What is the recommended treatment after 6 Pluvicto doses?

I talked to my Oncologist and he said I don't have enough bone mets / spots to justify using Xofigo at this time. Xofigo (radium 223 isotope) only goes to the bones and doesn't do anything against soft tissue invasion. The only bone pain I really have is in my right hip / femur where I have a rod and screws in place to reinforce a sizeable bone met in there. I have 3 other small rib spots that have been treated with beam radiation and are doing ok. I'm also getting XGEVA / denosumab osteoporosis medication injections monthly that handles the rest of the bone pain for the most part, and Morphine ER when it gets really bad which is not very often, unless I overdo at work or with yard work, around the house etc.

Yes, I'm an unlucky stage 4 advanced Prostate Cancer patient that has to work to keep my Medicaid insurance going because "I MAKE TOO MUCH ON SSDI"(?) for their "guidelines", so I have to pay a $130 / month premium for Medicaid but it's not enough SSDI to fight the sickening inflation here in the USA unless I work in addition to getting SSDI. It's all just so sick and wrong. Well, enough of my soapbox.

My primary concerns are soft tissue invasion. I have Cancerous illiac-chain lymph nodes and retroperitoneal lymph nodes that have already been radiated. They are slowly enlarging but not really big. The largest is between 2-2.5 cm and not painful yet. Cancer is spread out some against the bottom outside wall of the bladder where the Prostate sits next to it, but I'm still peeing fine, and Urology says the inside of the bladder looks pretty good. I also have some Cancer invading the right kidney ureter tube between the bladder and kidney. Urology says I can live quite a while with that before removing the kidney may become necessary.

The Radiation Oncologist says Pluvicto should treat all the Cancer, soft tissue and bone. He said they usually don't give Xofigo BEFORE Pluvicto, as both are radiopharmaceuticals and can wreak permanent havoc with the bone marrow in some patients. Depending on the success of Pluvicto, and if there's minimal bone marrow damage from it, they will sometimes consider Xofigo AFTER Pluvicto for advancing bone mets only, but this is not in every case.

Good luck I was put on Xofigo I didn’t have any bone pain ,I do have soft tissue on my back took zovigo for 5 months till I ended up in er ,then my dr tells me oh it don’t work on soft tissue my psa was .03 when I went on it ,so for 5 months it grew wild I’m so pissed now it’s all over my back an spine i go today for 3 radiation treatments on my spine who do we trust ?

Sorry to hear that your Dr. dropped the ball. I have studied and researched Prostate Cancer treatments as thoroughly as I could, so I can keep up with my Dr's plans. I've been fortunate to have very competent doctors. I wish you the very best in your fight against the bandit.

I am currently on Xofigo. Getting ready to get my fourth dose out of six. Won’t really know how effective it is until after the sixth dose and a PMSA scan. Unlike Pluvicto, you don’t have to have had chemo to get Xofigo, so for me Pluvicto would be a potential next step in treatment. But, I would have to have tried a round of chemo first. Most, if not all of my cancer is in the bones and Xofigo focuses only on bone cancer. Pluvicto, on the other hand is reputed to be affective on cancer in the organs and lymph nodes as well.
I really appreciate reading about the experiences and comments of everyone in this group and would like to put a plug in to everyone to include frequent prayer to our God in heaven, giving him thanks for all the good things that happen and asking for his help to cope with the problems.
May God bless and heal us all!

Can anyone share experiences on how Pluvicto treatment progress is being measured? Is it with MRI, CT, a PSMA PET scan with Pylarify or Gallium 68? if PSMA PET scan, is it being covered by insurance? any feedback would be appreciated as cost and coverage is a concern.

Urology times Combining the novel agent TAK-700 with androgen-deprivation therapy (ADT) led to a numerical but not statistically significant improvement in overall survival (OS) versus ADT plus bicalutamide in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), according to findings from the phase 3 SWOG S1216 trial. Despite missing the primary end point, a posthoc analysis uncovered a pathway for optimizing care in this patient population.1

The findings, which were presented at the 2021 ASCO Annual Meeting, showed that at a median follow-up of 4.9 years, the median OS was 81.1 months in the TAK-700 arm versus 70.2 months in the control arm (HR, 0.86; 95% CI, 0.72-1.02; P = .04). This 11+ month improvement in OS did not meet the trial’s prespecified criteria for statistical significance.

I understand Pluvicto has been approved in EU for a few years. Are patients there getting a second round of six?

Thanks!
Gina, daughter of father 87 years old who started Pluvicto Sept 22, 2023

Hi @cjbbjc2010, I'm tagging @donalan @leebeth @suwairi @patgwenn @ncoic @bburgess1 @royalbee @bamaples @bamaples @dlylecpa @robert570 who have experience with Pluvicto (Lu 177) and can share what testing they had done during and after treatment to monitor treatment success.

Cjbbjc, have you started treatment with Pluvicto?

Hi @gaherrma, how is your father doing on Pluvicto?

Prior to treatment, my husband had both a PSMA scan and a choline pet to check for discordance. Also a Guardant blood test.
The PSMA scan and Guardant test were done after each two treatment cycles, so immediately prior to 3rd and 5th treatment, and at end of treatment.