Does Pluvicto work? What's the prognosis?

Hi,They are thinking of trying Pluvicto with my husband. What is the prognosis with this? When I googled it, I read 15 months increased survival! That doesn't sound very good to me..Anyone had Pluvicto? How are you doing?This is all so scary...What about Immunotherapy for Stage 4 Prostate cancer? His PSA is up to 500, although 2 weeks ago it dropped to 490 and didn't increase..so we were thankful for that..Thanks,

@yougnu
What bothers me is that the number show A 50% or greater decline in PSA levels with 60% of the patients. These are more recent numbers.

The thing is, they’ve always gone by 1/3 get really good results 1/3 get OK results. I would consider a 50% decline just an OK result. One guy I know had to decline to almost nothing after three sessions. How does that compare to somebody who only has a 50% decline?

Pluvicto (177Lu-PSMA-617) shows high success rates in treating PSMA-positive metastatic castration-resistant prostate cancer (mCRPC), with over 60% of patients experiencing a 50% or greater decline in PSA levels (a key success metric). Recent studies indicate it can reduce the risk of cancer progression or death by up to 59% compared to alternative hormone therapies.

I can’t find any numbers that show a really good percentage of people getting really great results.

@jeffmarc I have stage 4 prostate cancer and my oncologist said that I would be getting Pluvicto as a treatment sometime. It is a matter of time. But he mentioned that my last PSMA PET scan showed that the average Standardized Uptake Value (SUV) was between 4 and 5 while my saliva gland was something like 12. According to him that Pluvicto works better with higher SUV scores. I wonder what typical SUV scores are for those 30% people who respond well to Pluvicto?

Some people have some major side effects from Pluvicto, most don’t. I have heard at least 5 people talk about their experience, In some cases they had to have more time between doses because of the side effects.

I saw a webinar where they discussed a person who lit up the Pet scan With metastasis from head to Legs. He had one Pluvicto Treatment and it almost cleared his pet scan, But his side effects were so bad that he could not take any more treatments

Be aware that it works really well for 33% of people OK for 33% of people and not at all for 33% of people.
If you have certain genetic issues, either hereditary or somatic, it can affect how well Pluvicto Works. You can ask for a somatic test before doing Pluvicto To find out if you’ve got Genetic changes Due to the cancer.

If you have BRCA2 or ATM It seems to work better. If you have RB1, PTEN or TP53 They are Pluvicto resistant.

One person I know Peter who runs the advanced prostate cancer reluctant brotherhood forum has had prostate cancer for 12 years. He’s had every treatment. He had the last one possible, Pluvicto, About six months ago. After three treatments, his PSA went down around .05. It has stayed close to that since. For some people, it works really well for other people. It doesn’t work as well. You just have to try it and see how well it works for your husband.

Here’s some feedback from people at Mayo
https://connect.mayoclinic.org/comment/1380711/
https://connect.mayoclinic.org/discussion/can-anyone-share-their-experience-with-pluvicto/

@brbriggs
The SUV scores are not the important thing most people talk about when they are about to have Pluvicto. The more spoken about issue is how many metastasis they have. Those always have a high SUV score. If somebody has multiple metastasis then Pluvicto is a good treatment to try before chemo since it has fewer side effects.

The salivary glands have a high SUV because they do produce PSMA. That does bring up one of the problems with Pluvicto, It reduces the amount of saliva you produce, and that can be a real problem when it comes to eating. Actinium, the alpha treatment is even worse on the salivary glands.

A Four or five SUV would not really imply a metastasis. You may get that on a Rib, but that is unreliable since injuries to the ribs can cause that. I broke a rib in my 20s and that always shows up.

@jeffmarc Thanks for replying so quickly. The SUV scores were of cancer sites outside of my prostate. I tend to have just a few sites at a time (since completing Chemo two years ago) and been using x-ray radiation to kill them off. However, earlier this year I had the treatment on four sites and my PSA score went down from 12 to 0.7 and then immediately started rising again. I am scheduled for another PSMA PET scan in a couple of weeks, so I will find out what is going on and what my new SUV scores would be.

@brbriggs
SUV 4 and 5 can be problematic, sounds like your hot spots were that low. Those can be moderately aggressive, Interesting that they made such a difference when zapped. Usually takes 10 or more to really be serious malignancy.

Definitely sounds like time to get another PSMA PET scan. At least what you’re doing is working And your PSA drops significantly when you have the treatment.

@jeffmarc The four spots were zapped five times with x-rays.

Hi,They are thinking of trying Pluvicto with my husband. What is the prognosis with this? When I googled it, I read 15 months increased survival! That doesn't sound very good to me..Anyone had Pluvicto? How are you doing?This is all so scary...What about Immunotherapy for Stage 4 Prostate cancer? His PSA is up to 500, although 2 weeks ago it dropped to 490 and didn't increase..so we were thankful for that..Thanks,

Interesting reading, as usual...CAl77 had it best...it's new, so there's not a lot of empirical data.

I'm starting after PET-PSMA showed activity in the bone and the prostate after being quiet (no abnormal hypermetabolic activity) for 2 years...T is still low (18). My Doctor and I chose Pluvicto rather than Xofigo because of the metastasis to soft tissue as well as the bone (L4).

I'm starting next Tuesday and await the treatment. I, too, have been through all the series of different treatments and, although the new SUV was relatively low, I can't take any chances...It's, as I've said before, a 'crap-shoot'..."darned if you do, darned if you don't".

I also have the questions about the info from the manufacturer..."15.3 months vs. 11 months"...What the hell is that supposed to mean??? If I had 11 months to live and my Doc didn't tell me that, I'd be pissed!!!

I have to read that in terms of extending my lifespan...NOT in terms of months, but by percentages...

I'll keep y'all posted as to the results...Oh, it's not going to be the PSA solely, rather the scan after ...3-4 treatments...

Blessings to all