Is the success rate of Pluvicto based on the PSMA test?

What you’ll find in the data is that PSA levels can go up during Pluvicto treatment. Fluctuations and temporary spikes in PSA are quite common, especially during the first few cycles of therapy.

A temporary spike in PSA that occurs shortly after the first or second injection can happen. As the targeted radiation from Pluvicto successfully damages and kills the cancer cells, those dying cells rupture. This massive cellular breakdown releases a wave of stored PSA directly into the bloodstream.

This type of spike is actually a sign that the treatment is actively destroying the tumors.

If it were me, I would go for that 2nd (& 3, 4, 5,& 6) treatments.

If Pluvicto doesn’t work, you move on to next steps. (Was he PSMA-positive?)

Sometimes you have to wait for the third treatment for the PSA to really start dropping, but it does not look promising. Pluvicto doesn’t work for everyone. You could try to get actinium. You may have to go to Europe to find a country that does it. I know someone who went to Austria.

Be aware that Pluvicto 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.

@brianjarvis

Thanks..that gives me hope that the 2nd treatment will show his PSA dropping.
Yes, PSMA positive.

@cal77 He’s scheduled for up to 6 rounds, correct? Take this one step at a time.

@cal77, has your husband had more Pluvicto treatments? How is he doing?

Hi Colleen,

He had the 2nd treatment July 8th. PSA yesterday showed a spike from 1200 to 1450 now. He's also very fatigued, only eating 200 calories a day, and some days throwing up.
Also, the scan showed one tumor had shrunk by 50% but in other areas of his spine and pelvis it was worse...
We see the oncologist tomorrow...We will probably get the 3rd treatment...
If this doesn't work, then not sure what else there is...

Howdy all,
Yes, Prostate cancer IS a nasty disease! I had my 3rd Pluvicto infusion a couple weeks ago. After the first, my PSA rose a bit but the 2nd infusion saw a 67% drop in my PSA, so it does seem to be effective for me. My knowledge is that the PSA readings are still the important marker, however if my PSA continues to go down the Doctor will order another PSMA-PET scan after the 4th infusion....
The main problem I'm having is sheer exhaustion that doesn't improve over the 6 week course and seems to be cumulative during my series of infusions. I nap twice a day even after getting a good 7 hours sleep overnight. Anybody else dealing with that??
Hang in there. I find that seeing the efficacy makes the side effects more tolerable...
Blessings to all

@deccakid
A lot of people have the problems you describe. Some people don’t have just a little bit of fatigue. As usual, everyone is different, I’ve even seen much worse problems due to the chemo side effects.

Chemo does not change your life, Yes, while you are on it, it can be not too bad or a real pain, Again, no two people are the same. I was in an Ancan.org Advanced prostate cancer meeting and one guy came in and said he was doing chemo but after doing chemo, for 10 days, he couldn’t eat food, didn’t taste good. He lost a lot of weight then he’d have a few days where he’d recovered completely, ate a lot of food, then back to the next chemo session. The other people that said they were just uncomfortable for a few days after, had to rest to recover.

Other peoples chemo issues explanations
https://connect.mayoclinic.org/comment/1379518/
https://connect.mayoclinic.org/comment/1380026/

Hi Everyone,

Saw the Oncologist today. After the first Pluvicto, PSA went from 800 to 1200. After the 2nd Pluvicto went from 1200 to 1460. I was hoping this was normal as cells were dying and releasing PSA, but Oncologist said spikes this high means the treatment isn't working.
This is very upsetting.
We tried Chemo - Doctaxel for 4 infusions and that didn't work.
Now, Pluvicto after 2 treatments, they don't want to continue.

They are thinking maybe trying a different Chemo, but my husband has to build up his strength and his appetite.
He lost 25 lbs in the past 6 weeks from the Pluvicto and no appetite.
They want him to go back on Dexamethasone, but then he said he can't sleep but he will try 1/2 dose.

Not sure where we go from here. We are running out of treatments.

How come none of the treatments are working. All they've done is weaken him and given him extreme fatigue and nausea, and didn't work.

Anybody else have these treatments not working?

@cal77
Wow!,
That is not good news at all...and I feel (and pray) for you. I can't answer any better than anyone else, although I've not heard of a treatment that didn't have SOME positive effect...and never a negative effect.
This I DO know: is that all cancers are sneaky "Sons of Guns"...they can and often will find their way through the medical maze we try to throw at it.
As Jeff said, and I certainly acknowledge, we ARE all different..."One man's meat is another man's poison"...perhaps there is a treatment that works for you that wouldn't work on me...that's life.
I can only encourage you NOT to give up!!...keep researching, keep fighting!

Love and blessings
Have Faith and pray!!!