Cabazitaxel or 177Lutetium-PSMA ?

[mgaa]

my father PSA has now reached 32.5 with mets all over his bones and it also reached his skull vault which is terrifying me a lot.

he has already been on the following medicines over the last 4 years along with goserelin acetate implant shot every 3 months:

-Bicalutamide

-Abiraterone

-Taxotere with and without Cisplatin

-Enzalutamide

-Paclitaxel + Carboplatin

-Mitoxantrone

-Radiation

his recent PSMA shows:

**progressive course of the prostate, achieving up to 25.5 SUVmax (compared to 11.78 SUV max previously)

**Progressive course of the previously noted left external iliac PSMA-avid lymph node, measuring 17x12mm and

achieving 50.2 SUVmax (compared to 11x16mm and 40.22 SUVmax previously).

**- Newly developed PSMA avid left common iliac

lymph node measuring 15x10mm and achieving 47.21 SUVmax.

- Over all progressive course of PSMA avid osseous metastatic deposits with newly developed others currently seen at skull vault, both scapulae, right humeral shaft, few bilateral ribs, most of vertebrae, sacrum and pelvic bones currently achieving up to 50.18 SUVmax at LV1

- No metastatic visceral lesions detected.

now our MO recommended either:

1- 177Lutetium-PSMA (4900$/session )

2-Cabazitaxel (1400$/session)

as we're not covered by any mean of health insurance, the decision is hard for me specially with no data favoring one over the other except for TheraP trial: pubmed.ncbi.nlm.nih.gov/380...

which is making things more complicated in my head rather than helping me, I want to take the better decision for my father so any input is highly appreciated.

I have updated my profile with all the details to help with your recommendations.

Thank you

[meowlicious99]

Has he had FDG scan to correlate with PSA scan ?

[mgaa in reply to meowlicious99]

No, is that to figure out how much of cancer cells have PSMA receptors and then how much will roughly benefit from the Lu-177-PSMA-167 ?