Looks like lutetium is next for me (if I can get it)

[mysticmini]

Finished 6 cycles of chemo with Carboplatin added. Scans show mixed results. mipsma 2. Dr. Kwon is suggesting lutetium to push the cancer off the edge of the cliff. He’s suggesting to have it sooner rather than later. I have low tumor load. And Mets to Lymph nodes in pelvic region and subclavical. My oncologist as MSK also suggested lutetium as a next step, but after cancer starts progressing again. I’ve always had a low psa (higher it ever got was 1.44. It’s .22 now) I’ve also already failed Zytiga. Any thoughts on lutetium as next steps and sooner rather than later? Also had Guardant 360 genetic testing done. Awaiting results. I’ve had no radiation treatments done, and still have my prostate. Currently just on Lupron.

[GP24]

Dr. Kwon recommends to attack the tumor before it is progressing again. He says this is more effective. As Pluvicto has low side effects I would start with it now. You could check after three or four cycles if it works for you and whether it makes sense to continue or get a rechallenge with lutetium some time later.

[Tall_Allen]

How many metastases have you had, other than in pelvic lymph nodes?

Treatment with Pluvicto when there is low tumor load can cause excess toxicity.

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ncbi.nlm.nih.gov/pmc/articl...

[TeleGuy]

I took the same approach in 2019, push it off the cliff. My PSA went up to 3.1 when abiraterone failed. I switched from prednisone to dexamethasone and it took my PSA down to 0.63 in about a month, and that's when I started treatments in Germany. I had 16 months of undetectable PSA following treatment.

[TheWizardofWesley]

For what it's worth... My money is with Dr. Kwon

[marauders]

Mystic: I am not sure I have much to add to the wise replies already on the list. The Board ops asked me to possibly chime in because I had 18 months of Zytiga. My original situation was fairly similar to yours with stage 4b large pelvic nodes and a questionable small pubic bone met. This was in 2017 so no PSMA scans at the time but testing was aggressive and I have a very well regarded Prostate Oncologist advising me as you do with Dr Kwan. My Psa was 370. No biopsy was suggested by 3 consultants to minimize infection risk so I do not have a Gleason score. I was placed on Firmagon right away along with Casodex which was switched to Zytiga after about 2 months. Taxotere was started after about 6 weeks while I had a port placed and some cardiac stents placed. I tolerated this extremely well and actually would return to work 15 minutes after chemo. I had the usual hot flashes and significant strength and physical weakeniing and zero libido some permanent paresthsias in the balls of my feet which May have been prevented in retrospect by removing my warm shoes and socks during chemo. Interestingly, I have no problems with my hands which were exposed and always cold.. my psa dropped from 370 to less than 1 in 2 months and then stayed at .02 after starting Zytiga and Taxotere. Pelvic Salvage IMRT with a boost to the prostate bed plus SBRT to the questionable node was performed after chemo finished. This Also was basically side effect free except for some minor bowel issues and 2 episode of hematuria which was due to radiation vascular changes. This has stopped after I stopped Plavix as suggested by my cardiologist. Interestingly, my serum testosterone essentially did not return after ceasing ADT after 18 months so i agreed to use Testosterone gel replacement after a total of 36 months of girlish testosterone levels. This was opposed by some of the MD’s although suggested but not pushed by my Prostate Oncologist. Interestingly, two other oncologists who have seen me are now suggesting this to appropriate patients. For the last 3 years I have had a 0.2 psa with a functioning but probably quite atrophied prostate. As explained to me in the very beginning by the prostate on ologist, studies show thatpatients with advanced prostate cancer do better by hitting the tumor with all 3 modalities rather than waiting for recurrence. This certainly worked in my case although we all have diffeent situations an d cancer sub types. So far I am very fortunate as I hope you will eventually duplicate. Remember there are recent studies confirming the approach taken for me and suggested to you and there are more up to date drugs available. I would suggest taking the advice of Dr Kwan because his experience is immense. If for some reason you want more input, then I would find an equally experienced Prostate Oncologist for a consultation. I hope my experience is helpful to you.

[mysticmini in reply to marauders]

Thank you so much for sharing your experience.