My husband had his fifth isotope 9 weeks ago. Novartis has had a control problem and did not administer his sixth and final isotope. My question is without the treatment he jumped 0.51 to 1.50 psa. Does the psa only stay down as long as you are administering treatment??
LU-177: My husband had his fifth... - Advanced Prostate...
LU-177
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Cynthgob
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Pluvicto leaves alive many cancer cells that did not express much PSMA. After killing off the PSMA-avid cells, the remaining ones now have access to space in which to expand and access to nutrients and oxygen that the other cancer cells had deprived them of. To some extent, all PCa tumors are heterogeneous within them and between them with respect to PSMA expression.
In men in whom almost all of the cancer cells are PSMA-avid, growth can be delayed quite a long time, but, unfortunately, it is never forever, as far as we know.
Yes I have read that. One of his doctors wanted to combine xtandi and pluvicto but my husband balked at that. Thank you for the great information!
My onco suggested 3 x Docetaxel after my 3x Lu-177 ( my first chemo). It wasn’t what I wanted or expected to hear but decided to do it as I keep reading about how heterogeneous PCa is. It isn’t SOC but due to delay in Lu-177 supplies thought I’d mention it.
Good Luck
Xtandi increases the PSMA expression and thus should make pluvicto more effective. It was not a good decision to avoid xtandi.
His reason made sense at the time. He wasn’t on any medication when he started pluvicto and thought he wouldn’t know which was causing side effects if he started both drugs at once. Very little side effects from pluvicto as it turned out. Hindsight 20/20.
Do you know if that is exclusive to Xtandi or do other APIs perform the same or similar in enhancing PSMA expression?
This report just mentions Xtandi:
pubmed.ncbi.nlm.nih.gov/319...
Probably other antiandrogens like Apalutamide or Darulutamide will work as well. However, there have been no head-to-head comparisons yet.
I had 3 rounds of Lute-177 with no previous cancer treatments. I came home and 6 months later my PSA started doubling. I went back to Thailand and had one more treatment then a month later I had 20 rounds of IMRT. I came home and after a year I'm still holding at 0.01. After a year of quarterly Lupron shots, I'm gaining weight and losing my ambition, I'm now 12 pounds overweight (hard to take when you were a former marathon runner) but I'll take life every time.
My treatment was similar Bangkok. I had 2 Lute-177, PSA was 19 reduced to 1.6 then 3 months later back to 18.6. I think chemo would have been a better option & cheaper!
My husband had 1st treatment of Lu177 he was to have 2nd Lu from Norvartis but they suspended product as they had a quality issue don’t know what that means and makes you uneasy for when they resume production in 6 weeks . My husband’s clinic got the 2nd Lu from Finland, can’t your clinic do the same. My husband PSA has come down after one treatment from 10.9 to 7.8 which we think is good news. We are paying privately in the UK don’t want to travel when we still have a pandemic, best wishes to you both along this difficult journey
Hi from another UK wife. Would you mind sharing (pm if you prefer) where you had treatment and the cost? This may be for us down the line, though not had a PSMA scan. Did you have that privately also? Many thanks.
My father started Abiraterone and Prednisone in Feb, so far so good but I'm already looking to the future. Genesis Care in Uk offers LU177genesiscare.com/uk/treatmen...
I have completed four courses of therapy using the PSMA ligand according to the 177Lu+225Ac - PSMA-617 protocol (5GBq +4MBq activity) at the Center of Excellence in Nuclear Medicine in Baku, Azerbaijan. My GS: 8 (4+4), PSA before the start of treatment was 212.9, according to the results of PET-CT with PSMA, total damage to the bones of the skeleton with control areas according to SUVmax up to 198. 11 months after the fourth course of therapy, my PSA 0.062, the primary focus in the prostate and mts in the bones are not reliably determined. Since the first course of therapy, my PSA has been decreasing all the time (the graph of decline is below)! In this center, a mandatory recommendation is to undergo an additional PET-CT study with rfp 18F - FDG before starting treatment to assess the subsequent therapeutic effectiveness of the upcoming treatment with radioisotopes. My status was negative to this FDG molecule, in other words, my foci in the bones and prostate did not accumulate this rfp. Mandatory conditions in this center: 1. Cancellation for the entire duration of treatment at least two weeks before the start of therapy of all drugs against bone resorption; 2. Retention by all possible means of T on castration values. I keep my T until today with the drug Zoladex 3.6mg. once every 45 days (calculated experimentally for myself) at the level of 0.087 nmol / l (2.5 ng / dl). And one more thing that was revealed after the end of treatment: I had a mutation in the BRCA1 gene, but I did not take Olaparib. According to the statistics that I keep among more than 25 patients who have already been treated using the PSMA-617 ligand, all things being equal, the therapeutic effectiveness of this therapy is directly proportional to the presence of FDG(+) colonies of malignant cells in the foci! If there are more than 50% FDG(+) cells in the foci, the therapeutic effectiveness tends to zero and the doctor recommends not to carry out such treatment using PSMA! This is the very case that Tall Allen is talking about, when malignant cells that are not expiring on their surface PSMA receptors quickly take the place of PSMA(+) cells destroyed by radiation! Something like that, my opinion! As can be seen from the graph below, the breaks between courses (at the recommended 8-12 weeks) for various reasons were from 3 to 4 months, but my PSA continued to decline all this time:
Dynamics of PSA reduction in PSMA therapy
You can preserve your bone density with estradiol patches:
Very interesting. I was about to start Pluvicto on May 20 but the initiation of treatment was put off because of some reported quality control issue. Strange thing is that, during my PSMA PET scan, about 30 minutes after injection of the 68GA-PSMA-11 tracer, I started to feel like I was getting the flu, with aches and pain in the areas of my known cancer, spine, hips, ribcage, shoulder, etc. Most of the pains which popped up then (and a few more) have continued on for about 3 weeks. My PSA is quite high now, probably in the >600 range. It's like my cancer liked the tracer and is now exploding. I've been going downhill so fast skeletal wise, since the PSMA-PET scan, with the Pluvicto issue, I wonder how long I'll last.
I hope that turns around soon. Almost sounds like the treatment is worse than the disease. We are all Guinea Pigs. Except j-o-h-n. He's a Guinea Hog.
How is your husband doing physically?
Better than he was doing on other treatments.
Getting 6th isotope mid June so they must’ve opened the plant at novartis!
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