How much internal radiation can a guy take?

[baltha]

I have bone mets in both femures and Ischium. I have read about Radium 223 as well as Lu-177 and AC-225 and variations.

Can I start taking these radio pharma drugs with abandon without worrying about accumulated radiation? Should I plunge into the genre asap or wait for the best and safest to be revealed ( if I last that long)?

I am thinking it might be better to do external beam radiation of worst pain spots until the these new radio pharmaceuticals are fully vetted and approved. How much internal radiation can a guy take?

The only detestable downside to EBRT is the weakening of the bones as my mets are not near organs.

History: Stage 4 metastatic prostate cancer for 2 years; currently, mCRPC; have had Docetaxel+Lupron and am now on Lupron+Abiraterone ( with rising PSA of abput 9.1)

Deep appreciation for the brains out there!

[Tall_Allen]

"Can I start taking these radio pharma drugs with abandon without worrying about accumulated radiation? " Are you seriously worried that too much lifetime dose of radiation will kill you in 20 years?

"I am thinking it might be better to do external beam radiation of worst pain spots until the these new radio pharmaceuticals are fully vetted and approved. How much internal radiation can a guy take?" You can certainly get palliative radiation to painful metastases. That has nothing to do with using systemic radiotherapy. Lu-177-PSMA only targets tissue that expresses PSMA. Xofigo only targets bone overgrowth due to metastases. You can take them until they no longer help you.

Your bones are already weakened by your cancer. The radiation will stop further decomposition.

[baltha in reply to Tall_Allen]

I am drowning in poorly grasped views and data and so much appreciate your views.

I am about to undergo External Beam for my femur. The only downside I see , as my my Radiation Oncologist told me on my first visit, is that my femur will be weaker after external beam radiation than before (though of course further decomposition due to malignancy will be arrested for a longish time one hopes).

I have not done Radio Pharmaceuticals yet but may have to go there soon. My concern about cumulative radiation derives from reading that it is not advisable to take Lu-177 after Radium 223. I assumed, probably incorrectly, that the caveat had to do radiation overload. I must review that source to try to understand what the heck it is all about.

[Tall_Allen in reply to baltha]

The trials of Lu-177-PSMA excluded men who'd taken Xofigo because they wanted a pure reading. Unfortunately, when they build a requirement like that into a clinical trial, it becomes part of the drug's indication after approval. That's also why Xofigo isn't allowed in men with visceral as well as bone metastases. It isn't that Xofigo won't work or would be toxic, but Bayer wanted to give it the best chance of succeeding by only allowing bone metastases. Now, you can't get it if there are visceral metastases, which is a shame.

Interestingly, there is a new radiophamaceutical now in clinical trials that may combine the benefits of both Ac-225-PSMA and Xofigo. Th-227-PSMA attaches to PSMA-avid sites, but it decays into Ra-223 and lets go of the PSMA ligand, which then replaces calcium in bone metastases.

prostatecancer.news/2018/10...

[Leader4077]

As far as cancer pain management in the bones, joints, or muscles, I swear by cold water therapy........works VERY quickly to relieve pain EVERYWHERE. Got a scan last month with lots of Mets. I live on a lake that is about 47-48 degrees. That works but bacteria is there so I switched to a bathtub this month that comes out of the tap at about 52 degrees.....8-12 minutes tops.Local football star Russell Wilson has pushed this ice bath for years and he never misses a play. It might slightly shrink some tumors but no hard research on that yet. Pain relief for me has been 8 hours. Deep breathing enhances it while you are soaking....I don’t even need ice at 52-53 degrees. Do this along with Firmagon shots and just started Taxotere

Mike in Seattle