Pluvicto

[NDJIM]

Are there any cases or studies that demonstrate long term remission or complete prostate cancer elimination following Pluvicto or other radio pharmaceuticals? Thank you in advance.

[street-air]

in a study of a bunch of patients, the longest anyone held off PSA progression was about 30 months however of the 68 who responded, all but one ended up with PSA progression by 20 months. I'm not an expert at reading the other charts in the study researchgate.net/profile/Sh... however it is fair to say that by the time PSA starts to increase again, the treatment is over with and the course of the disease resumes.

PSA progression free survival curve for pluvicto

[TWTJr]

I am 24 months post Lu 177 treatment; PSA remains undetectable; testosterone low normal; no other ongoing therapy.

[dhccpa in reply to TWTJr]

You're off all ADT and anti-androgen therapy?

[TWTJr in reply to dhccpa]

yes. Off all rx other than blood pressure meds. For what it is worth, my MD, head of uro-oncology at Methodist, a former full professor at MDA believes that, after 24 yrs of various but numerous prior treatments, and the most recent and last LU177 rx, I am cured.

[dhccpa in reply to TWTJr]

Excellent!

[TWTJr in reply to dhccpa]

I should add that I believe I received an overdose of LU177 on my fifth and last treatment almost 2 years ago. I went into marked bone marrow failure, which has resolved but required 5 months of transfusions, as well as marked renal failure, which now requires dialysis. However, I am otherwise OK, alive, without residual disease and much better off than being afflicted with castrate resistant PCA.

[dhccpa in reply to TWTJr]

Ouch! What a trade-off.

[TWTJr in reply to dhccpa]

yes, big tradeoff. Damn near died of the rx. Quite a trip. Dialysis is a pain, but the alternative is pretty bad as well.

[NanoMRI in reply to TWTJr]

Interesting your bio reads G 6. Was this ever upgraded?

[TWTJr in reply to NanoMRI]

No, and bx was repeated, again G6. However, I believe the samples (done 24 years ago) likely were either misgraded, or higher grade foci were missed. Over the years I have had bx confirmed at least 15 metastatic osseous lesions, treated systemically and most also treated with either SBRT and 3 treated with cryoablation.

[Tall_Allen]

No.

[JohnInTheMiddle in reply to Tall_Allen]

Sure is a lot of chatter about radio pharmaceuticals though.

[Tall_Allen in reply to JohnInTheMiddle]

Since only about 95% of cancer cells in one individual express PSMA at its peak expression, the remaining 5% will eventually take over.

[JohnInTheMiddle in reply to Tall_Allen]

I would imagine that ethical oncologists (a.k.a. "all oncologists?") would normally share this with a prospective candidate for radiopharmaceuticals? Then it's only a matter have how long the 5% takes to become dominant ... which I suppose is true of every therapy.

[Justfor_ in reply to JohnInTheMiddle]

They react like gases. Give them room and they will expand to occupy it all.

[Tall_Allen in reply to JohnInTheMiddle]

I don't think anyone promises a cure.

[TWTJr]

I am a retired MDA trained radiologist, and fully familiar with all the above comments, as is my oncologist. chief at a world class hospital. It should be noted that many cases of unusual responses to toxic treatment are not reported, as is the case with my to date response. Time, and only time, will provide further data. I will report to this site my clinical course. Naysayers may be right. We shall see.

It should be noted that my case is being reported, but publishing in reputable medical journals takes about 2 years.

[Brysonal]

Not long term but in Nov 21 I had bone mets popping up everywhere - spine, ribs etc

Undetectable PSA again at this weeks tests. Currently off ADT and just taking Apalutamide as a mono therapy with testosterone slowly rising ( 3.4 this week)

I went with an unusual triple and started with a shot of degerelix back in Dec 21 and starting Lu-177 as an unusual first line treatment. I had 3 of these but then 3 Docetaxel to deal with the non PSMA expressing cells

However I also had SBRT direct to 3 mets, 20 x VMAT sessions to pelvic region and 2 bracytheraphies ( very controversial here in Uk)

I added Apalutamide which I’m still on and volunteered for the OVM 200 vaccine

So threw the kitchen sink at Dec21 - July 22 until I was undetectable and clear on scan.

No idea what did what but the Lu177 x 3 plus 3 x Docetaxel made sense to me. Not sure that it’s been trialled though

[TWTJr]

PCA is a variable, vicious disease, with quite variable responses depending on the host environment, cell genetics, exogenous treatments, and more independent variables that can be defined. Responses can be recorded, but with so many variables it is difficult to reliably predict durable responses to specific treatments. I believe some progress is being made, but nowhere near reliable and certainly not durable on a long term. Need much more data and perhaps AI some day will help sort out whats best and what is a waste of time.