Lutitium and last resort

[Goldberg]

I can’t remember if I posted this. I am scheduled for lutetium on November 15. I have had (carbotaxel + docetaxel). Gone through Zytega, Xtandi and two years of Lymparza. I have had an FDG scan plus pet scan. They indicated that I have Mets in bones and lymph glands no surprise l Have a high mutational tumor burden sometumors have good PSMA Expression and then many do not . I think the lutetium is like a Hail Mary to be followed up with Keytruda if it does not work. Any and all discussion about my situation will be appreciated.

[Tall_Allen]

Please go over this with your doctor. The concern is that Pluvicto may actually allow the non-PSMA-avid cancer cells to take over and grow faster:

prostatecancer.news/2019/12...

You may be better off with one of the BiTE clinical trials described in that article.

[tango65]

The way to predict response to Lu 177 PSMA treatment has been studied.

If the SUV mean of the PSMA positive lesions is less than 10 and/or the discordant negative PSMA lesions found in the FDG PET/CT have a volume of 200 ml or more, the response to Lu 177 PSMA treatment is poor.

thelancet.com/journals/lano...

The other problem is the diffuse infiltration of the bone marrow by the cancer which could lead to bone marrow depression during Lu 177 PSMA treatment even when there is a low global response. Try to find out if the PSMA PET/CT showed bone marrow infiltration.

You could consider getting a second opinion about doing the Lu 177 PSMA treatment.

[lewicki]

Is AC-225 available to you?