Is there any order to when new medications or PARP inhibitor are tried?

[Shorehousejam]

My medical oncologist is hell bent on me doing Lu 177 pluvicto next, I was hoping to try other things first…

Medical Oncologist suggested waiting for the next two months to see if PSA is still rising…and to do a pet scan

Diagnosed 06/2022

Gleason 8/9 Oligo metastatic 3 lytic lesions two resolved

Started Firmagon 7/6/2022

Zytiga with Prednisone 7/20/2022 currently still on these meds

Docetaxel Chemotherapy on 08/11/2022

End Docetaxel Chemotherapy on 12/23//2022

Completed 6 cycles @ 21 Days

Had Davinci Radical Prostatectomy with Lymph Node Removal on 03/14/2023

Only 8 Lymph Nodes Removed, according to operating urologist surgeon that is what he saw to remove

Germline; BLM missing a copy

Genome: Tier 1 ATM Frameshift Alteration

Mass on prostate bed I haven’t radiated as medical oncologist thinks it’s better to treat with systemic therapy. I believe this is causing my PSA to rise.

I prefer to radiate, as I finally have my colitis under control with no more bleeding, it’s been a long road with that issue since last July

What number PSA do I wait to before getting a pet scan?

Jan 4, 2024

0.46ng/mL

<=3.99 ng/mL

Dec 7, 2023

0.29ng/mL

<=3.99 ng/mL

Nov 7, 2023

0.11ng/mL

<=3.99 ng/mL

Oct 10, 2023

0.09ng/mL

<=3.99 ng/mL

Sep 7, 2023

<0.06ng/mL

<=3.99 ng/mL

[cesanon]

Lu 177 pluvicto works only on certain types of cancers.

You first want to get scanned to make sure you don't have half and half of each kind.

I forgot the proper scans to do this.

But Tall_Allen knows.

Probably best to do it now, before you run into an immediate need for the results of those scans.

They have the most experience with this stuff in Germany. Maybe that's where you should go to get it done.

The scans and the treatment.

[Shorehousejam in reply to cesanon]

What’s half and half?

[cesanon in reply to Shorehousejam]

A mix of different prostate cancers. Half of which will be unaffected by that particular treatment.

[Shorehousejam in reply to cesanon]

How do I find that out?

[cesanon in reply to Shorehousejam]

There is a lot of discussion on the subject in this forum.

Basically you get two different types of scans. TA knows what these two scans are (Tall_Allen)

[Bethpage in reply to cesanon]

PSMA and FDG-PET

[cesanon in reply to Bethpage]

Yes yes yes, those are the two scans.

It's a no brainer. Just get them right now. Don't wait.

[Shorehousejam in reply to cesanon]

Ok Thank you

[lokibear0803]

One combo is Pylarify for PSMA+ and FDG for PSMA—.

You look for level of discordance — the mix of PSMA + vs —. If no PSMA—, there isn’t any discordance, and Pluvicto can be a good bet. Even with some discordance, there are trials proceeding with Pluvicto anyway. There are also recent trials using alpha emittter (e.g. AC225) instead of or in combination with beta (Lu177, as used with Pluvicto).

[MateoBeach]

Now. Get the PSMA PET scan now since PSA > 0.20. Consult a RO in the meantime about salvage RT to prostate bed and SBRT to oligomets. Decide on Pluvicto based upon the PET scan results.

[Gmailer]

See if your cancer will respond. Of course you need to have the PSA-pET68 for that. If you can afford it Dr. Sen has been doing this for 10 years here in Delhi. Yes, Delhi, India is correct. I have 9 1/2 years now with vaccines that seem to have done the trick, although for me I am not cured. I just had some more done as I was at .78, and knew it was time. My oncologist took me off Zytiga for two months and my PSA went to .78 from .22 in about a month which is going to the extremes for me. Good thing it went down to .08 last time which means I didn't need the radiation for now. I may do that later. The radiation here has all the dosing so you get a lot stronger than you get in the states. 18k is a lot of money for many of us. It was a long trip for sure from Newark for me. I will be getting my first shot today so I am hoping I will feel it. I sure did the first time for sure. I have only done Lupron for two years due to the side effects from it. I can tell you one pilot that did the radiation appears to be cured of this dreadful disease. Another has 6 1/2 years so you never know. This is in India. I am glad my PSA went down so far that I don't qualify for radiation now. Need to be at least .50 to see it in the scans. I was diagnosed in August, 2014 with a PSA of 212. We found out here when I did the PSMA PET-68 scans in 2017 that it was in my bones. The vaccines took care of it, and I had a prostatectomy in September of 2019. Vaccines wouldn't get rid of it. I pray that you can find something that works for you. Zytiga actually quit working back in 2017 and it wasn't good at all. Still fighting this thing. At least I know I should have it out. Radiation does work for some people, but you need to get checked to make sure kit may work for you. It is about 19k here if you do the other pet scan like they do in Australia. That's for everything. Of course that's a lot less than in the states if you are there. Pretty sure I will make it to 10 years which wasn't good at all for me.

Best of luck to you.

Never know which disease you have. Hopefully, I am at least through most of it.