Pluvicto and prostate cancer in the bone (spine)

[crony]

I have heard the Pluvicto is not the best solution for cancer in the bone due to red blood cell count declining. Does anyone have thoughts on this? thank you. Jim

[Tall_Allen]

You mean if there is cancer in the bone marrow? It is used for that too.

[crony in reply to Tall_Allen]

that I do not know. I only know it has been in my L2 for 3 years and then suddenly it has moved to the L1 and S 1. I am getting a PSMA scan wend and a genome test

[spencoid2]

I am being treated with Pluvicto for metastasis mainly in bones. Also have some in lymph nodes but they have not been increasing much. It was the increase in bone mets that prompted the use of Pluvicto after chemo did not do much other than slow down progression.

[wvdmb in reply to spencoid2]

Does Pluvicto make you sick or anything? Has your PSA gone down any?

[spencoid2 in reply to wvdmb]

There are side effects some of which can be life threatening. They monitor your blood work carefully and ask that you respond immediately if certain symptoms occur. Fever shortness of breath and a few others are signs of serious trouble. The annoying side effects are nausea, constipation (mine alternate but constipation is probably due to morphine use) increased pain in bones, and a whole host of others. Your red blood cell count goes down and causes fatigue which can be severe but it is usually for just a few days. My side effects have been relatively minor a few days of fairly severe fatigue dry mouth and increased bone pain. My PSA went down after infusion number 2 and them up past prior level after infusion three. These tests were done close to infusion and were not influenced by the infusion itself just time and the action of the prior? The day after the infusion you get a SPECT scan which shows where the Pluvicto is concentrated. It is still showing that it is gravitating to the painful sites and oher know mets so it is doing it jobs. Not sure how well it is eradicating the cancer. You also get a CT scan at the same time as the SPECT. This is mainly to provide a map to interpret the SPECT but also can show progression or the reverse. Mine shows minor suppression which is better than continued progression.

The worst part of the whole ordeal is the SPECT scan. I have it under control now but the first one was horrible. I was strapped in with 2 feet of velcro like a straight jacket, was not warned that the sensing pods would be within an inch of my face and the brand new machine fucked up so they had to do the scan three times. I was a total wreck by the end. Now they do not strap me in just use a wrap that i know i can get out of so i do not feel trapped. The scan starts with the head so I keep my eyes closed from before that until it is past my face. You can hear the sensing unit rotate in increments maybe 8 to 12 times and then you are moved to the next position. I count the rotations and after the second repositioning can open my eyes again. No terror with the last scan. CTs and MRIs were never a problem for me but the SPECT is something else.

[rsgdmd in reply to spencoid2]

Doing scans after getting Pluvicto varies by the institution. I had 3 rounds of Pluvicto (& stopped as PSA started to rise & PSMA PET showed progression) at Abramson Cancer Center (U of PA). They don't do any scans post Pluvicto injection. I've heard of others being checked with a geiger counter.

[spencoid2 in reply to rsgdmd]

Scan type varies because gamma cameras are expensive and rare. Fortunately I am having Pluvicto at UCSF which is well funded. It probably make little difference to those of us who have been irradiated repeatedly but injecting more nuc med for a PSMA PET scan should be avoided if possible? And if you are far from the treatment center you have to stay overnight. In SF that adds another who knows what cost. Fortunately there is a fund paying for my accommodation overnight and that of my husband and two Poodles.

[rsgdmd in reply to spencoid2]

I specifically asked & they said there was no evidence for need. If Pylarify went to spots, Pluvicto would also. PSMA PET radiation is very minimal and very short acting. I'm only 20 min. away.

[spencoid2 in reply to rsgdmd]

Wondering why they decided on SPECT which they say they always use after Pluvicto. It is not a matter of eliminating my traveling. And Chat GPT suggests that PSMA is more sensitive and that the radioactive agent has a short half life and a small dose is required. Maybe they want to know exactly how much Pluvicto has gone to the sites. Sure it will be correlated to the amount of PSMA PET but ???

[CAMPSOUPS in reply to spencoid2]

You answered it. SPECT will show whether Pluvicto is attaching to PSMA tumors etc.

I didnt get a FDG-18 scan before Pluvicto just the PSMA and so the SPECT was some peace of mind knowing Pluvicto was attracted to my PC.

I think the size of and ability to judge tumor regression or progression can be seen on the SPECT as well. The radiologist discussed some of my bone mets reaction to Pluvicto based off the SPECT.

Had my SPECT after 3rd Pluvicto infusion.

Had my 5th infusion couple weeks ago. Doing good PSA going down. Troublesome bone mets resolving. Maybe some extra fatigue compared to normal. Definitely no saliva production but no salivary gland pain.

[spencoid2 in reply to CAMPSOUPS]

So maybe the SPECT is better in some minor respects? I thought of another advantage, the immediacy. Determining whether to continue Pluvicto can be decided sooner. My SPECT results said there was evidence of regression. Not sure if PSMA would show density of met as well, maybe the size would show but not how much PC is actually in the met? I just leave it to the pros and do not question everything.

[Maxone73]

it is used for that….but I would check also actinium for that purpose

[spencoid2 in reply to Maxone73]

actinium sounds good. i can sleep with my dogs right after infusion. however it seems to be hard to find other than trials. there is one i found with both actinium and LU 177 but not conveniently located.

[wvdmb]

If the insurance approves my husband will start this treatment soon. We were told his bloodwork is good now and they monitor it regularly. This treatment is one of our last options. His cancer was stage 4 when first diagnosed. It metastasized to his bones.

[janebob99]

Have you considered doing testosterone replacement therapy (TRT)? It will raise your Hct and Hub (red blood cell count) significantly. Morgentaler from Harvard has shown that doing TRT in advanced cancer cases is safe and effective.

Bob

[Islandboy2021 in reply to janebob99]

Can this be done when you have failed all other treatments and Mets are advancing.

[janebob99 in reply to Islandboy2021]

I don't know exactly.

The best source of information about the use of T with advanced prostate cancer patients is Dr. Abe Morgentaler (Retired, from Harvard). You may want to Google his papers.

The other approach is to do BAT testosterone therapy by Dr. Sam Denmeade at Johns Hopkins. hopkinsmedicine.org/profile.... It appears to be quite successful for patients like you.

Bob

[PELHA in reply to janebob99]

This is good to hear. Hubs was on TRT after prostate cancer that was radiated. But was only started once PSA was 0. He felt great on this but after a few years PSA started to rise so doc had him stop. Now has a few bone Mets. So started the quarterly Lupron shots beginning of this year (was 200 before that and now down to 54) and a month ago they added Erleada. PSA in one month went from 9.8 to 1.8. Next month having a scan to see how Mets responding. Wanting to learn more about how estrogen plays a role as have just been starting to read about this aspect. Thanks for your info though I don’t claim to fully understand all!

[janebob99 in reply to PELHA]

We're all waiting for the results of the Phase-III PATCH trial 5 and 10-year survival outcomes. I was told recently that it will be published this Fall. So, they are aren't collecting any new data at this point; just analyzing the numbers. It will make a big splash when it publishes. Stay tuned!

[Gl448]

Blood transfusions are an option if Pluvicto causes anemia.

There are also ESA drugs that make bone marrow produce more blood cells as an option.

[God_Loves_Me]

I have note from other group : (neulasta.com/) Neulasta is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection

[louschu]

I'm a success. 6 rounds. Did not have soft tissue involvement. All bone. Currently cancer free. I'm told by Mayo that I an an exception. Chemo took care of soft tissue 6 years ago.

[LongTimeRunning]

My RBC declined over 5 Pluvicto treatments as did my WBC. My last and final infusion was in November and both RBC and WBC are starting to recover. RBC is now roughly 85-90% of pre-treatment and WBC close to 100%, but this recovery based upon a blood test 2-weeks ago in which they finally bounced back (from 2-3 samples per month, including the previous week). About 2.5 months after last Pluvicto infusion. Waiting for next test in a month or so to see where they are at.

[Neathuh1]

I’ve had 4 Pluvicto infusions and am now slightly anemic. Apparently it does lead to that.