Results as reflected in PSA downward trend continues to impress! Current PSA is 0.030 down 80% from pre-treatment level.
Reviewing: I am mHSPC, lymph node only to pelvis and abdomen. No bone involvement. Diagnosed in 2007 Gl 4+3. RARP had ECE, SVI and positive margins. Underwent docetaxel and prostate bed only SRT in 2007.
In 2014 my PSA was over 5.0 and went on bicalutamide + dutasteride as alternative ADT. Positive PLNs on PSMA in 2019 led to hemipelvic SRT and 6 months ADT.
However, PSA rising in 2021 to 0.20 and repeat PSMA PET showed recurrence in two new LN sites, one para-aortic, so now metastatic. I started a modified BAT program in 2019 because of sarcopenia and spinal collapse with nerve compression.
For the current recurrence I chose:1) SBRT to the 2 nodes. This was done April l1-15 2022 in Bend, OR.2) Followed 4 weeks later with Lu-PSMA-J591 radioligand treatments in Perth Australia with Dr. Nat Lenzo of GenesisCare AU. This was two infusions only, two weeks apart. Side effects wer one week of moderate fatigue and diarrhea. Blood counts dropped mildly and promptly recovered.
PSA before treatment May 6, 2022 was 0.149. 0.176 in March 2022. PSA declined to 0.057 by one month July, 1 2022. Down to 0.048 Sept 19 (4 months after), and now down to 0.030 8 months after treatments.
Note that I am also on my modified long-cycle BAT regimen. (Not in clinical trial but overseen and monitored by my MO.) I have detailed this in other posts but basically consists of 8-10 weeks of high dose testosterone cypionate, 400mg every 2 weeks, a transition to short acting T-gel, then 4 weeks of ADT using Orgovyx. This has been exceptionally good for my body and QOL. But I cannnot seperate the benefits from the SBRT/ plus Lu-J591 treatments in May, from the benefits from the mBAT. I am just happy they are continuing to work at this time.
Thanks everyone for your support. Paul aka Pablo aka MateoBeach
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Thank you for sharing and congratulations on your results! I am curious who and how came up with the "modified long-cycle BAT regimen"? I will read your earlier posts, if the answer is there. Also what's "Lu-J591"? How is it different from Pluvicto and is it FDA approved?
My older posts probably have more detailed info about how I crafted my long cycle mBAT and also about Lu-J591 as a (probably) better radioligand for PSMA targeting radioligand therapy vs Pluvicto.
I had developed severe sarcopenia (loss of muscle mass and strength, often with obesity or overweight). This was a result of ADT and otherwise inadequate hypogonadism. I had the full gamut of symptoms. The worst of which was loss of muscular support of spine and degeneration of vertebral discs. I had spine collapse at L2 with severe disabling nerve compression pain requiring two decompression surgeries. In order to heal I needed supplemental testosterone. I designed a BAT protocol that was therefore on longer periods of high testosterone, 8-10 weeks. Then followed by 4 weeks of castrate T from ADT (Orgovyx) to keep my prostate cancer populations in check. Same theoretical foundation for conventional BAT but with extended cycles. It has worked very well for me going on two years now and I remain hormone sensitive even though out 15 years with APC.
J591 is a humanized monoclonal antibody targeted to find and bind the PSMA protein on PC cells it Carrie’s the same 177Lu isotope that can kill the cancer cells when so bound. It’s binding and persistence is very much stronger than the weak binding of the Pluvicto ligand. So more efficient at targeting and killing PC cells anywhere in the body, even tiny micro metastases and circulating tumor cells that do not show on PSMA scan. It is experimental and only available in Australia at this time to my knowledge. There is a clinical trial underway through GenesisCare in Perth for mCRPC using it. I was not in the trial since mHSPC so paid out of pocket. Due to efficiency, less Lu isotope is needed so costs were not bad. I am very pleased with the results so far. It is an excellent option for some with low volume residual cancer after SBRT who have low SUVmax and don’t qualify for Pluvicto. Personally, I believe it is superior. However it does have significant marrow toxicity since it circulates much longer than Pluvicto does. This does recover but must be monitored. No kidney toxicity since it is not excreted through the urine, but rather the bile.
Bayer is currently developing their own monoclonal antibody radioligand. And Weil-Corning is using the J591 to deliver Ac225 in an early phase clinical trial. Paul
I assume high testosterone levels of the BAT add to your quality of life?
Did you consult yourself with an endocrinologist?
I am curious what was the cause of your spine collapse? I am osteoporotic now 4.5 years on Degarelix ADT injections and probably heading also that way.
When did you have your last dexa scan? Do you have intentions to have one?
The PET scan and even the best CT only picks up down to 2mm or 4 mm.
I was wondering if the dexa scan could give you a peace of mind? It could maybe under certain condition pick up multiple small mets if they are close together but smaller than 2 or 4 mm? This is only my thinking maybe it is just theoretically possible under certain condition.
What do you think?
I think our member Lewicky stopped taking ADT for already 2 years afte 225 AC in Germany.
Yes IAm indeed keeping it in mind. Would have contacted the lead at Weil-Corning to see if I could get it out of trial. Nat Lenzo in Perth also mentioned it but he cannot get do to the W-C patent. But since PSA still dropping no need to pursue now. Good thinking, Seasid.
See my reply to Oldguy above with more details. Dexa scan 3 months ago showed no longer osteopenic, due to testosterone, Xgeva and much exercise. Now that my body is well healed and stronger, No spine pain. Consulted 3 smart urologic oncologists in approving my regimen who are very knowledgeable. No endocrinologist needed.
You said before that you are on Prolia. What made you to switch to Xgeva? It may be necessary if you plan to use Actinium (alpha particle emitter like Xofigo is.) I am not an expert on that.
I would feel more comfortable with Prolia. Xgeva is too strong.
Good question. Indeed it is a matter of comfort with it. I have not had any bone mets and want to stay that way. I do believe the soft evidence that denosumab alters bone micro environment to be less favorable for metastasis. But too much of it for too long appears problematic. I decided to increase intensity for one year from Prolia (60mg, 6months) to Xgeva dose 120mg at 3 month intervals for a year. Then I plan to go back to 6 month dosing again. No. clear answer. Will discuss with MO tomorrow.
You could also go to the endocrinologist like me if you wish.
I was really shocked that you are changing to Xgeva.
I digged up a resent research paper from Basel the home of Novartis which said that bone strengthening agents are only good for breast cancer for older ladies if I good remember. Definitely not for prostate cancer like us.
Bone-Targeted Agents and Metastasis PreventionRobert Coleman
Additional article information
Abstract
Simple Summary
Bone metastases are common in cancer patients and the role of bone-targeted agents in prevention of metastasis have been evaluated in multiple clinical trials over the past 20 years. Results show that in breast cancer the use of adjuvant bisphosphonates (and possibly denosumab) reduce bone metastases and breast cancer deaths in postmenopausal women. These effects are in addition to the benefits associated with the use of standard adjuvant endocrine, cytotoxic and targeted treatments with prevention of one in six breast cancer deaths at 10 years. Similar benefits have not been observed in other cancers that typically spread to bone, such as prostate or lung cancers. Biomarkers that can predict patient benefit from the use of bone targeted treatments in the adjuvant setting are being evaluated. Currently, tumour expression of the transcription factor, MAF, seems to be the most promising biomarker; benefits from adjuvant bisphosphonates are seen in the 80% of patients with normal levels of expression irrespective of menopausal status, while over-expression is associated with a poor prognosis and a higher rate of visceral metastases.
Better question. What was the maximum number of mets what you had? I hat 15 bone mets at my diagnosis, some of them in my neck. I can't use BAT or anything too risky. Still I am fine now without any visible mets and I am only on ADT since June 2018.
I went to the RO to see if I have any CRPC mets to radiate and we didn't find any. Therefore we made a decision to irradiate my prostate.
And that is exactly the optimal setting for Lu-PSMA-J591 treatment, micrometastatic disease only after SBRT. And plays well with BAT. Dr Lenzo asked me to stay on high testosterone phase through the treatments in Perth and for 3 weeks after.
Congratulations on your success! You seemed to have been treated with a version of LU177 which is new to me. I hope to start treatment in a PK Clinical trial with Dr. Scott Tagawa at WeilCornell NYC after a visit on 29th of June. This is treatment with LU177-PNT 2002. Four treatments at 8 week intervals. I started a thread on those having/having has LU177 treaatments at :
I see that the LU177-PNT 2002 is just a different name for Lu-PSMA- I&T which is another small molecule radioligand tha has been around for quite some time and is not actually new. It is very similar to the ligand Pluvicto. It is also regally excreted very rapidly limiting the radioligand availability to bind and kill the PC cells. I suspect it is being tested in SPLASH to get it approved to compete with Pluvicto. Yes there will be some efficacy, we already know this from long usage in Australia and elsewhere.
Scott Tagawa at WC is also heading trials with the monoclonal antibody ligand J591 and Ac225 alpha emitting isotope. This is much more promising on my opinion and suggest you bring it up for discussion during your counseling for the trial. Paul
My initial response was encouraging with LuPSMA177. PSA went from 8.1 to 0.19 after the third infusion. But slowly crept upwards after that. Since meeting with Denmeade in January, I have been conducting a self administered BAT protocol. Responding well. When it shows signs of failure, Xtandi for 2 to 3 weeks then back to BAT.
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