Historically, when prostate cancer was detected at an advanced stage, there were only a few options after hormone therapy. That is no longer the case. With access to a new therapy, men with advanced or metastatic prostate cancer have a better chance of living a longer, fuller life.
Treatment Options for Metastatic Prostate Cancer
Late-stage prostate cancer can be treated with several different treatment options, including:
- Hormone therapy. This type of therapy can be administered through drugs to block testosterone production or with surgery to remove the testicles. Men who choose to undergo hormone therapy can experience various side effects, such as erectile dysfunction, low sex drive, and symptoms associated with menopause (hot flashes, weight gain, and brain fog).
- Androgen Receptor Targeted Therapy. This type of therapy is administered by taking pills daily to stop androgens from fueling tumor growth by connecting directly to the androgen receptors. Newer anti-androgens include Abiraterone, Enzalutamide, and Darolutamide. Common side effects include fatigue, diarrhea, rash, and hot flashes.
- Immunotherapy. This type of therapy uses a person’s immune system to seek out and destroy cancer cells. Common side effects include fever, chills, fatigue, joint pain, nausea, and headache. These side effects happen with the infusion of cells back into the body and typically only last a couple of days.
- PARP Inhibitors. PARP [(poly (ADP-ribose) polymerase] is a protein that helps cells repair themselves. A PARP inhibitor is a form of therapy that keeps cancer cells from fixing damaged DNA. Common side effects include fatigue, diarrhea, nausea, and joint pain.
- Bisphosphonates. This drug may be used to treat bone weakness caused by the spread of prostate cancer to the bones. Bone weakness can sometimes damage the jawbone, leading to tooth loss. Common side effects of this type of treatment are nausea and diarrhea because of how it affects the kidneys.
- Chemotherapy. Prostate cancer that has not responded well to hormone therapy may respond to chemotherapy. Men receiving chemotherapy for advanced prostate cancer could experience side effects such as fatigue, hair loss, and weight loss due to nausea and poor appetite.
In cases where other prostate cancer treatments have failed or cancer has returned, one or more of these treatments may be recommended. Some men choose to go forward with these recommendations. Other men who wish to avoid significant side effects, may decline.
Fortunately, making a decision might be easier for these men thanks to clinical research for prostate cancer, which has made a new treatment option available.
Pluvicto®: A New Advanced Prostate Cancer Therapy
In 2022, the U.S. Food and Drug Administration (FDA) approved an advanced prostate cancer therapy called Pluvicto® (lutetium Lu 177 vipivotide tetraxetan). A type of targeted therapy, Pluvicto was initially designed to treat a type of advanced cancer called prostate-specific membrane antigen–positive, metastatic castration-resistant prostate cancer (PSMA-positive mCRPC).
During clinical trials, cancer researchers monitored how prostate cancer patients responded to Pluvicto. After data was collected and reviewed, this treatment helped patients live longer and slow the growth of their cancer with minimal side effects compared to those who received the standard treatment. The drug was determined to be a safe and effective treatment option for some men living with advanced prostate cancer.
In July 2026, the FDA approved Pluvicto® for certain patients with PSMA-positive metastatic prostate cancer to receive this innovative treatment earlier in their care journey. This expansion now includes adults with PSMA-positive metastatic hormone-sensitive prostate cancer receiving androgen receptor pathway inhibitor (ARPI) therapy.
This approval broadens the number of patients who may benefit from radioligand therapy and provides an additional treatment option before disease progression to later stages.
Consult with your prostate cancer specialist to determine if treatment with Pluvicto is right for you.
How Pluvicto Targets Cancer Cells Outside the Prostate
Prostate-specific membrane antigen (PSMA) protein is found in high amounts on prostate cancer cells. Some normal tissues may also contain small amounts of PSMA.
To determine whether Pluvicto may be right for you, your doctor will order a special imaging scan called a PSMA PET scan. During this scan, a tracer such as Pylarify® attaches to PSMA-positive cancer cells, helping your care team locate cancer throughout the body.
Pluvicto is administered through an IV infusion, usually once every six weeks. It travels through the bloodstream and seeks out PSMA-positive cancer cells wherever they are located, including in the bones, lymph nodes, and other organs. As a targeted therapy, the radiation in Pluvicto pinpoints and binds to the cancer, delivering precise doses of radiation directly to the tumors while leaving healthy tissue alone. Upon absorbing the radiation, the cancer cells are destroyed.
It travels through the bloodstream and seeks out PSMA-positive cancer cells wherever they are located, including in the bones, lymph nodes, and other organs.
Who May be Eligible for Pluvicto®?
Pluvicto is not the right treatment for every prostate cancer patient. Because it is designed to treat a specific type of advanced prostate cancer, certain criteria must be met to be considered eligible. Men who meet the following qualifications may be able to receive Pluvicto:
- Have advanced, also called metastatic, prostate cancer. This means the cancer originally developed in the prostate gland but is no longer contained in that area.
- Have PSMA-positive disease confirmed by a PSMA PET scan.
- Meet the treatment requirements for one of the FDA-approved uses of Pluvicto.
- Are receiving or have previously received certain hormone therapies, and in some cases chemotherapy, depending on the stage of your disease and treatment history.
Based on your diagnosis of prostate cancer, your oncologist will be able to determine if treatment with Pluvicto is right for you.
Potential Prostate Cancer PSMA Therapy Side Effects
Because Pluvicto targets cancer cells more precisely than many traditional treatments, some patients experience fewer side effects than they would with chemotherapy. When side effects do occur, they often include fatigue, nausea, loss of appetite, or dry mouth. Other side effects may include a drop in red and white blood cell counts. If you experience certain serious side effects, treatment may be delayed, adjusted, or stopped to protect your safety.
Patients who have low blood counts or kidney issues, such as renal obstruction, before starting therapy may be less suitable for the drug. Patients with urinary incontinence should be closely monitored while taking Pluvicto.
Because Pluvicto contains a radioactive component that leaves the body through urine, your care team will provide instructions to help protect family members and caregivers after treatment.
New PSMA Therapy Available at Virginia Oncology Associates for Men with Advanced Prostate Cancer
Virginia Oncology Associates is pleased to offer PSMA treatment for patients with advanced prostate cancer. If you've been treated for prostate cancer without success — or, if it has returned- please contact our cancer centers in the Hampton Roads area to learn more about our services and customized prostate cancer treatment options.
Virginia Oncology Associates is located in Norfolk, Virginia Beach, Hampton, Newport News, Williamsburg, Chesapeake, Suffolk (Harbour View and Obici), and Elizabeth City, NC.
Originally published March 2024. Reviewed and updated September 2026.
