Pain after Pluvicto infusion

[Oct18]

First I'd like to thank everyone on this site who provides advice and help for all of us asking questions. So here is my next one: I just had my 2nd Pluvicto infusion and my hip and upper femur (where there is active cancer and 6 months removed from my hip surgery I have posted about before) have almost unbearable pain. Has anyone had an increase in pain as a reaction from the Pluvicto? If so, how long did it last? My cancer is in the bones as of September, no soft tissue and no lymph nodes.

My PSA at the start Oct. 9th was 14.7

Nov. 18th PSA was 14.3 (checked locally before Xgeva shot and Lupron.)

Nov. 20th PSA was 15.79 checked at Duke before infusion.

I've been taking Tylenol and or Ibuprofen for the pain prior to my 2nd infusion. The Dr. called in Oxycontin for the pain which I will try at night. A year ago I was running, lifting and exercising even during Chemo so this has been a long year. I am on a trial which does not allow steroids but if that may help, I will just opt out of the trail. I'm only getting the Pluvicto anyway, and not the study drug. Any shared experiences would be appreciated.

[spencoid2]

My bone pain increases after pluvicto. I think it is a known side effect. It can get pretty bad at times.

One thing I want to mention that was explained to me but I forgot who said it. This only applies if you are taking abiraterone which is possible since pluvicto is being given to still castrate sensitive patients. You do not seem to have a profile so I can not tell if you are castrate sensitive and taking aberaterone.

I was taking oxycontin for pain while I was still castrate sensitive and was taking abiraterone. It seems that codeine itself is not analgesic, rather that it metabolizes into morphine which actually is what reduces the pain. Apparently among other things aberaterone prevents this from happening. This is what chat said after first saying no and then changing it "mind"

Your doctor's observation is correct: abiraterone can interfere with the metabolism of codeine. Abiraterone inhibits the enzyme CYP2D6, which is responsible for converting codeine into its active form, morphine. This inhibition can lead to reduced effectiveness of codeine for pain relief.

[Oct18 in reply to spencoid2]

that makes me feel better although I’m sorry you have to deal with the bone pain as well. How long does your pain last after each infusion? I’m not on Xtandi or Zytiga, I took both a few years ago for three years until I became castrate resistant at the end of 2021. I took Zytiga then switched to Xtandi after my liver enzyme’s were raised. I took my first oxycodone tonight and that did not seem to touch the pain, it just made me very tired. Ibuprofen. and or Tylenol has helped with the pain just enough to make it tolerable..

[spencoid2 in reply to Oct18]

the onset of and severity of pain is highly variable. different each time. and it is difficult to tell the difference between pain caused by treatment and that which is just the disease advancing. my doubling rate is about .7 months and PSA is well over 1100 by now. i keep getting new pains and have no way tel the cause. fir example just tonight after diong nothing stressful other than maybe leaning on the table working on computer i have a new quite bad pain in the middle of my back. i hope that morphine takes care of it or that it is less painful when lying down.

i am taking more and more morphine and am having a real hard time getting a pain doctor.

i see my primary care doctor real soon after she got fired and we had to track her down. it is so strange that with oncologists urologists etc she is the only one to be willing to prescribe morphine.

i am afraid to go to bed because i don't know what to do if the pain does not subside.

[Oct18 in reply to spencoid2]

I’m so sorry to hear that! prayers that you get relief from your pain.

[Miccoman]

When I got a second opinion on Pluvicto, the MO at Memorial Sloan Kettering recommended a course of steroids for a week after every injection to guard against "rebound pain." So I had a diminishing dose of steroids every time and no pain. I have extensive mets all through my pelvis and spine.

Also, just to throw it in, my pelvis pain had been helped tremendously by acupuncture. YMMV

[Oct18 in reply to Miccoman]

I read of someone else getting steroids for their pain as well. I will ask my Dr. about that option. I have had acupuncture in the past for aches and pains so that is also good advice. Thank you.

[j-o-h-n]

To a libra from a libra,

If you would, please update your bio. Maybe just copy and paste portions of your above posts and of any other pertinent posts in the past as your bio. As you well know, it helps you and helps members. Thanks and we all hope you pain subsides.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Oct18 in reply to j-o-h-n]

Got it and will do

[j-o-h-n in reply to Oct18]

Thank you...(from the 6th to number 18).

Good Luck, Good Health and Good Humor.

j-o-h-n

[Oct18 in reply to j-o-h-n]

I was diagnosed Oct. 2018, that's what came to mind when creating my profile. DOB is Feb...

[Oct18 in reply to Oct18]

and profile is updated

[j-o-h-n in reply to Oct18]

Oops............

Good Luck, Good Health and Good Humor.

j-o-h-n

[Tall_Allen]

Radiopharmaceuticals cause inflammation=pain. If NSAIDs don't work, ask your doctor for a Medrol Dose Pack.

[Oct18 in reply to Tall_Allen]

Will do, as always thank you TA!