Zytiga no longer working - Pluvicto vs chemo

[Bspouse]

Hello. My husbands PSA has been rising since last August. From .50 to now 1.71. It has been rising slowly and MO kept saying to wait. We went for second opinion at Sloan Kettering and got the answer. Most recent PSMA PET scan in November showed no new mets and most of his original many metastasis to bones and lymphs have 'dissappeared' although maybe they are just undetectable. Both doctors said wait until PSA goes above 2.0 and do another PET scan in May. They also didnt see any benefit in switching from prednisone to dexamethasone. My husband has no pain.

His MO is leaning toward Pluvicto as next option since he already had chemo. But husband is concerned about the radiation and the need to self isolate from Pluvicto. We have 4 young grandchildren and my daughter is pregnant. Literature says 2 weeks away from a pregnant person after getting dose of Pluvicto. My husband feels that being with the kids is what keeps him going and makes him happy so he doesnt want to lose precious time with them. And he doesnt want to take a chance of exposing them to any radiation at their young age. So he is hesitant about taking Pluvicto and leaning toward chemo again since he tolerated it well 4 years ago.

Any thoughts on this? Is Pluvicto worth it? It seems like it works for some but not all. Any other options? We'll of course ask his doctor when the time comes but we want to be prepared.

Thank you for support and insight.

[Bspouse]

Also - He had genetic testing a while ago and does NOT have any BRCA or any other of the tested mutations. Sloan Kettering is now going back to his original biopsy to look at genetics on that.

[Tall_Allen]

That question is exactly what was examined in this clinical trial:

prostatecancer.news/2020/05...

As you see, the sequencing made no difference in survival, although Pluvicto had an advantage in reducing PSA and delaying progression. Maybe discuss the questions at the end with your oncologist.

[Bspouse in reply to Tall_Allen]

Thank you for sending this, Tall_Allen. I was hoping you would have some ideas.

The questions at the end are all valid. I thought he would get taxotere again but do they always use Jevtana in the 2nd chemo? It sounds like jevtana has worse side effects. I was wondering if they should do an FDG pet scan as well as the PSMA scan, it sounds like they should.

Have to say the 19.6 month average overall survival has shaken me.

[Tall_Allen in reply to Bspouse]

That was just the median survival in that group of patients -- there was wide variance.

[rowdy1 in reply to Bspouse]

97 months survival here, Type 4 mets to bones. I have been NED progression for 3 years now. Thank you Jesus and my Doctors and the nurses too. I love writing NED, because that is what they say if you are cured. I just am at a long push against this beast.

[anonymoose2 in reply to rowdy1]

Thank you for the great report brother in Christ.

[CountryJoe in reply to Tall_Allen]

Forgive me for jumping on this conversation. 7 years into this battle, with 3 years of ADT and 3 years of vacation, I am back on ADT (Zoladex and Casodex). My PSA went up to 40, then with 3 months of ADT fell to 9. From there it has been dropping slowly1 point per month. Now at 8). It's going down but sooo slowly. A recent scan shows mets to the spine, ribs and skull, although less than a previous scan). Am I in resistance? My MO wants chemo, but I am reluctant. Please give me some advice.

[Tall_Allen in reply to CountryJoe]

If PSA and b one metastases have decreased, you're not resistant.

[CountryJoe in reply to Tall_Allen]

Thank you for responding, TA. My plan is to continue with the Zoladez as long as there is downward movement regardless of the slow monthly decline. Is a PSA of 8 worrisome?

[Tall_Allen in reply to CountryJoe]

It's good compared to 40.

[CountryJoe in reply to Tall_Allen]

🤣🤣🤣

[dk73]

hubby has done it all. Surgery, radiation, taxotere, Zytiga, Xtandi, more taxotere. Pluvicto caused major skeletal bone spread. Quit after 4. Now on Jevtana chemo every 21 days until it no longer works. Started at age 64, now 72.

[Bspouse in reply to dk73]

I was wondering if my husband could get taxotere again, Did taxotere work the 2nd time? I’m sorry Pluvicto didn’t work for your husband, How is he tolerating Jevtana?

[dk73 in reply to Bspouse]

The second time with taxotere did work but after #9 he got covid and had to stop. His PSA was .8. By November it was 27 and he started pluvicto. After #4, he was switched to Jevtana. His PSA went back down again from 235. But he got radiation cystitis in September’24. Battled it for 3 months. Had to go off chemo. Once back on PSA went over 500. It’s down to 300 now. If it doesn’t go down more or stabilize, he will go on hospice

[Bspouse in reply to dk73]

I praying that it keeps going down.

[TJGuy]

Waiting for scans to find your PC would seem the best choice here. Your at a opportunity to kill PC with a number of different methods, don't pass this up, you need to know where your PC is and then kill with a number of methods. Going to 2 or 3 isn't a problem.

[Bspouse in reply to TJGuy]

Thank you.

[Proflac]

I really feel for you in this dilemma. From what I think I know(!) It's difficult to predict at the present time, (assuming PSMA scans etc show a response is possible), if pluvicto will be successful in any given individual. The quality of life issue is so important to your husband - I can sense that all that time not being able to hug his grandkids or daughter is a real concern. With chemo he will be immunosuppressed, though that's really a risk to him not them Best of luck with your decision. We decided not to go with pluvicto for similar reasons, although there were other factors involved in my husband's case. Our grandchild is our heart's delight and often the only thing to light up the day. Its a tough one. I hope you manage to work out what you feel happiest with - its always a gamble, but from the evidence, it looks like chemo first was not inferior. Good luck.

[Bspouse in reply to Proflac]

Thank you for your kindness and understanding. We want whatever will give him the best chance of holding back the cancer, but quality of life is so important. For now we’re just spending as much time as possible with the grandkids.

[stealthrider]

Zytiga stopped working for my father in law, switched to Xtandi and that worked for a couple years. PSA starting to creep up again.

[Bspouse in reply to stealthrider]

Thanks , that is another option.