After two (2) Pluvicto infusions, my PSA went from 2,000. to 3,000. I haven't had any hormone treatments for approximately six months, and was subsequently told my Dr. should have kept me on Standard of Care (SoC) right through Pluvicto.
Q1: Anyone out there know of any options open to me in this situation?
Q2: would continuing with Pluvicto with hormone treatment be reasonable?
Frank.
Doesn't appear to be a positive response....where are you being treated?
Q1: Cabazitaxel chemo or this trial: urologytimes.com/view/psma-...
Q2: You could try to continue Pluvicto with Xtandi which increases the PSMA expression of the tumor and makes Pluvicto more effective. urotoday.com/conference-hig...
Pluvicto is only FDA-approved along with ADT.
My oncologist wants me to start Pluvicto this month. I have looked at the FDA and Norvartis' requirements for Pluvito eligibility. Per the FDA.gov /drugs/....... on March 23, 2022.
"for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR) pathway inhibition and taxane-based chemotherapy"
And
"Patients with previously treated mCRPC should be selected for treatment with Pluvicto using Locametz or another approved PSMA-11 imaging agent based on PSMA expression in tumors. PSMA-positive mCRPC was defined as having at least one tumor lesion with gallium Ga 68 gozetotide uptake greater than normal liver. "
Just two weeks ago I was diagnosed with significant bone mets using Lu-177 PSMA PET CT scan. I was told this week that I had to have a second scan with Ga-68 PSMA PET CT to be eligible as noted above. Previously I had been diagnosed with multiple mets in my lymph system with rising PSA. PSA was 58 at my last lab.
They also have to receive "best supportive/best standard of care (BS/BSOC)" because that was what the VISION trial dictated. Best standard of care for mCRPC patients always includes ADT.
My Onco said that I would be on ADT concurrent with the Pluvicto. What I copied before was from the FDA published doc. I have seen the ADT requirement in other docs as well (as part of concurrent SOC). I was only trying to state the eligibility requirements and not the treatment protocols.
The Vision trial used Pluvicto along with the SOC treatments the patient were receiving. When I had Pluvicto last October, I continued on ADT and Darolutamide.
I remember my dad's nuclear medicine doctor saying enzalutamide can increase PSMA expression which could be helpful with the pluvicto treatment. I also remember him saying PSA can increase before decreasing. He was still getting the regular ADT (lupron shots every 6 months).
I had 3 rounds of Pluvicto and stopped it after #3 because my PSA kept doubling. The oncologists agreed that it wasn't working. It screwed my PSA levels up. Went from around 2 to now 20. I t has started to go down. I'm currently on Jevtana chemo with prednisone.
Doesn’t pluvicto kill cancer cells expressing PSA? I know it does I guess im saying a lot of warriors get quite a PSA bump from this treatment. Couldn’t the bump in PSA be related to a bunch of dead cancer cell organelles/psa antigens molecules in blood stream?
As far as I know.... ADT isn't stopped. It is given concurrently with all treatments... Maybe except bat protocol
Repeat a PSMA PET scan now to see if there has been progression, where and how much. And get on ADT plus an ARSI such as enzalutamide or other promptly. Then, given the findings you might want to consider a combined Ac225 + Lu177 radioligand treatment(s) if you still want to pursue further PSMA targeted therapy. It would be out of pocket in Germany. Perhaps Scott Tagawa's trial of AC225-J591 at Weill Cornell if you meet the cirteria.
PSA and Testosterone 
Neuroendocrine and PSA 
