What next? Is my man a candidate for Pluvicto?

[TahoeJ]

I am the wife of my 14 year warrior, details in his bio. Finally after 3 PSMA scans, cancer has shown up in a few lymph nodes and in the original area of reattachment of urethra to bladder from his prostatectomy, and on the bladder wall. He has now been on Abi & Prednisone for 2 weeks, although after failing Extandi a few years ago, it probably won't do much for too long. We are going down to consult with an oncologist in Santa Barbara to see if he qualifies for Pluvicto, and we have a consultation with our wonderful Dr. Aggarwall at UCSF, also next week. My question is, can someone who has cancer in this bladder area have Pluvicto treatments? Is the possibility of rupture in the bladder or nearby intestinal organs too much of a concern to attempt it? And if not Pluvicto, what? I guess I thought we would have a lot more options at this point. I would appreciate any input, especially of fighters who have advanced cancer in the bladder area. On another note, I want to apologize for not being more personally active on this site. I have lurked for far too long, thinking I don't have a lot of expertise to offer. But I know that I don't need brilliance to give comfort and encouragement. So, hang in there fellow warriors and those that love and help them. And thank you in advance for any counsel you can give.

[Tall_Allen]

" Is the possibility of rupture in the bladder or nearby intestinal organs too much of a concern to attempt it? " I've never heard that come up before- why do you worry about that?

But the lymph nodes, anastomosis and bladder wall can be targeted with whole pelvic salvage radiation. I suggest you talk to Amar Kishan at UCLA about it. He also has a clinical trial of early use of Lu177PSMA ± SBRT (randomized) for recurrent patients. I'm not a big fan of that trial because it precludes hormone therapy. I think a similar treatment including salvage radiation and ADT, with LuPSMA in Germany or India would be a better idea.

[TahoeJ in reply to Tall_Allen]

But he has had salvage radiation (see bio). You can have it again to the same areas? He had been on Lupron for many years. We know or have assumed he was metestatic because of rising PSA, but a ct scan led to another PSMA scan this May, and then a cystoscopy which confirmed prostate cancer in these areas.

[Tall_Allen in reply to TahoeJ]

I'm sorry- I did not read the profile. But I am still unclear as to exactly what has been treated. The anastomosis was treated, but was the bladder site and pelvic LN? If not, he can at least have external beam to the entire LN area. Possibly brachytherapy to the bladder site and anastomosis - you have to speak to a good HDR brachy RO like Joe Hsu at UCSF. It hasn't been irradiated since 2010, so it may be possible.

If that is impossible, hormone therapy + LuPSMA in Germany or India may nevertheless be worthwhile.

[TahoeJ in reply to Tall_Allen]

Thank you Tall Allen, we will discuss the possibility at our meeting next week.

[j-o-h-n]

Greetings Ms. TahoeJ, We do not care if you were lurking......I myself am used to it...... my Vex-wife.....................

Hopefully info here will help Mr. TahoeJ.......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/15/2023 2:33 PM DST

[TahoeJ in reply to j-o-h-n]

Thanks for the greetings j-o-h-n. Good humor. We’d drown in this life without it.

[j-o-h-n]

drown? Now ya tell me.........And Silly me, I should have put away the clown outfit the day I married my ex-wife.... Oh dear me.....(gotta update my old diary now)....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/15/2023 4:56 PM DST

[slpdvmmd]

I think the combo of pluvicto and external beam radiation should be explored. This may mean leaving the country. I addition to Germany I know this a combination approach is being used in Australia.