next step - pluvicto?

[Juju0713]

Hello, please see my dad's bio for history. Within the past 10 days my dad has developed severe pain in his spine due to mets. He has MRI scheduled for tomorrow. His MO wants to start him on pluvicto at this time instead of doing spot radiation treatment. Does this progression mean he has now failed xtandi/talzenna combo? After pluvicto what options are left? Thanks to this platform and all for input/support.

[IVA65]

That's what my doc said we'd try if bone mets came back.

[speranza10]

Pluvicto seems to be a good choice. When the disease becomes resistant to it (I hope as late as possible) a good next step would be cabazitaxel.

[GP24]

After pluvicto he can get a cabazitaxel chemo. After that opevesostat may be approved by the FDA.

[Rolphs in reply to GP24]

I had not heard of Opevesostat. This looks like a very promising drug for CRPC.

Thanks!

[MJCA]

If he’s going on Pluvicto, I am surprised that the MO did not order a PSMA-PET scan instead of an MRI. The PSMA-PET utilizes LU-177, the same isotope used in Pluvicto. With this scan, it will light up wherever the PCa is. For years MRIs and CT scans showed “shadows”. I had no definitive proof of metastasis until my first PSMA-PET.

[Juju0713 in reply to MJCA]

he did have a PSMA scan in December I have not yet added that info to the bio but did talk about it in my previous post

[Seasid in reply to MJCA]

They want to see if he has any bone marrow involvement.

[j-o-h-n]

There's tons of posts in our H.U. history file that refer to Pluvicto. You may wish to peruse those post in order to get a flavor of Pluvicto's benefits or negatives. Regards to your Dad from all of us.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Startanew]

Hi, very sorry to hear your dad's having such a rough time. There is another drug out there. It's called zytega. I don't know if they would put him on that or there is chemotherapy. Chemotherapy is a good possibility too. But as far as xtandi I've been on it for a few years now and it's still working for me but they they've got new drugs out there. So keep hope and hang in there. Things are things will come together but he still got chemotherapy I believe

[Meshel48]

My husband has gone with the spot radiation when the pain would come up in different spots. He just finish with his shoulder and pelvis area and seems to be successful . He has had previously in rib area and back . The PSMA had shown that some areas had gotten better but the pelvis had grown in size since he completed Pluvicto in August 2024. Now he is on Lynparza 100mg 3 in morning and trying to get back up to 3 at night and 1 orgovyx and he also BRCA2. Hope this helps everyone's Doctor is different and he struggles with the Lynparza its just so toxic on the body. Good Luck .

[God_Loves_Me]

I am NOT a doctor or Medical advisor.

- Please talk to multiple oncologists before you decide on Pluvicto. I call and set up appointments with other MOs to get second opinions.

- Try Zytiga + dexamethasone. I know it has a very low chance of working once you fail Xtandi, but I would try because he had chemo in 2023, and he did not try Zytiga + dexamethasone combinations

- Ask for any clinical trial that has excellent results for current patients

- Have you met a radiation oncologist? I do not rely on MO. I go RO every 3 months and find opportunities to radiate anything to reduce tumor load.

- Do you know about Xofigo Radium-223? That also reduces bone pain immediately

- have you tried other injections besides Eligard? or maybe surgery time

- How about 225 PSMA Actinium,

- Provenge

[Seasid in reply to God_Loves_Me]

Prostate cancer is a system disease. You should treat it that way and maybe some SBRT irradiation of the CRPC if you can see it on the PSMA pet/ investigational CT scan with contrast. My first medical oncologist professor Richard Epstein warned me not to do local treatments maybe only at very late stage of the prostate cancer disease, like xofigo and/ or SBRT irradiation of the cancer. Radiation should be mainly palliative.

[God_Loves_Me in reply to Seasid]

Agree