PSA, Blood Workup 2 months after 2nd cycle of Lu177 (with Enzalutamide)

[pka21]

Prev Treatment: Abiraterone, Docetaxel (9), cabazitaxel (9)

PSA keeps on increasing trend being on Lu177 and Enzalutamide. Around 2 months after the 2nd Lu177 cycle, PSA increased to 39.8 from 28.8.

28th Aug - Started Enzalutamide,

PSA : 24 on 9th Sept 21

Added Lu177 psma therapy with Enzalutamide

Lu cycle 1 -》23rd Sept

PSA : 28.8 on 23rd Nov 21.

Lu PSMA cycle 2 -》 1st Dec 21.

PSA : 32.1 on 15th Dec 21

PSA: 34.1 on 30th Dec 21

PSA: 39.8 on 25 Jan 22

Next Planned Lu PSMA cycle 3 on 2 Feb 22, need to confirm with Dr now after this report.

Platelet, WBC, HB (9.8) looks fine as usual compared with his past reports.However below tests are showing higher values than the range:

Creatinine : 1.32 (<1.2) , Potassium: 5.32 (<5.1) , ALP: 101 to 126 (<128), TSH : 5.77 (<4.2).

Please suggest whether we should go for 3rd lu177 or not ? and also what about enzalutamide?

[Tall_Allen]

Can you get APCEDEN?

[pka21 in reply to Tall_Allen]

Thanks for the response Tall_Allen!Our Dr. is not in favor of APCEDEN So I really not sure whether we can/should go for APCEDEN or not..

We will have a consultations with our Dr's this week and probably will go for a scan and soon Biopsy too once get feasible site and do further tests.

But Do you think we should continue 3rd lu177 cycle on 2nd Feb when our PSA is increasing?????

[Tall_Allen in reply to pka21]

Why incur toxicity if it's not working?

[pka21 in reply to Tall_Allen]

Our Nuclear medine Dr. thinks doubling rate is not so high so we should consider 1 more cycle of lu and see......

We did not had a word with our main MO who has more experience with Lu psma behaviors but unfortunately Teleconsultation appointment I got just a day before 3rd lu planned date.

So little confused with proper decision 😔

[Tall_Allen in reply to pka21]

You may want to get an FDG scan before deciding. If it shows metastases in different places from the PSMA scan, further Lu177PSMA treatment may not be a good idea.

[pka21 in reply to Tall_Allen]

Thank you ..I will discuss this with our Dr. to do FDG.

Can you please suggest what should be our next treatment plan except APCEDEN. Getting disappointed to see maximum standard treatment options failed😔.

[Tall_Allen in reply to pka21]

Biopsy metastasis.

[Jennifer1800]

Why are your LU 177 treatments spaced so far apart? My father is getting LU 177 treatments and they are every 6 weeks.

[pka21 in reply to Jennifer1800]

In India, many Big hospitals like TMH, AIIMS do the lu177 cycles after 2 months.

We had our 2nd cycle delayed by a week ( i.e around after 9 weeks).