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Next Steps after chemo

Posted by jmbrooke @jmbrooke, Jun 28 9:15am

Hello,
I am 52. Diagnosed in March with prostate cancer 9 Mets to bones. Mainly on sacrum. One on skull. PSA 220. Gleasons 7s &9s. I began triplet therapy in April and just finished my 4th round of chemo. My PSA is down to 9.8. I have a PSMA scan scheduled for the end of July. I guess that will tell a lot of the story, but I am trying to figure out what options I will have after chemo treatment. Appreciate any advice. Thanks

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heavyphil | @heavyphil | Aug 18 7:04am
In reply to @jmbrooke "Thanks. This is summarized report from scan. Partial response to therapy. Smaller and less intense focal..." + (show)
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Thanks.

This is summarized report from scan.

Partial response to therapy. Smaller and less intense focal area of pathological tracer accumulation in the left lobe of the prostate gland and smaller, less tracer avid and more sclerotic osseous metastases. No new tracer avid lesions.

Both oncologists at Mayo and Fred Hutch have said to continue on ADT for now without radiation. I’m going to MD Anderson next week for another opinion.

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So you still have a prostate gland; your original treatment was radiation?

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jmbrooke | @jmbrooke | Aug 18 7:45am

Still have prostate. Original treatment was chemo and ADT. I have not done any radiation.

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beaquilter | @beaquilter | Aug 18 10:20am

I thought you'd only qualify for pluvicto if the PSA starts going up again? Really when it starts doubling, but that could even mean from 0.2 to 0.4!
Did you finish chemo?
My husband is past 4th dose of chemo and has been on firmagon since February I think and about 6 weeks later started zytiga. His PSA is lowering, drastically at first but now it's not so much but any bit helps. I think the last two readings were 1.5 to 1.3 he started at almost 300!

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jmbrooke | @jmbrooke | Aug 18 11:29am
In reply to @beaquilter "I thought you'd only qualify for pluvicto if the PSA starts going up again? Really when..." + (show)
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I thought you'd only qualify for pluvicto if the PSA starts going up again? Really when it starts doubling, but that could even mean from 0.2 to 0.4!
Did you finish chemo?
My husband is past 4th dose of chemo and has been on firmagon since February I think and about 6 weeks later started zytiga. His PSA is lowering, drastically at first but now it's not so much but any bit helps. I think the last two readings were 1.5 to 1.3 he started at almost 300!

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Yes, I finished 6th round three weeks ago. PSA from 220 to 3.6. My understanding is standard of care is to wait on Pluvicto until ADT stops working but I’m trying to understand why wait.

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beaquilter | @beaquilter | Aug 18 12:11pm

That's exactly what we asked! It's all about protocol and insurance!
I asked if it's kind of like giving antibiotics to a cold vs an infection....but that's not it
A few months ago they removed the chemo requirements. On their website it only lengthens life by 3-5 months so why not start earlier?
It's something like 20k per injection here in the US...or you can go to Germany or India and pay for it cheaper. Don't know how much cheaper and what about the week after where you're radioactive? You can't fly obviously and what about if you're in a hotel? I don't get how it would work out.
They told my husband that ADT might stop working after 18-24mths we'll see.
It's extremely frustrating!

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jeff Marchi | @jeffmarc | Aug 18 12:19pm
In reply to @jmbrooke "Yes, I finished 6th round three weeks ago. PSA from 220 to 3.6. My understanding is..." + (show)
Profile picture for jmbrooke @jmbrooke

Yes, I finished 6th round three weeks ago. PSA from 220 to 3.6. My understanding is standard of care is to wait on Pluvicto until ADT stops working but I’m trying to understand why wait.

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There is a good reason to wait. If chemo has worked and has reduced the metastasis and PSA significantly, then Pluvicto doesn’t make sense, yet.

If later, the cancer comes back and multiple metastasis appear, that is the time that Pluvicto is recommended.

They don’t normally do Pluvicto when there aren’t multiple visible metastasis. If there are only a few, then they prefer to zap them with SBRT radiation.

It is now possible to get Pluvicto before chemo. If there are multiple metastasis visible, then there is a choice between chemo and Pluvicto. They don’t give pluvicto if no metastasis are found. The same is true for chemo.

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