What’s Next?

[MJCA]

My bio illustrates my long 19 year journey with this disease. I turned out to be a great candidate for Pluvicto. All was going well. After cycle 3, a PSMA-PET showed all but one metastases were receding or dead. My PSA before cycle 4 was 17.7. My PSA before cycle 5 was 33.15. Due to the fast increase of my PSA, it was warranted I have another PSMA-PET before cycle 6. Unfortunately, Pluvicto has lost its efficacy. I had numerous mets to the spine, ribs, L femur. The PET also indicated that I had severe coronary artery calcification. I eat a fairly clean diet. A lipid panel showed no issues. I have been on a statin, Lipitor, for years. My PCP attributes the coronary issues to prolonged use of Lupron. My questions are 1. What’s next after Pluvicto? I believe it’s carboplatin, which I understand is platinum-based which my cardiologist states is not good for the heart and 2. Can long use of Lupron cause artery calcification? My latest PSA performed last week was 70

Sorry for the long diatribe. This is getting serious. Thanks.

[Tall_Allen]

1. How about Xofigo + Jevtana

2. My understanding is that calcification per se isn't the problem. The problem is "soft" plaques that can travel. Statins are supposed to make the plaques more rigid. GnRH antagonists (Firmagon, Orgovyx) might be better than the agonists (Lupron, Zoladex) for stable plaques.

[MJCA in reply to Tall_Allen]

Allen!

Thanks!! I will mention Xofigo to my oncologist. This PSMA-PET had two surprises: the failure of Pluvicto plus the coronary artery calcification. You know me by now, I just keep rolling with the punches!

[Miccoman in reply to MJCA]

Alan is right, of course. But my 2¢ is that you might consider getting rid of the atrophied boys and ditching Lupron and all that for good. I had and orchiectomy (polite word for castration) and am very happy I did. You can get testicular prostheses that will make you look whole but won't stand up to intimate encounters. Mind is clearer now, too. As always, YMMV

[MJCA in reply to Miccoman]

Interesting concept. I see my MO next week.