I know many people have a positive experience with Pluvicto. My dad was fortunate enough to get a go, but after two infusions his PSA did a gigantic jump from 42 to 119, over only two weeks. His doctors are puzzled, and so are we. His condition has deteriorated rapidly over the last few weeks, and now it is clear that PC progression is the cause, not Pluvicto side effects. We do not know if it was the treatment itself that somehow sparked the cancer to explode, or if it was something else. Clearly there is still so much we don’t know about this disease. For my father and our family it is a shock to realize that from thinking we would have several months together, we are now looking at a very tight timeframe. It seems unreal that he was hiking in the Norwegian mountains six weeks ago, and now he has a fever, pain is setting in and his mobility is reduced dramatically. His bloodwork is holding up, but he is fragile, which probably precludes other agressive treatment options. This is a devastating time for us, and I guess all I really want to say is enjoy the good days. Pluvicto can be a life saver, but not for all, and we certainly need more treatment options.
Another Pluvicto failure: I know many... - Advanced Prostate...
Another Pluvicto failure
Is his mutations checked? If he has BRCA2 Olaparib is highly effective.
He did a biopsy of the prostate at diagnosis. At that point no mutations were found. Later he did a liquid biopsi, with the same result. However at that point his psa was very low, so I dont know if things may have changed since.
The question is if the PSA rise is 'only' a PSA rise or flare. If there is no radiological progression, it might be a good idea not to stop the treatment.
Hi !
Most of the cases with ’psa flare” happens after the first cycle of Lu-177, normally the first or second week after the injection. This flare is oftened followed rather shortly with a rapid decline, often under the PSA you had before the injection.
I had a flare from what my ONCO told me. Before my 1 cycle my PSA was 5.8. Approx 1 week after my Lu-177 I had a PSA of 9.8. Then 4 weeks, before my 2 cycle my PSA was 2.28.
I was stressed out to say the least.
In a minority of cases, non-PSMA-avid tumors co-exist with PSMA-avid tumors - this is called "discordant." Pluvicto eliminates the PSMA-avid tumors and gives the discordant tumors more room and nutrients to grow. So it is possible to have more rapid tumor growth after Pluvicto. I think everyone contemplating Pluvicto should have an FDG PET scan in addition to a PSMA PET scan for this reason.
I wondered about that when I saw this post. Wonder too sometimes how many have thought Pluvitco didnt work when actually discordant..
I do have a question along the same line.
Its been awhile since I read your in depth cover of the two scans for comparison and discordance. Anyway does it have to be a FDG PET?
Can a standard NM bone scan (27.3 mCi of Tc99m MDP) and CT be used as the comparison to the PSMA PET ?
It has to be FDG PET/CT - which is available everywhere. Bone scans only show areas of bone overgrowth, not cancer per se, and not in anything but bone.
Yep I see. I've been getting the CT with the bone scans but no FDG PET. No Pluvitco yet though although have had a couple PSMA scans.
Usually FDG doesn't show anything for prostate cancer until the cancer is very progressed. But Pluvicto was approved for men after chemo failure and after 2nd line hormonal failure, so it may show up then.
Right thank you. I recall that. I was progressed at dx 3 1/2 years ago and continue to be so. Chemo and 2nd line adt's.
Thanks much.
It couldn't hurt to get an FDG PET/CT.
How about an Axumin? How does it fit in vs PSMA? Complementary or no? Thanks!
All of the data on concordance/discordance used PSMA and FDG, not Axumin.
OK thanks
Yes, and i suspect that is what may have happened in my dads case. In our case we didn’t get an fdg-scan covered, only the psma pet-scan. Even though we specifically asked for an fdg-scan. It is not requested in the European approval of the drug, so not all hospitals require it. My dads bloodwork is surprisingly ok, except for an elevated crp and psa. Our MO considers him to fragile to try any further chemo therapies. In the norwegian guidelines there are really no SOC-alternatives at this point, so it would require som effort on our MO’s part. It seems the PC is now highly agressive, so maybe it would prove useless. To us, including my dad, anything that may slow his decline would of course be welcome, but not at any cost. He was responsive to docetaxel, so maybe some kind of docetaxel/ platinumbased mix could offer some relief on the short term. Any thoughts?
Thank you TA for this insight. I am scheduled for my third Pluvicto treatment August 16. My PSA is undetectable, and it won’t be an indication of successful treatment, Scans are the only way I will know. I am scheduled for a PSMA Pet scan prior to my 8/16 treatment. I wrote my doctor and included your post and here is the reply I received: ”The C-11 PET choline scans are more superior to the FDG PET for the non PSMA avid tumors for patients with prostate cancer. This is why we proceed with this scan either 6 weeks after the completion of all 6 cycles or sooner depending on your response based on the repeat PSMA scans in between cycles.” Thoughts?
It sounds like a Mayo doctor - they are the only ones I know of that still push outmoded C-11 Choline scans. He is wrong. Prostate cancer usually progresses from metabolizing fats (which is why Choline PETs are useful at first) to digesting glucose (which is why FluoDeoxyGlucose (FDG) PET scans become increasingly useful for patients treated per protocol with Pluvicto).
All of the data on concordance/discordance used both PSMA PET scans and FDG PET scans. If he has seen data that used Choline instead of FDG for that purpose, I would very much like to see it.
Here's the data that I've seen:
I have more confidence in the C11 than the reply below. They're both (C11 and FDG) tools in the toolbox which can be used properly or not, they show different progressions; and there's more to a PET than the scan itself--the skill and experience of the radiologist means a lot. Poster below has been very confident in devaluing C11 for years, now. I'm unsure of his credentials. Fwiw, My PSMA scans and C11 have differred from each other for years with more avidity on the C11 side, btw.Ski fanatic? Alpine, or nordic?
Same here. My husband's PSA spiked dramatically and he developed liver mets during his Pluvicto treatment. He has been taken off the Pluvicto and is now having chemo every three weeks. Pluvicto was quite obviously not the medication for him.
It is such a dussapointment. May I ask which chemo you have moved on to? How is he responding?
They have him on Taxol. He's had three treatments with the fourth (total of six) in a week. I don't know when they plan to reassess and see how he's doing with it. He was pretty sick the first round, but that seems to be decreasing over time. He is losing his hair and beard and not thrilled about that, but glad to be off the Pluvicto.
Exactly my case too. I am on my 3rd chemo session and will be scanned after the 4th.
Sorry to hear about your dad’s condition. Thank you for writing about this, which highlights the potential need for an FDG PET for those of us considering Pluvicto. Best wishes to you and your dad.
One more possibility - lu177 FAPI46, Dr Ishita Sen, Memorial, New Dehli. The only ww offering this treatment as far as I know
The jump that you saw would not in my mind be a gigantic jump, though it is certainly a large one. Mine goes up approximately 50 to 100 points every 30 days.
Sometimes the dying cancercells are releasing PSA after lu177 injections and the PSA is rising f for several weeks.
Have you considered Actinium 225? Watch Dr. Kwon, with Mayo, discuss this at about 34:45, in the following video:
PSMA & Lutetium-177 in 2022 | Eugene Kwon, MD | DIY Combat Manual for Beating Prostate Cancer Part 4
youtube.com/watch?v=bwUJJP6...
Thank you! Yes, we are investigating AC 225. If scans show no fdg-positive mets/ many psma-positive mets, it might be worth a shot. I am a bit worried that his unsuccesfull try with Lu bodes ill for success with AC-225, though. But I don’t know if that generally is the case or not.
Time for a reassessment: Get an FDG PET scan to find out the extent of non-PSMA avid disease. And repeat the liquid biopsy for new actionable mutations. He is very likely to have new mutations found that are related to the rapid acceleration of his PCa.
If advanced hormonals (ADT plus abi, enza, or darolutamide) don't bring it back under control, then perhaps BAT would be worth a try. And that can also combine well with opaparib. The high/rising PSA probably makes neuroendocrine less likely, so that would be favorable. Paul
Wow!!! I’m going to try to save this post to share with Joe’s onc if Pluvicto fails!!!!
I'm so sorry to hear of your father's Pluvicto failure... I'm in that club as well. With a scan, alongside monthly PSA testing, it was revealed at 3 months (3 treatments) that my PSA had accelerated to 658, from 295. My bone scan caught me off guard. I immediately went to a regimen of Jevtana + CarboPlatin, every 3 weeks, 10x.
My PSA is now at 605 (after 4 tx)... I'm at just over 5 years post-dx. Stage 4 at outset (mets to bones)... I still feel lucky.
God bless us all.
I am saddened to read your post.
My husband has had just one dose of Pluvicto. The tumor in his chest has not changed at all, and his PSA has risen. I wonder how many more they’ll do before they decide if it’s going to work.
So, so scary….and I’m so sorry you’re facing what you are now. I lift you and your family up to the light and the love, praying for your peace and comfort.
Wow, so sorry to hear this. I just mentioned to a fellow here on HU that I would prefer Pluvicto over Docetaxel because it seems easier on the body. Wrong. There seems to be a percentage of Men that do terrible on Pluvicto.
I know that Beam Radiation will cause PSA to jump for 3 months or so, which is why they usually wait 3 months to test PSA. If LU-177 is like liquid radiation, it would seem they would wait. But that does not answer the pain and fever.
Gosh, so sorry. So much to learn. Maybe they should ramp up the dose from low early to high at the end? I wish I had answers for you and your Father. That is a steep 6 week decline from hiking until today.
Comfort him. Believe in the power of touch. Take his mind back to the good times. So very sorry for this turn. I wish I had the answer.
Much Love, Mike
St Petersburg, FL
I am very sorry to read about your dad's condition. This is a disease with far too many unknowns and progression that can appear swift but just wasn't caught in PSA test or scans.
It must be very hard to have the time you thought you would have together reduced by so much. The key is as you said. Focus on the time you have with him, regardless of his condition. He will know you are there. Offering comfort and permission to let go is important.
It sounds like your father was a vibrant man who lived life as full as possible. I am sure you have many great memories with him, which is never enough but it worth a lot as time goes on.
Take care of yourself too. It is truly hardest on the loved ones who have to bear witness to the progression of the disease and finally succumbing to it. You life will go on and as the intense grief subsides, you should make an effort to really enjoy your own life.
Good luck and may your father have a smooth and pain free transition.
I know it’s been almost a year but your post confirmed what I’m sensing that Pluvicto can (in some cases) make things a lot worse…I’ve dealt with PC for over 10 years with the last 4 1/2 being metastatic…I’m scheduled for Pluvicto in a couple of weeks…I’m 86 and am feeling ok.,,,I’m just very Leary that things could get a lot worse and at this age I don’t have the time to recover…yes my psa is high, but my red blood cell count is very low and testosterone is zero.,..So the Pluvicto fatigue side effect possibility really scares me….
My Husband's update after Pluvicto.
Pluvicto Experiences?
3rd Pluvicto update
If Pluvicto fails…what next?
Pluvicto and PSA 
