Lutetium617 failure- advice?

[MarkEmrys]

Hi

Psa risen from 5.4 to 7 after second infusion of lutetium617. Any advice appreciated…

Background

Oct 209 dx pc with pelvic bone mets

Initial therapy ADT plus 6 cycles docataxel

Follow up with external beam radiation.

2021 psa rise did SBRT to two bone mets (vs 5 at start)

2022 started lutetium617 after psa reached 3.4.

Still on goseralin for adt

Any thoughts?

[Tall_Allen]

How long did you wait before the PSA test?

[MarkEmrys in reply to Tall_Allen]

4 weeks after second infusion as a kind of mid point between cycles

[Tall_Allen in reply to MarkEmrys]

Did you do an FDG PET scan?

[MarkEmrys in reply to Tall_Allen]

Yes. There was concordance.

[Seasid in reply to MarkEmrys]

That is good that there was concordance.

Did the FDG PET scan detected the whole (100% the same) area what the PSMA PET scan detected?

Or was the detected cancer area what was detected by the FDA PET scan smaller than the cancerous are what was detected by the PSMA PET scan?

If you said that there was concordance that would mean that bought PET scans detected exactly (100%) the same area.

[MarkEmrys in reply to Seasid]

Yes my understanding is that there were no areas of caner without PSMA expression.

[Seasid in reply to MarkEmrys]

Was the cancer detected by the FDA PET scan smaller than the cancerous area detected by the PSMA PET scan?

[MarkEmrys in reply to Seasid]

My. understanding is that it was. FDG and PET-PSMA scans in two weeks will show current situation.

[Seasid in reply to MarkEmrys]

If the FDG PET scan detected area is smaller than the PSMA PET scan detected cancer area than the FDG PET scan is not fit for the purpose to detect the whole PSMA negative cancer. Therefore you don't really know if there was a concordance or not. (I am not knowlygable enough but that is what I think). Maybe you should get a chemo if your PSA continue rising. That is why you should have a PET scans in two weeks. Get a liquid biopsy also. Hope your PSA only jumped why your cancer is dying?

[MarkEmrys in reply to Seasid]

Thanks seasid. Will keep posting on this

[Seasid]

Are you taking Enzalutamide?

[MarkEmrys in reply to Seasid]

N0. But Looks like that is a strong option. Radiation oncologist want scans (PET PSMA and FDG) in two weeks. Talking to my MO next Wednesday...

[Seasid in reply to MarkEmrys]

Ask them for a liquid biopsy while your PSA is above 5. Don't miss that chance.

[d3is4me]

Mark Thank you for your important update. Did you have a FDG before your first infusion.Sorry LU does not seem to be working I will be sceptical about having Lu for future treatment

[MarkEmrys]

Yes there was an FDG. Apparently sufficient concordance to go ahead, but not aware of exact details of this.