Radiopharmaceutical treatment now instead of last resort.

They frequently do not want to give people Pluvicto unless they have visible metastasis. They are warming up to the idea of giving it sooner rather than later. You have to depend on your doctors to be willing to do that.

Have they told you it is not possible to use SBRT to zap the metastasis you have? That is another option.

Jeff.

No Not yet. I’m switching my care to Mayo Rochester in May. I’m only a couple of months into this journey. Biggest issue so far is not the cancer but trying to fight with insurance for approvals at almost every step of the way.

We’ve only talked about ADT, external beam radiation, and possibly chemo if/when the first two don’t work.

I was negative for all germline genetic tests. Negative for somatic genetic testing as well so I guess immunotherapy is out. …

@lanksta25 from my reseaRCH, even with Gleason 10, Stage IV, the ADT ( Orgovyx and Nubeqa) should bring your PSA down dramatically, then prob 45 seesion of EBRT. then see what is going on...you may never need Pluvicto !

also, they might want to give you a short round of chemo as well..at this point, how well you respond to the ADT is big prognostic indicator and later after radiation, might be a better time to asses further treatments if needed at all.

@lanksta25 Welcome to the club fighting for coverage. I have filed 7 appeals with the insurance typically rejecting and outside review approving. Now trying to get IMRT paid (was authorized on appeal, but fine print says authorization is not a guarantee of payment). This is on an employer self-insured plan. The insurance administrator must get a big bonus for rejecting claims.

@jim18
This sounds like no insurance at all. There are some low cost plans that are designed to just pay as little as possible and not really be sufficient for a cancer case. It’s not that the company pays, it’s that they pool the money employees pay and that’s all they have. If your case is expensive, they can’t afford to pay for it. Are you working for a large company?

You should ask your employer How this plan was designed. It may make sense to find a different job. All plans have to cover you, Even if you have a pre-existing condition.

@jeffmarc I work for one of the the largest aerospace and defense companies in the world. So it’s massive. I have the best insurance plan the company offers with secondary insurance, critical care coverage, and maxed out HSA.

It’s just the way employee commercial plans are these days, in my opinion. Always deny at first because a certain percentage of us just won’t challenge it. Pretty sure it’s standard procedure to deny claims for some billing codes and make us try and try again. We give up or get pushy. It takes a lot of work, patience, and time.

@jeffmarc Anthem BCBS with $1000 deductible, $6000 max, 10K+ employees. Get a lot of Not Medically Necessary. Expect it would be the same with UHC since they have a much higher claim denial rate. Have learned to stay away from Medicare Advantage when the time comes.

Consider that when Pluvicto (Lutetium-177) went through clinical trials, it was only intended for those who had already exhausted all other treatment options; this was their treatment of last resort. Since then, there have been clinical trials demonstrating its efficacy earlier in treatment of the disease - but, not as the first line of treatment.

So, it’s not about being “50 and want to give Pluvicto a try” or about fighting with insurance companies.

It’s about whether or not you meet the eligibility criteria for use, which is generally for those who have failed standard of care treatments, and have:
> PSMA-positive metastatic castration-resistant prostate cancer, who have already received 1-2 chemotherapy regimens and androgen receptor pathway inhibitors (ARPIs).

If you meet those criteria, and your treatments aren’t working, then you may be a candidate.

(During April-May 2021, I had 28 sessions of proton radiation + 6 months of ADT for a localized 7(4+3); Medicare paid for it all.)

@brianjarvis

The requirements for chemotherapy prior to Pluvicto Have been eliminated. That should open it up to a lot more people getting it sooner. I have run into a couple of people in the last few weeks that are getting Pluvicto instead of chemo. This is usually because they have health conditions or are at an age that chemo would cause too many physical problems. Pluvicto is definitely easier to tolerate.

Pluvicto is very expensive in the States. Hopefully it will be cheaper where you go.

For such a young man, your PCa is very strong and needs the most stern intervention possible. Pluvicto in the States is only indicated for castrate resistant mets. Use overseas is off label. Pluvicto should do as well and may be better than other treatments. It is so senseless to under years of ADT which causes the PCa to be castrate resistant and only then can you use Pluvicto.