Pluvicto Question

[MJCA]

Hi Fellow Warriors!

Six months of Taxotere failed miserably. After 8 rounds, I was done. After chemo, my second PSMA-PET showed additional bone mets and a spread to the lymph nodes.

My MO told me I was a good candidate for Pluvicto, so, three months after finishing Taxotere, I started that therapy. Today, I am 3 weeks out from my second treatment. I feel like I was hit by a truck. I am SO fatigued today. I also have a terrible appetite. My question, are these normal symptoms at this stage?

Thanks!

[GP24]

Taxotere suppressed the bone marrow and Pluvicto will do so too to some extend. I think this is the reason for your problems. I would ask the doctor to take a break from Pluvicto until the blood values have improved.

[MJCA in reply to GP24]

Thanks for your reply. Even without the meds I am somewhat anemic. While under chemo I did have an iron infusion. I have been on Lupron (this time) for 6 years. Then Erleada, Nubeqa, Zytiga and Provenge; and now Pluvicto. I just think my body is tired.

[Elbers123]

There are a lot of people on this site with inspirational stories. But your strength in the face of adversity is on top of the heap. Sorry the treatments are tough. Thank you for sharing. I hope this is a temporary down turn.

[MJCA in reply to Elbers123]

Thank you for your kind words! I have good days and bad days. I just want to be able to travel again!

[chips1942]

Hi , You’ve certainly been through the wars. I’ve been on a similar path in recent months. 7 cycles of Docetaxel late last year & just completed my 3rd cycle of Pluvicto. They do wear you down. I’ve found the Pluvicto easier than the chemo in terms of side effects. Be very careful in monitoring those blood tests with your doctors as they can be an indication of long term impacts of the treatments. We are in a marathon with our PCa not a horse race. If you need to take a break from treatment for awhile to recover & maintain some QOL do so. Best

[MJCA in reply to chips1942]

Thanks. Since doxetaxel last year, my QOL has diminished. I hope it will improve.

[profsailor in reply to MJCA]

docetaxal knocked me down too. It took me about 6 months after the 10th infusion to really have some energy again. But, my hair grew back (kinda curly on one side), my appetite returned, and I felt better by the time I started Pluvicto. Side effects have been minimal and PSA dropped to 0.04. After 4 treatments, it has increased to 0.09. No more treatments until it increases and we do another PSMA PET. I hope you feel stronger soon. Keep up the good fight.

[OldWarrior]

I did 8 rounds of Docetaxel ending in Nov of last year. Pretty much went sideways PSA wise. Started Pluvicto a month later - two rounds so far. Fatigue is the major side effect after Day 3-5 when I’m just miserable. Hemoglobin is the limiting factor. Getting weekly Epoetin Alpha shots (brand name Procrit) as supportive care - keeps me in the mid 9s. Also did a dose reduction down to 80% last cycle. PSA down 50% or so. Don’t want to delay treatment and lose momentum. Everyone is different, if you need to take a break to maintain some QOL - do what you have to do for you and don’t spend too much time looking back.

[Explorer08 in reply to OldWarrior]

My wife did weekly Procrit shots for years but was switched to Aranesp by her hematologist. Aranesp is administered every three weeks.

[MJCA in reply to Explorer08]

I’m borderline anemic. When that does occur I am given Venofer.

[MJCA in reply to OldWarrior]

Thanks. I’m pretty tough. My hemoglobin is fine so far. I would rather push through and get this done.

[Miccoman]

Hi MJCA, I just finished my 6th Pluvicto and as time has gone on there has been less fatigue. Even though it was masked by taking Dexamethasone (steroid) I know it has lessened because I had to lower the steroid dose as I went along to avoid becoming over-active.

OTOH, kidney function problems build over time also. I only have one and the Nuclear Medicine doc had to make a judgement call to give me the full dose for my final shot. Now I'm pushing water, lots and lots of water -- my nighttime pees are really impressive now! LOL

My RBC runs just below normal and has for years, while taking Lupron and Xtandi and during the 4 doses of Chemo (had to stop due to side effects). Never low enough for the docs to do anything, but below that line on the graph.

The other thing that has changed, aside from a huge drop in PSA, is that my Alk Phos has returned to normal and everyone has been commenting on how well I look -- and I feel great, too. That started just before my 5th shot.

As always: YMMV

[MJCA in reply to Miccoman]

Hi,

Interesting. No steroids are being administered with Pluvicto. Which I am glad. My numbers seem to be okay. I just think I have been on so many different therapies over the past 6 years.

[Miccoman in reply to MJCA]

I know. I've been on this path since 2014 when I was diagnosed Stage 4 with extensive mets -- was supposed to die this year, but I've been a bit of a rebel all my adult life! LOL (and you have to laugh, it's good for you). I've done casodex, lupron, xtandi, provenge (immunotherapy), docetaxel and cervical radiation before getting to Pluvicto.

Oh, and they did the steroids, diminishing over a week, for me because they were afraid of rebound pain due to the extensive mets. Plus they were very worried about this being a positive experience after they almost killed me with a simple "light" course of 5 radiations of my cervical spine at the beginning of '23. And they didn't even kill the cancer there, oops!

[MJCA in reply to Miccoman]

I hear you. I have done everything you have done minus the Xtandi; instead erleada, nubeqa, zytiga and brachytherapy. I have had this mofo almost 18 years now.

[Miccoman in reply to MJCA]

PS, I forgot to mention that I had an orchiectomy so I am off Lupron. I think that is a big part of why I feel so good mentally. The Lupron (3 month) SEs were driving me crazy after 8 years so when I needed a TURP I had them take the, now totally useless, balls as well. Very happy with the results.

[j-o-h-n]

You've got one great plus going for you. You're not married.................. Hang in there.....

Good Luck, Good Health and Good Humor.

j-o-h-n