Hello, My answer (for what it is worth) is "A". Many of the German doctors (who have a whole lot more experience with Lutetium than here in North America) are convinced that Xtandi (enzalutamide) increases the expression of PSMA. There have been several clinical trials looking into this although I am not totally sure of the results. Try ENZA-P (NCT04419402) to start. I would definitely mention this option to your medical oncologist and see what he/she has to say.
There is at least one paper that I know of that claims it does. There are some prerequisites though: Two weeks to one month before the pet scan and no concurrent or recent ADT. I don't know if chemo affects things in any way.
I would started a month before the PSMA PET/CT. The PSMA expression of the mets in the PSMA PET/CT has a prognostic value for the efficacy of the Lu 177 PSMA treatment. If the mets have a SUV value below 9 the Lu 177 PSMA treatment is less effective.
His last PSMA, prior to chemo, showed SUV values of 37-65, so it should be interesting to see what this scan in July shows. Thank you for that number; this is helpful.
I've heard about patients taking Xtandi (Enzalutamide) with chemotherapy, there was a recent trial (PRESIDE) that demostrated a benefit for patients who were on Xtandi to continue it during Docetaxel chemotherapy.
It depends. . . I think they have generally found that enzalutamide may increase PSMA expression for Lu-PSMA-614 treatments primarily in mCRPC patients that have been on ADT for substantial time.Your husband is still mHSPC and on ADT but not for that long. So there is some uncertainty there. For example, my Lu177 physician here in Australia where I am now to receive Lu-PSMA-J591 treatments told me he wants me to stay in my high dose testosterone cycle throughout the treatments to have the cancer cells as metabolically active as possible. I too am mHSPC.
So best to have the baseline PSMA PET scan done without adding anything nd then consult with the physician who would be doing the treatments. He may want to do one cycle without enzalutamide and then do a repeat scan to assess the situation. It is not one size fits all.
Sadly, he is no longer mHSPC. He has been considered mCRPC since late fall. You are right; we could add the enzalutamide after the first treatment if we think it might help. My hope is to kill as many of those cancer cells as possible!
Yes you read it right, using enzalutamide with Pluvicto enhances PSMA expression in castration resistant prostate cancer. However, Enza is associated with significant side-effects and some patients are not able to tolerate it. It is advisable to consult your primary treating physician, prior to starting the treatment.
I am happy to report that he started enzalutamide in July, prior to treatment and has tolerated it with no side effects. He has had two Pluvicto treatments this far, and has scans scheduled in 2 weeks, so we will see his progress. Thanks for the input!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Screening for Pluvicto
Radium 223 instead of enzalutamide 
Enzalutamide and headaches
Relugolix/Orgovyx or Enzalutamide/Xtandi? 
Enzalutamide (Xtandi) or not
