What’s Next?

[MJCA]

My bio illustrates my long 19 year journey with this disease. I turned out to be a great candidate for Pluvicto. All was going well. After cycle 3, a PSMA-PET showed all but one metastases were receding or dead. My PSA before cycle 4 was 17.7. My PSA before cycle 5 was 33.15. Due to the fast increase of my PSA, it was warranted I have another PSMA-PET before cycle 6. Unfortunately, Pluvicto has lost its efficacy. I had numerous mets to the spine, ribs, L femur. The PET also indicated that I had severe coronary artery calcification. I eat a fairly clean diet. A lipid panel showed no issues. I have been on a statin, Lipitor, for years. My PCP attributes the coronary issues to prolonged use of Lupron. My questions are 1. What’s next after Pluvicto? I believe it’s carboplatin, which I understand is platinum-based which my cardiologist states is not good for the heart and 2. Can long use of Lupron cause artery calcification? My latest PSA performed last week was 70

Sorry for the long diatribe. This is getting serious. Thanks. And yes, this was posted to 2 different groups.

[Tinuriel]

I'm sorry I can't address your questions as I have some of the same ones, and I hope others will respond who can. But I can say that I admire your long fight, and I wish you a solid next step. Praying for you today.

[Hidden in reply to Tinuriel]

I don’t know about coronary issues with Lupron but I have a very hard time walking and my oncologist said it’s probably from long time use of Lupron…..

[Tinuriel in reply to Hidden]

My husband's been on lupron for 9+ years, had PSMA scans without showing any heart issues being noted. He had some trouble walking, but it turned out to be a back issue unrelated to his cancer that has since been resolved.

[MJCA in reply to Tinuriel]

Thanks I appreciate your kind words.

[MJCA in reply to Tinuriel]

Thank you. Your kind words are very appreciated.

[Cenerus]

The answer appears to be Yes, it does. Low testosterone is associated with metabolic syndrome. This cluster of symptoms includes high ldl and triglycerides as well as high blood glucose. I'm in the same boat as you and have been looking into this. My current cholesterol meds are pretty maxed out right now, so I don't have much room to improve other than diet and exercise. Even there, I can only do so much. Your hardening arteries is possibly related to being on Lupron for a long time. Switching to another LHRH agonist/antagonist drug won't help. What might help is to go on estrogen therapy as a way of driving the testosterone down while possibly improving the cardiovascular situation.

[MJCA in reply to Cenerus]

Thank you. I have enough crap to deal with just with the cancer. Now I have this additional BS.

[Cenerus in reply to MJCA]

I know how you feel. I have an appointment with my cardiologist tomorrow and then one with my medical oncologist on Thursday. Life was so much simpler in the past.

[MJCA]

Yep. After finding out Pluvicto failed, my MO is seeing me Thursday.

[God_Loves_Me]

I am sorry I thought it worked for you.

Have you find out whether keytruda works for you or not ? I was reading somewhere that it is good idea to send biopsy tissue to keytruda and they can tell you immediate whether it going to work or not

recently Tall_Allen mentioned that xofigo + carboplatin is good options too.

clinical trial that I believe work for me it ARX517 and other good feedback I heard about was AMG 509

I spent time on your bio and little confuse that you had docetexel but you never did nubeqa or xtandi or apalutamide. the reason is after docetexal this drugs has great chance to work again I think you straight started pluvicto without trying nubeqa or xtandi or apalutamide

Also see if you can try immune checkpoint inhibitor may be. I do not find genetic test results in your bio

[MJCA in reply to God_Loves_Me]

I have had genetic testing done twice. As far as Keytruda. It appears the floor is a score of 10.0 I am at 9.5. I do not recall what this represents. I remember it presented this way about 9 months ago. My MO told me he may have some wiggle room with my insurance. I don’t think this treatment will be on the table.

[Cali3 in reply to MJCA]

At this stage, would strongly recommend getting second opinions from UCSF(Small, Aggarwal) and/or City of Hope (Dorff). The consults can be virtual.

In addition to the suggestions posted eariler, if your mets are all PSMA avid (if you haven't had one already, you will need to get an FDG PET to check for discordance), this trial at Stanford looks promising.

64Cu-SAR-bisPSMA and 67Cu-SAR-bisPSMA for Identification and Treatment of PSMA-expressing Metastatic Castrate Resistant Prostate Cancer (SECuRE) (SECuRE)

clinicaltrials.gov/study/NC...

Clarity Update: Complete response in first patient ever treated with 2 doses of Cu-67 SAR-bisPSMA at 8GBq

claritypharmaceuticals.com/...

For the coronary artery calcification, check with your cardiologist to see if you can get a scan to get the coronary artery calcium score. It will quantify your risk.

[MJCA in reply to Cali3]

Thanks. Last year the mediator of an online support group suggested thesecondopinion.com. Provided them ALL information. I was told they could not provide an opinion. So, I am done with that shit. I have A LOT of faith in my MO who attended Stanford Medical School, residency at UCSF and is now back at Stanford. I am the ONLY ONE navigating all my medical crap. I am tired. At this juncture, I could give a flying f*ck about a clinical trial.