Charlie is still hormone sensitive. I thought I had read that some clinics prescribe an ADT drug to cause PSMA expression to increase to enhance the treatment. My husband is getting his first treatment this Monday at Fortis Memorial Research Institute in Delhi, India.
For those of you having a difficult time traveling under Covid or not able to get in for treatment, we had to jump through many hurdles to be authorized to enter India under an emergency Visa. We will let you know how it goes.
Hello paige 20180,
Wishing you the best.
I am just 20 minutes away from this hospital. Please let me know if I can be of any help. It will be my good luck to help a fellow PC warrior.
Khatri
9999988309.
Khatri,
How incredibly kind to you. We will definitely call if we have any issues. I wish we could take you to dinner. Maybe the next treatment when we aren't under such strict rules for our emergency travel Visa. Thank you again!
The drug these clinics use is Xtandi or Enzalutamide.
eurekalert.org/pub_releases...
You will not get a prescription for Xtandi while you are hormone-sensitive. Therefore I took Bicalutamide which is similar to Xtandi. I know another patient who observed an increase in PSMA expression when taking Bicalutamide. I was called a super-responder by my doctor but I cannot tell if Bicalutamide did the trick.
I would take Bicalutamide in the hope it increases the PSMA expression plus take it for six months after the PSMA treatment to delay a possible recurrence.
Thank you! Our doctor was thinking he’d put Charlie on Lupron a month after treatment. We was going to wait to see how the LU-177 did and then try to further give the cancer an extra punch. Would you suggest Bicalutamide instead of Lupron from your experience?
If you want to give Bicalutamide a try then start today! It takes at least a few days to increase the PSMA expression. This has to be done before the infusion. Maybe you have left some Casodex pills from 2018 when Lupron was started.
After the PSMA infusion I think it makes no difference whether you use Lupron or Bicalutamide. I took bicalutamide plus 20 mg Tamoxifen because this has much lower side effects than Lupron.
There were trials which combined salvage radiation with ADT and showed a benefit for that for high-risk patients. This is the reason I took Bicalutamide for six months after the PSMA treatment. I would not just wait and see! A recurrence is likely and that will be a disappointment for you.
Really appreciate your thoughts. He’s done salvage radiation plus SBRT and his spine hasn’t responded well to the SBRT. I’ll be sure to share with our doctor what worked well for you.
I mentioned salvage radiation just to provide a reason to start with ADT after the infusion. Doctors often do not want that because they want to see how well the Lu177 treatment worked.
Hi
I have been taking Bicalutamide for the past 6 weeks and I have noticed a soreness developing in my breasts.
You mention 20mg Tamoxifen. Does this help reduce the soreness in the breast ?
HI GP24. Were you hormone sensitive when you took Casodex prior to LU177? Thanks
Yes, otherwise I would have got a prescription for Xtandi instead.
Wishing best of luck to Charlie and you! Safe travels!!
I don't know if Casodex will have the same effect on PSMA expression that the stronger hormonal agents do.
Allen, Do you know if Abiraterone has the same effect as Enzalutamide on increasing PSMA expression?
Hey. I think we need to be clear that there may be a big difference in men that are hormone sensitive versus resistant trying to get a better PSMA expression prior to treatment. My husband is doing Lu177 still ADT sensitive. Most men have had this treatment later in their treatment. The doctors we have seen think my husband is actually having this treatment at the best time possible with a low burden of 4 lesions, hormone sensitive and no chemo. Please read the studies and note whether the study is for hormone sensitive or resistant.
While PSMA "flair" is documented with 2nd line hormone therapy in castrate-resistant men, men who are hormone-sensitive may not demonstrate PSMA increase after ADT initiation. Below are links to studies demonstrating this. The first study, in particular, compares the immediate effect of ADT+Bicalutamide on PSMA expression in hormone-sensitive verses castrate-resistant men, demonstrating that 62% of the hormone-sensitive men had a decrease in PSMA expression at day 9. If Charlie's scans show him as very avid now, my thought is why do something that could change that. Maybe only if the response is not as ecpected. I would love to hear other thoughts, but I don't think there are any studies showing a flair for hormone sensitive men.
ncbi.nlm.nih.gov/pubmed/305...
ncbi.nlm.nih.gov/pmc/articl...
Thank you so much Shanti!
Praying for a good result
Shanti1 is correct. Read that evidence carefully. I too am awaiting Lu-PSMA treatment and am HS. My strategy will be to have the first treatment without the drugs. Then repeat PSMA scan to assess response. If less than excellent response I would add enzalutamide (not bicalutamide) to prep for a subsequent round. This is being studied further in clinical trials.
But what I would really want, under compassionate care is Veyonda, idronoxil. Look up the LuPIN trial by Noxopharm. Sorry I do not have the link on my phone.
Good luck and travel safe.
Thank you! Yes. Shanti has helped me so much. You too thanks.
I recently discovered Bangkok is again accepting medical tourism. I had 3 treatments there from Mar to May. My PSA dropped from 990 to 0.14.
I had 3 treatments in Bangkok last spring with no p vous
No previous treatments only the radioligand. My PSA went from 990 to 0.14 and no Mets.
I started my Radioligand (Lute 177) in Bangkok - cold turkey with no previous heavy duty drugs. After 3 treatments my PSA which was astronomical is now 0.10 and no mets in sight despite being lit up like a Chritmas tree after my gallium.
Wow. That’s just the best news. Thank you so much for sharing your experience. I’m so happy you are doing so great.
Best wishes to you Charles.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 09/03/2020 6:36 PM DST
I began Cosadex for 6 months in July 2016 when I had salvation SBRT to PG.
Once that failed in 6 months, it would not work again, and I had Zytiga, which worked for 8 months, all with ongoing ADT. I than had chemo which only increased Psa and didn't do anything, but docs said it would maybe make a second round of Zytiga work again, or make Xtandi work OK. But has 4 shots of Lu177, and after No3 shot I began Xtandi and Psa went from 25 before Lu177 to 0.32 one year later, probably because chemo at least had effect of making my Pca sensitive to Xtandi or Zytiga, but also Xtandi was favourite to increase PsMa expression. But since low Psa 0.32 last November 2019, it rose to 30 before 5th shot Lu177 on 24 July this year. It is thought Xtandi is not having anti hormone effect, but docs said I should keep taking it to make my Pca express more PsMa. I was also given compassionate course of 20 Veyonda suppositories two a day for 2 days before and 8 days after each Lu177 because it also boosts PsMa expression. Next Lu177 is in 2 weeks and I'll get Veyonda again.
I do not know if Cosadex would work as well to boost PsMa, and no doc has mentioned it.
Psa is now about 7, so maybe PsMa boosting is working OK.
Patrick Turner.
Lu-177 in Austria - Report and underlining high importance of both FDG and PSMA PET/CTs 
Lu177 versus Actinium in Germany or in India. I need advice.
"Early initiation of Lu-177 PSMA radioligand therapy prolongs overall survival in metastatic prostate cancer"
Suggestions 
Test of a new Lu-177-PSMA-based radiopharmaceutical at UCSF
