looking for treatment advice

[Bspouse]

Hello All,

I am reading so much about LU-177 and immunotherapy. But I am wondering when we would start looking into these treatments. Husband is on Abiraterone, Prednisone and monthly Lupron shots. He completed 6 docetaxel treatments in April. PSA has slowly gone from almost 7000 to 4 since last diagnosis last September. So far it is still slowly dropping each month but no where near undetectable.

He has done well on all treatments thus far and feels good except for the fatigue. Oncologist hasn't suggested any additional treatments - We are awaiting genetic testing results to see if he has any specific mutations.

Question is : Do we wait until PSA starts to go up and he is castrate resistant, OR wait until PSA stops dropping and hope it stays low for a while, or should we be proactive and try to kill more cancer cells while they are down and he is feeling healthy?

Seems so many of you are actively pursuing additional treatments - is is fool hearty to sit back and wait at this point?

[Tall_Allen]

"Do we wait until PSA starts to go up and he is castrate resistant" Yes. He is doing just fine now. A PSA of 4, considering where he started, is pretty good.

Pluvicto and Provenge (the only approved immunotherapy) are only FDA-approved for castration-resistant men. When PSA goes up, he will qualify for both. Although it is usually true that sooner is better, it is not always true. Some medications are more effective when cancer cells are actively growing:

prostatecancer.news/2019/02...

[Fightinghard]

enjoy each day

follow your MO guidance on further treatments. Remember that this is a marathon not a sprint.

[Ramp7]

Early treatment with LuPSMA177 is an unexplored area that has drawn a lot attention.

[spencoid2 in reply to Ramp7]

There was a forum a while ago mentioned on this site. There was one doctor who advocated eraly LU177 treatment instead of using it as a last ditch effort. I think that makes sense. Of course there are side effects and possibly really bad ones considering your health status. And as Tall says some treatments might be more effective on actively growing cancer cells. It would be good to have an answer to this. I don't believe there are any trials for castrate sensitive patients yet but there are some for castrate resistant without prior chemo. That is what I am aiming for. If LU177 (and of course there could be differences with different lighands) is effective on cells whether they are actively growing or not, it seems to me to be a no brainer to start very early treatment for anyone with metastatic disease. Maybe they could do very low dose and or work on better ligands so when there are just a few stray cells they can be zapped with little damage elsewhere.

When I was diagnosed with and treated for gleason 9 PC, my oncologist said there was a fairly high chance that there were undetectable micro mets and that only time would tell. Well time did tell. I think the chance of mets was something like 38%. To me that is worthy of treatment.

[Ramp7 in reply to spencoid2]

And the case you describe fits me to a Tee. I have not had Chemo. Have failed Lupron with Zytiga.

[Ollie1948 in reply to Ramp7]

my case.... my doc just suggest Xofigo with Xtandi or .... Chemo!

[Ramp7 in reply to Ollie1948]

My MO was going to recommend those as well. I did my own research and contacted Dr. Beltran at Dana Farber.

[Grateful4this]

Considering his PSA was 7000 and now is at 4 seems like big win since you say it is still slowly dropping. I agree to follow your MO's advice but push for action if his PSA begins to rise. LU is still in its early usage stages and there is a lot to learn as to when is the time to begin this treatment. Best of luck to you

[MateoBeach]

Seeking Lu-PSMA treatment while still mHSPC May indeed prove to be wise. Although this has not been proven yet in clinical trials so it is not approved for insurance or Medicare coverage. I believe there are a couple of clinical trials for Lu treatment in earlier stages, so you may want to search for these and see if you can meet selection criteria. Otherwise, you can investigate treatment abroad which would require self pay. There are good and experienced treatment sites in Australia, Germany, India, and Finland. Many on this site have been and are traveling for Lu treatments abroad.

As for treating microscopic sites, I have had treatment in Perth with a monoclonal antibody Lu ligand called Lu-J591. Described in my previous posts this year. Paul

[slpdvmmd]

You can read my profile to see my experience. My conclusions about radioligand therapy based on my personal experience, discussions with Nat Lenzo in Australia, the Heidelberg Group where I went, and with Eugene Kwon who I just saw this week for a second time are as follows. 1. I would get a PSMA pet now to look for residual targets. 2. It is more effective for lymph node than bone. 3. Do not hesitate to go overseas. Right now going to Istanbul seems to be the best option. Actual costs could be less than what your copay would be here. Kwon has sent a lot of patients to Istanbul and spoke highly to me of the quality of care and treatment plans.

[Spyder54]

Listen to Tall Allen, he is one of the smartest and is current on latest Clinical Trials. Plus, you have done everything right, despite a terrible Dx.

Enjoy these moments and your husbands Progress. Your Team is giving you good advice. There is No Cure, just extension of life, and that we need to make the best of it.

Change and new therapies are coming. Stay tuned. Listen to your body speak.

All our best to you and yours, Mike & Barb

[Bspouse]

Thank you 😍

[Brysonal]

Hi there, I developed Advanced Prostate cancer in 2021 with my mets being all to the skeleton. I decided I wanted to try early Lu-177 following the experience of many on this site who travelled whilst hormone sensitive. I explored the early clinical trials but nothing was suitable in my timeframe so I travelled to Finland from the UK to have a unusual combination of 3x Lu-177 infusions and 3 x Docetaxel infusions in addition to starting hormone therapy injections. Both my Finland and UK oncos agreed radiotherapy to the prostate and wider pelvic area was indicated following ‘stampede trial’ style scans that showed I was a sub type that would benefit. Off SOc I had some SBRT to a T9 met that showed some potential activity following the post chemo scan. Very controversially the Finland onco. Recommended 2 x brachytherapy in addition which I also decided to do. Apa has now been added to my hormone therapy so really believe I left nothing on the table. My PSA has now been undetectable for 3 months but aware it’s not a cure and am watching the science for new options. In the UK I am going to discuss the phase 1 OVM 200 vaccine that is in first in human v small trial. I am very interested in Mateo Beaches trip to Perth as mentioned above. Provenge appears off the table for the hormone sensitive like he said and I am in the same boat. Other thing I did was a private genetic test but had no actionable defects found last year.

Good luck