Post Hormone Therapy and now CrPC- Shoudl next step be Pluvivto/Lutetium or Chemotherapy

[mg_22]

Hi. My father (84yr old) was diagnosed with prostrate cancer in 2011- he got radiation at that time and the cancer returned in 2018. Sinc ethen, he has gone through hormone therapy (Luperon, degarelyx, , Enzulatamide, Arbiterone , ) and the cancer is now Castrate/ Hormone resistant so we need to move this treatment to the next stage. It is stage 4 metastatic, has moved to lymph nodes but is not in the bones. We have the option to either start Pluvicto/Lutetium or Chemotherapy. We are leaning towards Pluvicto/ Lutetium as it seems to be more targeted treatment and has lower side effects. Pretty big decision, and some questions are haunting me and hoping sombody can share their experiences with this: (1) Does starting with Pluvicto reduce expected longevity - will chemo still be an option as somebody mentioend, pluvicto is hard on bone marrow and then chemo may not be tolerated. If yes, Does doing chemo first and then pluvicto enhance longevity (2) Pluvicto results in radiation exposure to the body- I would imagine the body can take only that much radiation and if once you start the treament, do we start a certian countdown (whereas if we do chemo, the countdown doesn't start) . Any thoughts would be much appreciated.

Update- Jan 25, 2026

Thanks you all for your thoughful suggestions. We decided to go with Pluvicto/ Lutetium therapy. Our Rationale follows- We did not get a sense that there are any clear answers on longevity/ rectivation of receptors in Chemo Vs Pluvicto. However, we did get a sense that side effects are expected to be lower which made intuitive sense considering this treatment is more targeted. Also, with a push towards Pluvicto also being considered as first line treatment (even before becoming hormone resistant), though not approved, seemed a positive sign. Finally, it seemed there is a way back to come to chemo (check in after two sessions) if required, as our father, though 84, very diabetic and overweight, is asympotomatoic, and is in relatively decent mental and physical state. Hoping for a positive outcome.

[j-o-h-n]

Good Idea to post your questions/concerns in the ADVANCE PROSTATE CANCER (stage IV) group. Just copy yours from above and paste it there........... better room to use for you dear Dad in fighting his Pca.

Good Luck, Good Health and Good Humor.

j-o-h-n