PSMA With Lu-177 Treatment Way Earlier...is that a bad idea?

I’ve had that same question about most advanced treatments.

Most of it is due to insurance companies and what they will pay.

Also what the established protocols are. Few dics will break the rules

Yes. FDA approval waits for the trials conclusion and the "Visions" lutetium 177 human trial isn't over until May of 2021. It is better to have insurance pay for a big chunk of the treatments, though you could go to Germany and get it now.

It is not the dead tumor proteins that are the kidney problem, it is that is where the lutetium is removed from your blood stream so your kidneys get a lot of radiation, as does your bladder. Too much and they die, which would be a problem. Thus the admonition to drink lots of water and urinate frequently during lutetium 177 treatment. The rest of your body will also get a bunch of radiation - you are supposed to stay 6 feet away from other people for a week or so due to concerns that your bodies radiation may harm them.

Further - you need to know how much lutetium is right for the tumor load you carry. At this time, they have to make a best guess from looking at gallium 68 PSMA scans. If there are just a few cancer cells floating around somewhere, it is going to be hard to figure out how much lutetium 177 to give you over what time span to get those cancer cells and kill them.

The medical fraternity is a little leery of injection powerful and dangerous radio-pharmaceuticals into your body at an early stage of treatment hoping that it will extend your life for a few months ? They will know more about how effective Lu-177 really is when this trial is over. But for now, they have proven treatments that can still CURE you if needed (as far as I know, Lu-177 has not cured anyone of prostate cancer, I am an active participant in the Vision trial) and if a cure is not possible, then they can extend your life for YEARS while keeping the side-effects manageable..I doubt even the German doctors would recommend Lu-177 at this point in your treatment. Too risky and not necessary...

I hear all of you. The advice is excellent. I bet in however many years I will look back at this post and say "What a newbie I was!"

I also want to thank all of you that are in the VISION study, or any study. Maybe after the VISION study completes they will start others earlier in the treatment cycle to see if it is beneficial. For example. here is something closer to what i was thinking...although even this study is later than I was imagining, but its moving in the right direction (its also only 10 people and not randomized).

https://www.clinicaltrials.gov/ct2/show/NCT03828838

I was hoping to find something where say they give maybe 5% of a "regular" treatment (I am making that number up for illustrative purposes) to those of us at high risk after primary therapy. Even at 5%, I would bet the number of cells it needs to touch is small enough that even 5% would adequately cover it. That 5% treatment along with the regular SRT or ART could be a knockout blow.

Stephen,

a Lu177 treatment will treat what you see with a PSMA PET/CT. The PSMA PET/CT shows the PSMA expression of the tumor lesions which is sufficient for a Lu177 treatment. If you do not have enough PSMA expressing tumor cells showing up on a PSMA PET/CT, the ligands you get with the infusion will attack healthy cells because they cannot find tumor cells to attach to. Also, the PSMA expression is higher if you are castrate resistant.

You will have the best results with a PSMA PET/CT if the PSA value is above 1.0 ng/ml. So with your current PSA value below 0.1 you will see no tumor lesions. There is nothing to be treated with Lu177.

The dead tumor material does not clog up the kidneys. This are dead cells which your body takes care of like any other dead cells. The unused ligands you got with the infusion are excreted via the kidneys and that is why they check your kidneys before the Lu177 treatment. If the kidneys do not work, the radiating ligands will gather in the kidneys and destroy these.

They focus for later stages of PCa because the Lu177 treatment is not FDA approved and thus should only be used after everything else failed. In Germany this is the official recommendation but many ROs will treat you earlier, provided you are castrate resistant and failed Zytiga.

You cannot use this therapy to clean up circulating tumor cells after surgery. Six months of ADT will attack remaining cells instead. Like a chemo for colon cancer patients after surgery. This is an alternative approach your URO may not agree to.
Adjuvant Androgen Deprivation for High-Risk Prostate Cancer After Radical Prostatectomy: SWOG S9921 Study

George

Post Edited (George_) : 11/13/2019 12:52:26 PM (GMT-7)