Delayed Lu psma treatment and rising psa

[Vsahay]

My father was supposed to habe his 2nd lu psma treatment on in may this year at a 2 month interval from the first cycle.After the first cycle,his psa had gone down from 21 to 8(tested in may).However,due to covid crisis ,we couldn't travel for treatment.Today,his test reports show a psa of 13.

What should be done next?Should we arrange for the next cycle of treatment or wait for more time as he is still asymptomatic.I am also worried if the lu psma treatment shall still be effective in controlling the disease after this long period of delay.It is a very confusing situation as we did not want to undertake a risky journey for getting the treatment in this period of covid.

Any advices would be of great help.Thankyou.

[Hidden]

No scientific backing of what I would have done in your father's case. Just a layman's crude risk-reward assessment. I would have waited until PSA climbed again to 20. This would seem to me as resetting the counter to its default, or back to square number one.

[CalBear74]

Vsahay,

Talk to your oncologist about the delay. Discuss ADT , especially 3month Lupron. This will slam his PSA. Then restart your Lutetium treatment perhaps in the fall.

[Vsahay in reply to CalBear74]

He had undergone orchidectomy in 2013.Hence,lupron won't be of much help.

[romil316]

I am sorry for being out of context but how much did it cost you to get 1 cycle treatment of Lu psma in India? I am a fellow Indian.

[j-o-h-n in reply to romil316]

Hello romil316, Would you please update us on your bio... AGE? LOCATION IN INDIA? SCORES PSA/GLEASON? TREATMENTS TO DATE? TREATMENT CENTER(S)? DOCTOR'S NAME(S)? Thank you. All information is voluntary, but it helps us help you and helps us too.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/03/2020 9:33 AM DST

[Vsahay]

My father got treated at AIIMS Delhi.One cycle of lu psma cost around rs 30000 .You can contact Dr M P Yadav at AIIMS for furthur guidance.

[romil316 in reply to Vsahay]

30K right?

[CalBear74 in reply to romil316]

We are talking about rupees not dollars aren’t we?

[Vsahay in reply to CalBear74]

In Indian rupees.

[Vsahay in reply to romil316]

Yes.

[romil316 in reply to Vsahay]

Thank you so much for your kind reply

[GP24]

The two months is the shortest period between Lu177 cycles. I think it is good to have more time between the cycles, prostate cancer grows slowly anyway. Also, the body has more time to recover the salivary glands then.

[Vsahay in reply to GP24]

Thanks for the reply

[TeleGuy in reply to GP24]

I wanted originally to be on an 8-week cycle but my docs in Munich said that they are seeing that the cancer can start coming back in that time frame and their approach is to keep hammering at it on a 6-week cycle. I moved to 8 weeks only after we were confident that we had it knocked down.

My salivary glands recovered pretty well until after treatment #4, and after #5 if I eat dry food like crackers I need liquid to help it go down the hatch.

[GP24 in reply to TeleGuy]

It depends how aggressive the cancer is, it has to be an individual decision. Also doctors make a living from treating you.

But I think in a Webinar with Dr. Hofman from Melbourne, Prof. Wolfgang Weber, who is at the TUM, presented the question, if one should really apply fixed timing of the cycles or make this an individual decision instead.

I was fortunate to be a "super-responder". I had requested a PSMA PET/CT after the first cycle already and sure enough, no mets could be detected any more. However, I was treated for lymph node mets while I was hormone-sensitive.