is Xtandi the only drug that increases PSMA expression?

[joeguy]

we hear quite a bit about taking Xtandi before Lu177 treatment because it increases PMSA expression. Do we know if any of the other 2nd or 3rd line ADT drugs have the same affect? I’m wonder specifically about Nubeqa ( Darolutamide)

[tango65]

Short term (around 1 month) regular ADT (lupron or similar) increases PSMA expression in castration sensitive cancer. Long term ADT in castration sensitive cancer reduces the PSMA expression.

pubmed.ncbi.nlm.nih.gov/299...

pubmed.ncbi.nlm.nih.gov/309...

pubmed.ncbi.nlm.nih.gov/311...

pubmed.ncbi.nlm.nih.gov/352...

Other study did not find increase in PSMA expression in hormone sensitive cancer after ADT but they found an increase in PSMA expression in castration resistant cancer after enzalutamide or abiraterone.

jnm.snmjournals.org/content...

[joeguy in reply to tango65]

I have been on some form of ADT for about 4 yrs total. I am castrate resistant, so not sure if I should expect increased or decreased PSMA expression

[tango65 in reply to joeguy]

My impression after reading several articles is that after years of ADT the PSMA expression is reduced.

When I consulted for Lu 177 PSMA treatment in Austria they told me that the low PSMA expression of the mets of my cancer was caused by the 2 years of darolutamide.

There is a tumor flare when ADT is started in castration sensitive and in castration resistant cancer but I believe it disappears if ADT continues for months or years.

pubmed.ncbi.nlm.nih.gov/311...

[joeguy]

Oh crap..... thats what Im concerned about after a few years of various ADT. Were you able to go ahead with Lu177 treatment with low PSMA expression?

[lokibear0803]

So this is confusing.

If for now only castrate-resistant men qualify for Pluvicto (as per VISION, right?), but too much time being CR (assuming one continues the ADT/etc) lowers your PSMA expression, this seems to suggest only those patients who’ve been CR (and continuing the ADT/etc) for a *short* time will be PSMA-avid enough to qualify.

Am I misunderstanding?

[joeguy in reply to lokibear0803]

Thats what Im starting to wonder........ Im working on getting into a Lu177 trial in Texas, and I just hope all the ADT drugs I have taken dont screw it up for me.

[Ollie1948 in reply to joeguy]

...is it at MDA?? ...I am trying the same

[joeguy in reply to Ollie1948]

It’s in Dallas at UT Southwestern.... they do have great trials at MDA, but for me it’s 4 hr drive to Dallas, 9 hrs to Houston

[Ollie1948 in reply to joeguy]

I am in Austin, 3h+ to MDA... I am waiting to get a call from them...

[joeguy in reply to Ollie1948]

I hear that some trials will pay for your travel and lodging..... hoping thats the case anyway.

[lokibear0803]

Well, if you’re deemed eligible for the the trial, then I’d guess in the eyes of those experts, you can have reasonable expectations for a benefit. I wish you every ounce of luck in the world, Joe. Please keep us updated with how things play out.

[joeguy in reply to lokibear0803]

Thanks loki........ I am tentatively accepted into the trial, but wont know if Im good to go until they do the scans to see if Im a good candidate. I was expressing PSMA at a high level about 1 1/2 yr ago when I had a PSMA scan done at the university of Iowa, but I have had 1 1/2 yr of Nubeqa since then...... fingers crossed

[KocoPr]

Can’t open seconds link on darolutamide

[KocoPr]

What is the trial number?Im 1 month into darolutamide so just want to follow it and study future options