I’m perplexed about Pluvicto

[Cateydid]

After one dose of Pluvicto, Joe’s PSA rose, and Mets are unchanged.

His second dose is August 4.

I asked his onc what good looks like: how will we know if P is working? When? No good answer……he’ll rescan after 3rd dose…..

His QOL is lousy, from what I see, anyway. Spends days moving between recliner and patio chair. Minimal pain….likely from not moving. A weekend with the grands results in 2 1/2 days in bed. Constant fatigue which seems only to be relieved with steroids.

With a partially collapsed lung, breathing is a challenge; he uses oxygen when he needs it. Referred to OSU pulmonary interventionist to evaluate inserting stent into lungs to open airways.

Having surgery August 16 to remove a bursa sac on an elbow due to repeat infections.

Zowie! Continuing to hope…… but I don’t know what for! Will the Mets shrink? PSA drop?

[JoeyDad]

Sorry to hear this. I’ve had 5 Pluvicto infusions….PSA went up after the first…then down…and then back up. I have pain in hip and shoulder. Doc has to decide if it makes sense to get last infusion.

[6357axbz]

From what I’ve read here it works well for some but not for others. Seems like a crap shoot to me.

[MyDad76 in reply to 6357axbz]

I believe that part of the problem lies in selection of candidates - as Tall_Allen has repeatedly stated, both FDG PET-Ct and PSMA should be performed as part of selection process. Unfortunatelly in most cases they only do PSMA scan.

urotoday.com/conference-hig...

[Cateydid in reply to MyDad76]

That is all they did. Thanks for this.

[Spyder54]

Dear Cateydid,

I have been following closely, the guys who have had LU-177, and also the similar J-591.

A recurring theme is that guys who get it early while PSA low, seem to do well, while guys with higher PSA or Metastasis expanding rapidly, seem to struggle, and often stop before final injections.

I view PLUVICTO as Liquid Radiation vs Beam Radiation. It seems like it would be very effective at damaging the micro mets in the blood stream, while Beam Radiation would be better for larger tumor mass.

Additionally, when I had Beam Radiation (SABR/SBRT), it was stressed to me that PSA will initially rise, because dead and dying PCa cells give off a ton of PSA, and to wait at least 3 months for the first PSA. Pluvicto is still relatively new in the U.S., and this may (hopefully) be part of the learning curve.

Like so many of our treatments, early always seem better ie: Provenge, Leutitium, Docetaxel, ADT2. The old….lets wait until we run out of options then we will give this a shot, seems to be wrong. Even ASCO changed the SOC with Docetaxel upfront (about 1 year after my Dx, so I have not yet had Docetaxel, or any of the Taxanes).

Here is a toast to your husbands PSA coming down in 3 months!

My best to you and yours, Mike

[MyDad76 in reply to Spyder54]

Seems that we all know two guys from the forum, who got a great response after being castrate resistant and had high PSA (RusLand and lewicki). They both got LU-177 and AC-225 combo. Wonder if that is part of their great response (and most probably they did not have FDG +/ PSMA - mets, which again leads to urgency of having both FDG and PSMA PET Ct).

cureus.com/articles/112714-...

[SeosamhM in reply to Spyder54]

Great post, Mike.

[Tall_Allen]

I'm sorry his QOL is so poor. Did he have an FDG PET scan in addition to the PSMA PET scan? Consider a BiTE or CAR-T trial.

[Cateydid in reply to Tall_Allen]

He did not get the FDG PET scan. I’m going to send a note through his patient portal to ask the Pluvicto doc to order that test.

I’ll look into the two trials you suggested as well.

Thank you.

[Tall_Allen in reply to Cateydid]

The PSMA-based BiTEs are listed in this link. (There are other BiTEs and CAR-Ts trials that are not based on PSMA):

prostatecancer.news/2019/12...

[robert570]

Having similar issues. I'm going on my fourth infusion August 17th and my PSA has gone from 1.95 Before the 1st infusion to 4.95 after the 3rd. Scans after the last infusion shows that nothing has changed or spread since the beginning of the treatment. My biceps are sore and it's difficult getting out of my chair. Body aches and sore joints since I started Pluvicto. I have an appointment with my oncologist this Wednesday. I'm seriously thinking about stopping this drug.

[Spyder54 in reply to robert570]

Hang in Robert570. Can they give you Celebrex for your joint pain?? A rising PSA is expected with beam radiation. Cannot imagine it would be different with liquid radiation? Hope your PSA comes down starting out about the 3 month mark. Please keep us posted.

Best, Mike

[robert570 in reply to Spyder54]

They are putting me back on Jevtana because after 3 infusions of Pluvicto, my PSA is rising too fast. It has risen to 10.12 since my last post. Jevtana was working to keep my PSA level before they switched me to Pluvicto. I will keep you updated. I start Monday August 21st on Jevtana.

[Bobcat64]

I’ve just finished number 5 therapy with Pluvicto and have had a slight rise in PSA after each treatment. PSA currently at 12.5. I wish you well as the SE are difficult at times God Bless

[Spyder54 in reply to Bobcat64]

Best of luck Bobcat. Remember dead and dying PCa cells give off a ton of PSA. Here is to hoping you start to see a PSA drop out about 3 months. Please keep us posted.

[j-o-h-n]

Kick ass, Joe......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 08/01/2023 7:45 PM DST