Pretty much the same thing is happening to me....after the second Pluvicto injection, I was having a much harder time recovering from fatigue, malaise, loss of appetite and difficulties evacuating . My PSA had risen from 17 to 24, that's the highest jump I have had so far in my four years battle.My oncologist immediately schedule for a bone and upper body scan to see if more metastatis has occured. I am doing the scans tomorrow ( 2-26 ) . Depending on the results, he will evaluate weather to continue on with Pluvicto or not. I am glad i found your post and others. It is possible that the PSA my lower and rise indipendently from other factors I guess. The only sure way to determine progression lays in imaging.... a bit nervous about tomorrow, but I hoping the results will be ok. Thanks.