Lutetium-177: PSMA Guided Treatment |
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- เผยแพร่เมื่อ 12 ธ.ค. 2022
- Lutetium-177 was recently FDA-approved in the United States for men with hormone-resistant PSMA-positive prostate cancer who have already been administered chemotherapy (regardless if the entire regimen was completed). Here, medical oncologist Mark Scholz, MD, discusses who qualifies for Lutetium-177, why it is not available to men with earlier-stage disease, and how to monitor whether or not the treatment was effective after it is administered.
0:07 What is a PSMA PET scan and its associated treatment, Lutetium-177?
1:59 Should a PSMA PET scan be performed after Lutetium-177 to see if the treatment worked?
2:50 What is the success rate of Lutetium-177?
3:54 If lutetium-177 works well, why is it not available in earlier stages of the disease?
5:49 How does hormone therapy influence PSMA PET scan and lutetium 177. Can they be used together?
7:38 After Lutetium-177, when should a patient get a scan to see if it was effective?
9:20 How do you interpret PSA after a patient receives Lutetium-177?
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Very nicely Done! Extremely informative Thank you 🙏 Both 😊😊😊😊🫡😊
I've come here because of musician Andy Taylor and my friend is stage two and is now pushing for treatment, thank you for your work.
My father died during a trial of a similar drug. Actually the doctor who is at Cornell assured us that he would be receiving the same targeting drug as the very much tested one that was recently approved. In reality my father received an untested targeting drug. It turns out the doctor served on the scientific advisory board for a small company who would benefit if this novel targeting drug turned out to be as good as the well-tested one. He used my father as a guinea pig as a way to make money for himself. However his targeting drug didn't appear to work nearly as well as the one that was very well tested. After one infusion my dad barely survived. When we asked the doctor if he should continue with a second dose the doctor was adamant that he received the second dose he said that my father was dying from his cancer. However before the treatment my father was walking around laughing pretty much his normal self. Immediately after receiving the first dose he struggled lost an incredible amount of weight passed out several times had terrible nausea. His albumin levels became very very low. We didn't know if he would make it through that first time and so when it came time for the second dose, it seemed obvious that he should not take it. He was finally feeling better but the doctor said he was dying from his cancer and must take the second dose. He took the second dose, The doctor took a long weekend and avoided my telephone call on a Friday. My father died that weekend.
Moral of this story is number one: doctors who run trials have their trial as their number one priority not you as a patient. The type of care that you receive during a trial is very different than as if your doctor wanted you to actually live. The doctor wants to know if his medicine works and is focused on running a very rigidly controlled environment. Be especially wary if you're in a phase 1 trial where they're trying to find the safe dose. By definition this is exploring doses which may not be safe. I knew all of this going into the trial however we were assured by this doctor that dosage levels were the same as successful lutetium prior trials. Also if you think there's any bad behavior from a doctor before the trial starts just cancel it get out of it. Our doctor did incredibly cruel things such as constantly pushing back the start date of the treatment and then after being delayed for 3 months The doctor said that the trial that he had been waiting for is full and why doesn't he go for this other trial. In fact the doctor was certain it would be better for my father. And this is where he lied about the equivalents of the drug that Dad would be taking versus the well studied lutesium targeting molecule. Then he finally went and traveled all the way to New York City he was told the drug is not available. go back home. This is for a man with stage 4 cancer.
Step two is to be willing to travel. My father did not want to travel to Germany where he could have had the well tested lititium drug administered for about $10,000 a dose. not that bad. certainly better than putting himself at the hands of a doctor who did not really have the patient as his top concern.
It's easy to say these things in hindsight but while it was happening it was difficult to navigate.
My impression and I'm not sure if this is true is that medical trials in the US are a bit of a wild west and I'm guessing it's because they are very well protected against legal action. I haven't read the specifics of what dad signed but I'm sure that it's something that says that they're not at fault for anything that goes wrong absolutely. And so then of course if they're not responsible then they don't have to act responsibly. And they sometimes don't unfortunately.
Going into this trial I was a major advocate for science and the advancement of science and learning and knowledge. Now I realize you need to have your eyes open you need to be able to think quickly and you need to be able to change direction quickly.
I'm sorry for the loss of your daddy in this way
I found it's very true in what you're saying
When someone goes from where you're daddy was laughing and able to enjoy life
We need never to go through that kind of touching .
GOD will take care of doctors like that
. They do take an oath to do no harm to their patients
Remember prayer changes things
@@barbaratankersley7117😅
I’m at the tail end of a clinical study for Lu 177 & while the dr performing the study is happy with my results after 4 infusions (they only did 4, not the 6 prior videos on PCRI had mentioned), I was hoping for better results. A few months before the study, my PSA was at 1.96, then it apparently went up to 3 as I was being processed, & then 2 months later at the beginning of the study PSA went up to 5. After the 1st infusion, it dropped to 2.14, then after the next it dropped to .7 & I was getting quite excited but the next PSA result was .55 & then a couple weeks later it was .56. My calculations (because of the dramatic drop from 5, the 2.14, then .7) I was thinking the PSA would drop down after the 4th infusion to somewhere around .2 or a little lower. Radiation oncologist performing the study said, no, it’s not linear. I said it sure looked linear with the continued drop & he said it doesn’t work that way. I had several bone scans & CT scans along the way & RO said the scans showed no disease progression & I should be happy with the results (I’m more than likely going to get a PSMA PET scan at the very end of the study in February 2023, but I’ve seen this play out before with my disease where the PSA would drop after a new treatment was added, but then watch it start to climb again. I’m afraid this may be the case again this time, too(plus, none of my team of doctors have heard about adopting a vegan/vegetarian diet to starve the cancer cells, in fact my urologist today said oh, eat anything you want, live your life, because ALL cancers are attracted to animal proteins, to which I asked why they use sugar contrast in PET scans for some cancers & animal protein contrast in prostate & a few other cancers that feed off of animal proteins? He just shrugged). I know my PSA isn’t high at the moment, but I am frustrated at the results & wonder why the diet isn’t recommended by all oncologists/urologists.
The docs specialize in areas but few have a background in nutrition, sadly. The evidence indicates a veg diet is helpful not only for a PCa diagnosis but for a healthy heart as well. Lower meat intake equals lower cholesterol for most, lower risk of heart attack, stroke, dementia, etc.
I wish they would just open it up to all of us. I have had pc for 5 years( rp, then radiation) and its coming back, I am on ADT and this is not fun. I have high grade cancer ( doubling every 3 months) but low volume and I cant get into a trial. as mentioned in this video by Dr. Scholz getting it early or at least while its smaller seems best thank you all for this forum!
Same I am going on Enzalutamide pills as well as keeping Zolodex injections
Again... What makes a Great Interview... are the Questions asked. YOU ask/are the Best. Thank You
Hubby will have this around the beginning of 2023. I pray this will help his quality of life during the duration of this medication. I will definitely will be keeping up with your videos. 🙏🏻💙🙏🏻
Well thought-out presentation. Clear. Concise. Thanks for that.
Again, thank you so much. All of your information and guidance help to navigate the trying times of advanced prostate cancer. Keep up the great work!
This is the Best Q&A for the Prostate Cancer Patient on You Tube. PSMA Guided Treatment SAVES LIVES. Lutetium is very interesting.
Great dr ...it is so good to develop awareness..coming from a dr and so lucidly and effortlessly pouring out..there are doctors who cares for humanity and God bless such breed
I paid for the PSMA PET scan myself. It was $6k at UCLA. Just in case you're wondering. I'm 53 and wanted to know what my status was and how I would proceed. I found that it was still local which I had hoped after all the other scans I had cat scan/mri etc. Blue Cross would not cover it. I have since had Tulsa Pro and am currently recovering. I hope this info can help you in your own decisions.
Wonderful info and reassuring, thanks!
My PSA in one year from .10 now
.33. I'm getting my first PSMA 2/14/23. YES, I've had Radiation and Proton in 2019, removed 2015. PSA 3.5 just before surgery. Robotic removal. Cancer in margins. T3a Gleason 5+4.=9.
Any time soon, you can share the data on men with Germline or Genectic Mutations? Lots of chatter on utter failure and hyper / hypo progression in this group
Can you address an original low PSA (before surgery) combined with a high gleason score (8-9) and active spread to the lymph glands after surgery? Basically, comment on someone who has always had low PSA but ended up with a more aggressive disease than expected.
I’m currently taking the pluvicto treatment. My dr has been regularly telling me this is not a cure and that my cancer will return after treatment. My question that I cannot find answers to is how do I maximize the time from treatment ending to reoccurrence. I was taken off zytiga which was starting to fail anyway. Now currently only taking Lupron while on this treatment. I get the diet and exercise advice that I have control over. Is there a plan for typical follow up treatment? Nubeqa, parb inhibitors? What’s next?
Thank you for your videos.
Have Metastatic Peostate Cancer.
After first rounds of Pluvicto PSA went down 1000. Just finished 4th round of Pluvicto. PSA went up, had another PSMA scan and found new spots on spine. What different options to go from here. Other than staying on last 2 Injections of Pluvicto. PSA is currently in the 500.
Please, I need some help. I'm an American living in Scandinavia, where they do not have this treatment available. However, they have decided to send me to another country that does have this treatment - in Helsinki, Finland. Prostate cancer in my bones and my PSA has been drastically rising since October 2022 and is now at 643. I have had one treatment of Lutetium and the pain is now gone from my bones. Helsinki will not continue treatment if my PSA continues to rise. Is it normal for PSA to continue to rise under this treatment? I was in terrible pain and have been bedridden for over 2 months unable to walk and sleeping 90% of the day. After just one treatment the pain is nearly gone and I am awake for the entire day now. Wife and I are so confused as to why my PSA is rising. After only 8 days it went from 490 to 643 - why is this happening?
Did you receive chemotherapy and are you on ADT now?
What is the success rate. How long could it last.
If the PSMA PET/CT scan is superior to all other imaging methods and even superior to biopsy, why then mpMRI and biopsies are being performed before even considering PSMA PET/CT?
I believe it has to be outside of the prostate. The PSMA only finds the prostate cancer that has traveled outside the prostate. I wondered the same thing as that could be a form of therapy, but it’s not offered.
@@MM-sf3rl That would mean that only metastasized prostate cancer cells express the PSMA protein on their surface. If that is really the case, then that would be a reasoning I could understand. I am not sure though that this is really the case and if not then IMHO it does beg for the question, why not to use the PSMA PET/CT already for the initial diagnosis, considering that 12-needle biopsies sample only 1% of prostate's surface and therefore often miss cancer which is present and also considering the fact that even with transperineal biopsies there is still up to 5% risk of side-effects like impotence and incontinence.
In my case, the insurance company would not pay for a PSMA scan until the traditional scans came back as inconclusive.
@@lamachine77 i would even be willing to pay it myself, nevertheless they don’t let me to get the scan without a doctor asking for it but none of the doctors I have visited wanted to help me because they have guidelines agreed upon by doctors and insurance companies to keep the costs of the health system down and if they make an exception for me, they might end up with more and more people asking for the scan for the initial diagnosis.
Hello,
I will add this to our list of questions for future videos. We have a few other videos with Daniel Margolis, MD, and Thomas Hope, MD, who are both radiologists, and they have addressed these kinds of questions. The PSMA PET scan may or may not provide as much information about the cancer's potential level of aggression (which is the purpose of the biopsy) and the MRI may sometimes provide more accurate information about the size and location of tumors within the prostate gland (whereas the PSMA PET can detect that cancer is in the prostate, but the radiologist may not be able to know exactly which parts of the prostate are tumor and which are benign tissue) but it is possible that protocols could change as more and more patients get PSMA PET scans and more studies are conducted.
😍👍👏
I am asking my once at utsw if I can do this. I bug him about every possible treatment I find out about.
S his tretment is available in India i which which city and hospital
Why is Pluvicto/Lutetium so "pricey" now that its available in the USA when it was and has remained reasonably priced overseas???
ITS A BUSINESS TO MAKE MONEY PLUS IT ONLY WORKS FOR FOUR MONTHS
Who is making $$ off luteseum,lupron,etc.is there any generic counterparts to these drugs been around More than a dozen yrs.,I learned from your format the highest psa was over 2500 without cancer& with cancer, thankyou pmsa isn't cheap,& a lot of insurance do not cover??
A lot of ppls are very concerned with the quality of life, sexual fct,urine flow, bleeding, from rectum penis,etc
dr.sholtz is sharp as a razor 🪒 suit& 👔 tie promotes healing, beautiful girl helps get points? Across,some watch for her diplomacy and professional??
I've Been having Urinary Issues for a while now. Flowmax, Didn't help, A second Pill (Can't remember what it was) But it was also used to regrow your Hair?? Didn't work. Went back to Dr again "Urologist" He did a Digital Exam coming up with a Slightly Enlarged Prostate, my 3rd trip. He decided that my PSA was "ONLY" 1.9, that I most likely don't have any Cancer? (My Main Concern). He went through my Penis with a Steel Rod to check my Bladder, and it was Clear and Looked Good. (so he said). That was Totally NOT FUN! So to rectify my Slow Urination Issue he recommended GREEN LITE LASER Treatment. I have NOT decided on just hat to do and am Kinda Concerned about This Silent Killer Hiding it's Ugly Head. I'am watching this Channel, and Just am Totally confused as to what to do Next? I have considered a 2nd Opinion maybe at Stanford University due to there expertise? But I'am just Unsure/Scared? Confused Don't know what Path to take??
My husband had the same as you.
Still same trouble peeing ok 6 mouths later number two surgery ok now Gleason 9 cancer.
I ask them why the cancer didn't show up on the first surgery they said they didn't go deep enough
This is not right.
I had a dr.tell me we should always do a rectal exam
And my husband PSA numbers had been up for a long time
I believe the V A hospital doctor dropped the ball
Then they told us they had no treatment for him
Our son got involved wanted a second opinion
We had to get there permission to do that.
So you do your research and ask questions a lot of questions
Right things down
Research.......
Prayers change things
@@barbaratankersley7117. Standard of care is MRI and guided biopsy. Digital Rectal Exam is nonsense.