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 to live 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
Recently, the U.S. Food and Drug Administration (FDA) approved a new advanced prostate cancer therapy called Pluvicto™ (lutetium Lu 177 vipivotide tetraxetan). A type of targeted therapy, Pluvicto is designed to treat a certain 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, patients who received this treatment lived longer 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.
How Pluvicto Targets Cancer Cells Outside the Prostate
Prostate-specific membrane antigen (PSMA) protein is found in prostate cancer cells, not in normal tissue. During a diagnostic test, a tracing agent called Pylarify® is used to help identify and attach to the PSMA protein on the cancer cell’s surface.
Finding the PSMA protein gives Pluvicto a precise target. The presence of PSMA on cancer cells allows your oncologist to see the prostate cancer on PET or CT scans.
Pluvicto is administered as an injection, which allows it to reach cancer cells throughout the body, even in bone or soft tissue. 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. PSMA treatment is administered every six weeks. Men receiving this treatment will go to the infusion room where other IV cancer treatments are given at their cancer center.
Pluvicto differs from other targeted therapies in that it is not a drug or hormone used to slow the growth of cancer. Instead, it is a unique type of therapy that can destroy tumors.
What Men Are 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:
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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.
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Cancer has developed to the point where it no longer responds to hormone therapy.
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Cancer has progressed after receiving taxane-based chemotherapy.
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Has metastatic castration-resistant prostate cancer.
Based on your diagnosis of prostate cancer, your oncologist will be able to determine if treatment with Pluvicto is right for you. Currently, studies are being conducted regarding the effectiveness in men with early-stage prostate cancer and its use in combination with immunotherapy treatments.
Potential Prostate Cancer PSMA Therapy Side Effects
The precision of Pluvicto’s targeted radiation means less damage to the healthy tissue surrounding the tumor. Because of this, there are often fewer side effects to worry about. Compared to chemotherapy, the side effects are modest, but not in all men. 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, your doctor may delay your next treatment or lower your dosage.
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.
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.
