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.