Update on Lu psma treatment-psa incre... - Advanced Prostate...

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Update on Lu psma treatment-psa increasing

Vsahay profile image
15 Replies

Hii everyone

My father has had two treatments of lu psma and his psa came down greatly.The third cycle was scheduled for 1st week of November but got delayed due to certain reasons.The psa was 6.2 on 17th oct and ALP 120.Today he got tested again and now yhe psa has risen to 12.5 and ALP to 289.I am very surprised to see this huge increase within such a short period of time.Has anyone else experienced such a situation?

Is it wise to go for the next cycle of lutetium now and whaat are the chances that it will work?

Any suggestions would be of great help.

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Vsahay
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GP24 profile image
GP24

"Is it wise to go for the next cycle of lutetium now and whaat are the chances that it will work?"

You did not provide your dad's patient history in your profile so it is difficult to answer that.

My experience is that the nuclear doctors do not recommend additional drugs so they can see how well their treatment works. My recommendation is to combine a systemic therapy with the Lu177 treatment to avoid a rising PSA value. Not knowing what your dad has tried already I cannot recommend anything. How did the Abiraterone with Dexamethasone work for him?

Vsahay profile image
Vsahay in reply to GP24

He is still continuing on abiraterone+prednisone 10 mg even though it had failed before he started getting lu psma .The doctor suggested that dexamethasone would probably not be useful in his case.

Most probably the increase in psa is dur to delay in treatment with lu psma but seeing the steep rise in psa i am concerned if the next cycle would work or not😰😰

GP24 profile image
GP24 in reply to Vsahay

Here are two studies which show a benefit when switching from Prednisone to Dexamethasone in combination with Abiraterone:

pubmed.ncbi.nlm.nih.gov/253...

ncbi.nlm.nih.gov/pmc/articl...

The first Lu177 cycle will be the most effective, the second is a bit less effective and the third less effective again. I would get the third cycle now and then try a Chemo with Docetaxel, then a Chemo with Cabazitaxel and then a rechallenge with Xtandi.

Chask profile image
Chask in reply to GP24

The switch to Dexa does not always work, and in my case it failed completely. I was experiencing a 6 month doubling time (from 2.1 to 4.0) while on Abiraterone + Prednisone. Switched to Dexa and next PSA reading 2 months later was 10. My experience of course should not prevent others from trying the switch.

GP24 profile image
GP24 in reply to Chask

The studies I cited report that it did not work for a percentage of the patients included. When you switch, you always hope that you will see a PSA decline.

Tall_Allen profile image
Tall_Allen

Always a good idea to get an FDG PET too. You don't want to be selecting for a non-PSMA-expressing prostate cancer.

Vsahay profile image
Vsahay in reply to Tall_Allen

I shall speak to his doctor in this regard

Tall_Allen profile image
Tall_Allen in reply to Vsahay

Maybe send him this link:

prostatecancer.news/2019/12...

GP24 profile image
GP24 in reply to Tall_Allen

Here is a new study looking into this:

link.springer.com/article/1...

They conclude:

FDG+/PSMA− lesions are a negative predictor of overall survival in patients with mCRPC undergoing RLT. However, it remains to be determined if patients with FDG+/PSMA− lesions should be excluded from PSMA RLT.

Tall_Allen profile image
Tall_Allen in reply to GP24

They found that "A significantly lower Overall Survival (OS) was found in patients with at least one FDG+/PSMA− lesion at baseline PET/CTs " Why would any patient in his right mind risk hastening his death?

GP24 profile image
GP24 in reply to Tall_Allen

I never heard that anybody died from a PSMA treatment. It just does not work that well, if you have a lot of PSMA negative lesions and only a few PSMA positive lesions. I still would get a PSMA treatment in this case to get rid of the PSMA positive lesions at least, hoping that this helps.

Tall_Allen profile image
Tall_Allen in reply to GP24

That was what we learned from Michael Hofman's analysis. Unfortunately, there is a phenomenon well known in radiobiology called "repopulation." When only partial radiological destruction of tumors occurs, it frees up space and resources for the more actively growing (glucose-feeding) tumors to expand. It results in quicker death.

prostatecancer.news/2019/12...

My friend, who had heterogeneous and discordant PSMA presentation, was warned against having Lu-177-PSMA therapy by an international team of doctors, including Michael Hofman, Matthias Eiber and Jeremie Calais.

GP24 profile image
GP24 in reply to Tall_Allen

Your friend had liver mets. A PSMA therapy will not work effectively against liver mets.

Tall_Allen profile image
Tall_Allen in reply to GP24

They didn't say no because of the liver metastases, they said it because of the danger of repopulation.

"A PSMA therapy will not work effectively against liver mets." Says who?

MateoBeach profile image
MateoBeach

Of a FDG PET scan is negative. Then more PSMA treatment may be beneficial. Ask about combined Lu Plus Ac225 (Actinium) PSMA treatment to enhance effectiveness. And if he goes to Australia for treatment, ask about combining Veyonda with Lu per trial protocols. (LuPIN trial).

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