Early use of LU-177?

[MiRob]

Hi does anyone know of studies/trials or cases of early use of LU-177 on PC patients with low cancer burden? My current PSA is <0.06 but is concidering early LU-177 treatment when my psa starts climbing again in the future.

Diagnosed juli 2015 psa 15. Biopsy 10/11 Gleason 9. Had RP and 32 nodes removed. 2 had cancer plus one seminal vesicles. Scans all clear.

Post RP psa <0.1

Aug, 2015 psa starts to accelerate. Scans (Choline C-11) only shows some cancer in RP area, but is refused radiation therapy. Diagnosed metastatic and placed on Bicalutamide 150mg

psa 1.1 -Nov. 2015. Dec. 2015 -8 rounds of chemotherapy.

Post chemo April 2016 psa <0.09. Adding Metformin 1000mg and Statin 40mg to the Bicalutamide treatment.

Psa 0.5 -june 2018. Bicalutamide dosages raised to 300mg. Gets a PSMA PET scan that “only” shows some cancer on the back of the bladder wall and some part of the RP area. Offered radiation therapy (32x) after second opinion at another hospital.

Post radiation psa aug. 2018 <0.06

Psa dec. 2018 still <0.06

I’m 56 years old and living in Scandinavia

[Tall_Allen]

If you are talking about Lu-177-PSMA and you are not showing significant PSMA-avid metastases, I doubt anyone would give it to you. Why would you want all that systemic radioactivity with nowhere to attach to? The external beam radiation seems much less dangerous.

[MiRob in reply to Tall_Allen]

Hi T-Allen. Thank You for Your reply. I’m only thinking ahead. You’re totally right. At my current status I do not have sufficient PSMA expression to benefit from LU-177. But if my cancer makes a recurrence and my psa starts to climb in the future when would be the right time to consider this treatment? And is it being used on low burden patients? Right now It’s seems Lu-177 is primarily used later in the process on patients with high cancer burden.

My thought is to go aggressive on the cancer when the burden is low and I’m fit and strong. Also I would like to postpone starting up on stronger ADT for as long as possible.

[Tall_Allen in reply to MiRob]

As I said - no one would give a powerful beta-emitter systemically when there is nowhere or limited sites to attach to.

[MiRob in reply to Tall_Allen]

I Agree. To your knowledge when would be the right time to consider this treatment? And at what PSA level?

[Tall_Allen in reply to MiRob]

When there are multiple distant metastases that are PSMA-avid

[Seasid in reply to MiRob]

Not when the cancer is low volume. It is not effective and toxic to your kidneys etc. According to doctors from Bonn.

ncbi.nlm.nih.gov/pmc/articl...

[Seasid in reply to Tall_Allen]

You are correct, in low volume prostate cancer Lutetium177 therapy is toxic and not effective according to these German doctors from Bonn.:

ncbi.nlm.nih.gov/pmc/articl...

[rococo in reply to MiRob]

Excellent pro active planning

[Tall_Allen in reply to rococo]

Please explain what proactive planning means in medicine and why it is good to do.

[MiRob in reply to Tall_Allen]

Proactive planning is not meant as treatment before it is required. I apologize if it could be understood that way.

To me proactive planning is looking at and getting knowledge about all possible well known and medically available (current treatments) for my own future treatment.

Unfortunately I got metastatic G9 disease and have been informed that my PC will eventually end my life. For the time being my PSA is only 0.06. I’m really grateful for this and I am living life to the fullest. But I also know that someday in the future I will need to have other treatments. I believe in the idea of aggressive treatment while my cancer burden is low and I’m strong. So my proactive planning is simply to prepare for what that possibly could be and have some understanding of it. (Like availability, possible positive effect and negative side effects)

[Tall_Allen in reply to MiRob]

I believe that what you call "proactive planning' is a license to give way to anxiety and is counter-productive. There is always plenty of time to choose your treatment plan as things progress, when they progress, and diagnostic criteria emerge. It is a myth to think that you can plan in advance. Whatever you "plan" now will be completely irrelevant as new treatment options become available. It is much better - less anxiety-producing - to live in the moment and deal with things as they are now. Otherwise you are giving your mind free range to worry about fictional possibilities. I advise you to take it as it comes.

[Burnett1948]

Burnett1948.MiRob I don't have the knowledge of Tall_All. I have had a PSMA PET scan which found a lymph node and for which I have had radiation. I find out the results in 2 days time. I understand that the PSMA PET scan marks metastasis for injected LU-177 to find and hopefully kill. I also know LU-177 is still being trialed. Given your history I can understand you wanting to give LU-177 ago. In Australia if you can't get on a trial it costs $10,000 for a course of LU-177.

[bobdc6]

I too like to keep up with all options, and keep a list from others who have "been there, done that". Here's a reference from a PC patient who was treated with LU-177 there.

LU-177 in Bonn Germany

[e-mail]>

Universitätsklinikum Bonn

Sigmund-Freud-Str. 25

53105 Bonn

Tel.: [phone]

Fax: [phone]

[Seasid in reply to bobdc6]

A paper from Bonn hospital explaining why Lutetium 177 PSMA therapy is not effective and even toxic for low volume prostate cancer:

ncbi.nlm.nih.gov/pmc/articl...