Pluvicto with low PSA?

[Lynsi13]

Hey everyone.. I'm sorry if I didn't get a chance to reply to everyone this took the time to respond to my previous post. It was poor timing on my part with a Christmas with my in-laws in the mix and well, just life!

Anyhow, dad and I go to his oncology appointment tomorrow to discuss his increasing PSA.

The last time we went his oncologist mentioned Pluvicto as his preferred next step.

I've been researching Pluvicto and it seems that most men begin treatment with much higher PSA numbers than my dad (and I'm assuming much higher tumor burden).

Dad's last PSA was .77 and his last scan (within the year) showed no evidence of disease. Granted it was a regular scan and not ultra sensitive, but his cancer has only ever spread to a nearby lymph node (thank God) and so far has stayed put.

My question is, would utilizing Pluvicto at this point be wise? Should he wait until he is more advanced?

Dad has had chemo within the past year for another, unrelated, cancer (lymphoma in the brain). While I understand chemo is an option, I don't believe he has the physical or emotional stamina for another round at this point. The chemo for his lymphoma was brutal.

Thanks for any input you might have and apologies in advance if I don't reply right away. I'm so busy, my friends!!

Lynsi

[Tall_Allen]

Pluvicto now would be a really bad move. It is a highly toxic substance, and with no PSMA-avid metastases to latch onto, it would accumulate in the kidneys, salivary glands, etc., where it can cause a lot of destruction.

[Lynsi13 in reply to Tall_Allen]

That's interesting. I had no idea.

What do you suppose a good next step would be? Is watching and waiting a possiblity? Honestly, it's what he desires..

As a recap, dad started with taxotere chemo, Lupron and Casodex in 2015. Moved to provenge and xtandi 2020. Had quadruple bypass, covid, brain surgery, chemo to brain (methotrexate and rituximab immunotherapy) and has since had a stent in place. He's 81.

I'll attach his latest PSA results.

PSA results

[Tall_Allen in reply to Lynsi13]

He seems to have excellent control of his cancer as of right now. I agree with him, that it's a good time for a well-deserved break from new therapies.

[Lynsi13 in reply to Tall_Allen]

I'm so thankful to have asked. I was hoping you would reply. I will talk to him and his doctor tomorrow about watching and waiting further. Thank you.. truly.

Do you have any suggestions for a good point to pull the trigger?

[Tall_Allen in reply to Lynsi13]

When PSA gets high, doubles rapidly, or metastases grow and spread.

[Lynsi13 in reply to Tall_Allen]

Thank you for the reply. I was hoping to get it before his appointment this morning!

A few more questions, if you don't mind.

You said, "when his PSA gets high." Do you have a more objective number in mind?

At what point should an increase/change merit another scan? His last scan was a PET and it was in December 2021. It was clear.

And when the time comes for another scan, which scan should he receive?

Thanks so much for your help. I have so much more peace about today's appointment.

Lynsi

[Tall_Allen in reply to Lynsi13]

These are all good questions and are a matter of judgment. Discuss with his oncologist.

[Lynsi13 in reply to Tall_Allen]

Thank you! I talked with his doctor today. Like you, he thought it was much too early to consider Pluvicto. He said since dad's PSA remains low, isn't moving rapidly, and he has no side effects or pain, he thinks we should stay the course and focus on dad regaining the strength and conditioning he lost this past year. Once things accelerate he will refer dad to the main campus at the Cleveland clinic and will order a psma scan.

Thanks for your advice. It's good knowing you're in our corner!

[Cateydid in reply to Lynsi13]

Lynsi13, I just came upon this post. How is your dad doing?

I just posted that my Joe had a successful experience with Pluvicto: 6 doses = < PSA and shrunken tumors!! We went through OSU, as we live in Findlay, Ohio.

I hope all is well in your world for the moment, and that - should your dad go the Pluvicto route - his treatment is as successful as my Joe’s has been.

[frankciambra in reply to Cateydid]

my husband just had his first pluvicto 9/11

how did your husband do with pluvicto?

we also see GU oncologist at OSU

[Cateydid in reply to frankciambra]

My Joe breezed through 6 doses of Pluvicto!!!! Really was easy, especially after how bad the previous chemo was!!!

His PSA had been only creeping up since he finished the course in February. It was at .29 last month: but is up to .46 this week. Onc says carry on……

[dadsdrdawn]

I am only answering as a daughter and one that has been in the health and wellness industry for 25 years. With an extremely low PSA, and the only "spot" of concern being the lymph node - besides all else that your father has dealt with - ALL I AM READING THAT IS IMPORTANT IS THE "NO EVIDENCE OF DISEASE".

Then why weaken the body and do chemo?

My father is 87 and has an extreme will to live and just did his first round of Lutetium Lu. He'll come back from Florida in 8 weeks for round 2 and to see if the spots on his lymph nodes, spine and back of his neck are any smaller - praying yes!

I would explore all things other than chemo, and get as much knowledge as possible for him to get stronger in mind and body WHILE you are taking in as much information as you can to make an informed decision of his next steps.

My father has a urologist, an oncologist, and a naturopathic MD that is amazing. Unfortunately although my dad doesn't EVER talk about his cancer, or that he has it... his biggest battle is having an appetite, and not feeling nauseous from certain foods. This has been going on for a year though.

He can't even think about the "anti-cancer" diet protocols of veggies and juicing and all of the things he tried doing before - most foods for the last year make him gag...and he just eats what he feels like, when he feels like it whether its pasta, a steak, or ice cream!

He's living a very full life despite his diagnosis and I just dropped them off at the airport yesterday for 3 months in Florida at a new condo they just bought and redocorated!!

I am blessed. And, I know that each day is a gift.

I pray your dad stays strong, and wish you big happy hugs of healing for you both and especially you for taking care of him!

[awb1]

Hi, I had taxotere 3 times, 7 years apart, each time I had low level disease and I was is good condition. Fatigue was the major problem but I worked through it. I've had most of the other treatments. Good luck with finding the best course of treatment for your dad.

[nobaday]

it would be interesting to know if the lymph node is PSMA avid and the SUV. Lu177 is very selective so does not poison the entire body, and selectively lands on prostate cells and zap them. Lu177 typically has minimal side efrects ) unlike chemo) some fatigue and some temporary dry mouth due to uptake on salivary glands. I have always had low PSA (was around 0.1 beginning August pre Lu177 and now is 0.02.). I am doing Lu177 to hit C3 and T8 to T12 Mets. Could be worth another discussion with MO to at least do a PSMA scan. It lit up my C3 and T8 to T-12. The lymph node could act to make new Mets.

And if you did say 2 to 3 rounds of Lu177 assuming PSMA avid, this does not preclude doing Lu177 again further down the road.

Or you could wait….

[Fightinghard]

sounds like he needs a break from more treatments right now. Pluvecto would be good next step BUT it can have side effects too. So I would suggest continuing to monitor the psa and let him enjoy some time with no new treatments. If/when psa shows steady rise and gets near 1.0, then do a new psma scan and if the cancer is psma avid, try the Pluvecto.