History: dx in '09. Failed surgery, then flunked SRT. Since then did VERY well with Lupron/Casodex (combined) so that after 9-12 months on I would get 1-2 year HT vacations. Twice I did scans followed by SBRT (also included 3-month HT shot) which did great...but of course the eventual PSA wake-up call.
Now my dilemma: I just did the PSMA scan again when my PSA increased to 2.0. It again found 2 hot nodes but this time close or in a previously radiated area. The RO did not advise doing radiation (that was my impression but I just sent a message to him with some further questions). He did offer to tx. it "aggressively" if I so desire.
I have a video appt. with my MO, Dr. Lam, in 2 weeks. I have read about LU177. As I understand it, they again use PSMA to target the cells? What all is involved? Is it 6 txs lifetime, but one or two might suffice? Is it given in the USA? I assume it is an infusion (like the PSMA scan but without the scan part)? What is the requirement to qualify for this tx? I have BCBS Medicare Advantage. They cover anything Medicare covers. Does it?
Finally, is this premature? Is HT (more modern HT drugs?) more appropriate now?
Sorry for so many questions.
Please advise
Mel
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I may have answered my main query. I looked at some more information. Am I correct that 2 prerequisites for lu177 are: castrate RESISTANT PC and prior tx. with chemo? Also, are they only doing clinical trials?
I opted for Lu-177 whilst hormone sensitive but had to travel as it’s not standard of care. I had an unusual 3x Lu177 and 3 x Docetaxel plus hormone therapy. Hormone sensitive treatment for me was Finland but I’ve read of others travelling to India, Bangkok, Austria and Germany where it all began.
I had Lu 177 PSMA treatment in Germany in 2016. The cancer was castration sensitive with multiple lymph nodes metastases.
The Lu 177 PSMA was highly effective. One treatment was enough to get rid of the mets according to 5 PSMA PET/CTs done afterwards.. No major side effects, some fatigue and a little edema because of the amount of fluids I was given.
It is possible that in Germany they will not treat oligometastatic patients. I know they will treat them in Vienna and in Perth (Australia).
I believe you can get if you are castrate resistant the Lutetium PSMA therapy in USA and Australia (in my local hospital in Sydney) with Enzalutamide in a clinical trial setting if you are less than 3 years after diagnosis and you have at least one lymph node effected and the lymph node size is above I believe 15 mm in diameter and then it is considered high volume desease.
For more information read the inclusion and exclusion criterias of the clinical trial.
I am just relying on my memory. You don't need previous chemotherapy.
i am hoping to get into the trial at UCSF that is for castrate resistant metastatic PC but does not require (in fact it prohibits) chemo. I want to avoid chemo.
if you cancer is low volume and SUV max under 10 than Lutetium 177 PSMA therapy can be toxic and ineffective. That is why the best cancer centers refusing to treat oligometastatic prostate cancer with Lutetium infusions. For oligometastatic prostate cancer you can use ADT and SBRT etc
Here is a reasearch paper wich explained why is Lutetium PSMA therapy toxic for low volume cancer.:
It may not be possible for you if you cannot travel and pay for treatment. Yet I was in same situation: hormone sensitive and oligometastaticic to lymph nodes only with fairly low SUV on PSMA scan. Had SBRT to the visible nodes. But knew non-visible micromets were very likely. That does not meet criteria for Pylarify Lu-PSMA treatment. So I consulted with GenesisCare AU (Dr. Nat Lenzo) who is treating such with a much more strongly binding monoclonal antibody ligand for Lu-PSMA treatments called Lu-J591. Had two easy injections in Perth, two weeks apart in May this year. (Nice vacation there.)
Early results are very good: PSA dropped by 2/3 to .057 and this week down further to .048. More details in my previous posts. Otherwise you could look through the current trials for earlier Lu-PSMA treatments. Paul
Have you also had Xtandi? might want to ride that pony for a while too. Also, I have had SBRT twice and would not hesitate to do it again in the same area if warrented. It is very targeted treatment. I realize we bump up against "Do No Harm" but there are risk/reward decisions in every path you choose.
Very interesting that Mateo Beach had injection just 2 weeks apart in Perth. Previously I have read reduced times from the 6 weeks of the VISION trial in Turkey and Russia, again 2 to 3 weeks apart.
This means that those travelling for Lu177 might not have to spend months/ travel back and forth to places like Australia, India etc I did just ask Tall Allen if he knows price at UMich or anywhere else in the US for those with no insurance or international travellers. He does not know but maybe someone else has found out. Let’s see how the US price compares with elsewhere in the world. Cheapest place I have found is New Delhi India which is $6000to $7000USD.
Of course, the clinical trial route is the other option with several good trial options available.
If considering Australia for LU-177 treatment you have to do the rounds of ADT first.
I was lucky to receive two infusions before they found out that I had not served my time on the ADT drugs. It reduced the PSA from 19 to 1.6, then came back to 19 two years later.
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65th bday last Sunday (Dx'd in 2015) Did 65 miles over two months with Bonnie and did a bday 5k. #10 Cabazitaxel right now, just got Lupron 
Lu 177 PSMA 
ADT Now or Wait for PSMA Scan
PSA Increasing on Lu177 + Enzalutamide.
