Allen]

They did to my husband this scan and accordingly they did the lu.

I didn't know, there is a condition for this treatment to work.

Now we only hv Actinium.

The lu did good with the ribs, but not with the other tissues.

I don't know what else to do

[Tall_Allen in reply to Nesrine]

Has he had Ra-223?

[Nesrine in reply to Tall_Allen]

What isRa-223?

[Tall_Allen in reply to Nesrine]

In the US, it is called Xofigo. It is a radiopharmaceutical that uses powerful internal alpha radiation to kill off bone metastases. It doesn't rely on PSMA like Ac-225-PSMA does, and that also means that it doesn't wipe out the salivary glands. But it only works against bone metastases. Here's an article from 2016 comparing it to Lu-177-PSMA:

prostatecancer.news/2016/08...

[Nesrine in reply to Tall_Allen]

Do you mean, if Lu177 didn't work, so Actinium would not work, too? As they are both PSMA targeting?

[Tall_Allen in reply to Nesrine]

Yes. An FDG PET/CT compared to a PSMA PET/CT can tell you if there is cancer there that is not PSMA-avid.

[Nesrine in reply to Tall_Allen]

I think I will have to ask his doctor. Thank you for all these information

[Nesrine in reply to Tall_Allen]

Tall_Allen

Do you know in which country can we have Xofigo and if it is FDA approved? Or where I can get these information?

[Tall_Allen in reply to Nesrine]

It is FDA approved, and available in the US. It is also approved by the European Medicines Agency and by NHS/NICE in the UK. Contact Bayer to find out where else.

[Rexwaterbury]

I had a similar situation in Heidelberg. After my first treatment I had a good response, but unfortunately that was lymph node only, not bone. Even increasing the amount of actinium failed to eradicate the bone Mets. The doctors could not tell me why the lymph nodes responded but the bones did not.

[Nesrine in reply to Rexwaterbury]

For us the lu did good with the ribs, but nothing for the other issues?

Here they want to do only Actinium