My father has had 5 cycles of LU PSMA therapy and his PSA has been continuously rising for the past 3 cycles. He is also on abiraterone 1000mg daily with prednisone 10mg. The psma scan suggests progressive disease with lesions in many bones. Doctors suggest to switch to enzalutamide 160mg and continue with Lutetium therapy every 2 months and see if it works.
I wonder if it will be of any help as the psa has been rising for the previous 6months while being on lu therapy.
Would it be a better idea to reserve LUTETIUM for rechallenge and start on other treatment for now?
Should we continue with lu therapy after adding enzalutamide or look into other treatment options like chemo(my father is chemo naive)
Will taking enzalutamide consecutively after abiraterone help? I ask this because many members of this forum have talked about cross resistance between abiraterone and enzalutamide.
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Vsahay
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I would have a biopsy to look at the mutations and IHC in order to help determine the best path for treatment.
It's sounds like chemotherapy would be a good choice moving ahead, then trying enzalutamide (Xtandi) later on. Nal mentioned the AR-V7 mutation which is a real possibility. But chemotherapy would still work with that mutation.
Probably, he will get very little out of enzalutamide. He may derive more benefit from cabazitaxel+carboplatin. After that, he may get more out of enzalutamide.
Get him vaccinated for COVID-19 now if he has not already done so. Then there is no need to be fearful of treatment in a proper infusion center with the usual precautions.
Yes indeed.Infact my father took the first 2 cycles at a gap of over 6 months due to covid crisis. still the psa was under control for from March to December.
After the first cycle , he got severe pain in his back and thighs for about a week that was controlled by pain killers. This does not happen for everyone. Most of the people do not get pain after the infusion. Also 15 days after the 1st cycle his psa rose and began to decline later. The pain did not occur in subsequent cycles.Apart from the pain, there were no other side effects.
In my opinion, LU 177 is a very good treatment option with few or no side effects.
It may be that is PCa is not very expressive of PSMA "PSMA avid" so the LU PSMA is unlikely to work. One way to check that is with an FDG PET scan to see if there is a mismatch between the two scans. If the FDG lights up in places the PSMA doesn't, it's unlikely the LU will be effective. That's the standard treatment protocol in Australia.
Please check about these in the blood test glucose iron and ferritin .fbs has very important role in the treatments. Ask your doctor about vitamin c therapy . High dose vitamin c may have lots of benefits. But before it you shoukd check G6pd in the blood test.God bless all of us
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I am in need of treatment advice for my Prostate cancer
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