PSMA-Targeted Therapy (Pluvicto)

PSMA-targeted therapy has been determined by the FDA to be a safe treatment for prostate cancer. Due to the specific targeting of the treatment, prostate cancer cells receive a high dose of radiation to kill them, but surrounding healthy cells receive only a limited amount of radiation and can survive. Any medicine that doesn’t go to the prostate cancer cells is filtered out through the kidneys and then eliminated in the urine. You will receive instructions on what to do at home to minimize radiation exposure to others.

Side effects of PSMA-targeted therapy
Side effects can include vomiting, nausea, decreased blood cell counts, tiredness, loss of appetite, change in bowel movements, urinary tract infection, weight loss, and abdominal pain. These are typically minimal, and will be closely monitored and managed by your health care team. If you have serious side effects, including kidney problems or very low blood cell counts, we will consult with your cancer care provider, and we may decide to change, pause, or stop the treatment.

A note on radiation exposure
PSMA-targeted therapy will contribute to your long-term radiation exposure, which can raise your lifetime risk of developing a second cancer. However, PSMA-targeted therapy alone has not proven to be a strong cause of cancer, and the benefits of treatment are determined to outweigh the risks.

The consultation begins with your cancer care provider who confers with ARA to see if you might benefit from PSMA-targeted therapy (Pluvicto). As part of the evaluation, blood tests and a PSMA-targeted PET/CT will be reviewed. Next, you will consult with the theranostics coordinator and molecular radiologist who will review your medical history, discuss the treatment plan with you, and address questions or concerns you may have. If it is determined that you will benefit from the treatment, and if you wish to proceed, a date will be scheduled for your first infusion.

PSMA-targeted therapy (Pluvicto) is administered by intravenous infusion. The full course of treatment involves six infusion sessions that are each six weeks apart. Depending on any issues that arise, the amount of each infusion may be decreased, or the number of weeks between infusions may be lengthened, or the infusions may be paused. During the course of your treatment, you will remain under the primary care of your cancer care provider, and we will coordinate with you and your provider to manage any issues that arise.

Preparing and arriving for your PSMA-targeted therapy

• Plan to spend about two to three hours at the ARA Theranostics Center for each infusion.
• Do not eat anything after midnight the night before your infusion day. Please take your usual medicines with a small amount of water the day of your infusion.
• Feel free to bring a book, computer, or other quiet activity to spend time on during your infusion. Wi-Fi and television are provided in the infusion room.
• If you wish, you can bring a friend or family member with you. Your family member or caregiver may be with you during pre-treatment, but will be asked to leave during the 30 minutes that the infusion is given.
• After getting checked in on your infusion day, you will be brought to your private infusion room with an attached bathroom for your use. You will be given a gown, scrub pants, and socks to change into. Your street clothes will be stored safely in the infusion room with you.
• You will have a chance to ask any questions you may have about the procedure.
• A paramedic will measure your vital signs (pulse, temperature, breathing, and blood pressure) and place an IV line in one of your arms.

The infusion process

• The infusion process lasts approximately 2 hours.
• About 30 minutes before the infusion is started, you will be given medicine that will help with any nausea or vomiting you may experience because of the treatment.
• The infusion will take ​approximately 30 minutes.
• You will be monitored closely by the medical team to ensure that you are not experiencing any negative side effects.

After the infusion

• You will be kept for a short period after the infusion to allow some of the infused radiopharmaceutical to pass from your body. The medical team will let you know when it’s safe to leave.
• ​It is​ recommended that you drink plenty of fluids and urinate frequently over the next few days.
• You will need to follow radiation safety precautions for up to a week following your treatment. All precautions will be discussed during your consult.

Your next treatment

• You will receive 6 total treatments spaced 6 weeks apart as long as your condition allows treatment to continue.
• Between each treatment, your health care provider may check your kidney function and your blood counts.

After the last treatment

• Your cancer care provider will check your liver, kidneys, and blood on a routine basis after your last infusion.

Follow directions on your patient discharge instructions to safely manage the radiation in the radiopharmaceutical as it passes out of your body in your urine. This will protect you, as well as family members and caregivers around you. If you need medical care within the first few days after your radiopharmaceutical infusion, be sure and tell your providers that you have been treated with PSMA-targeted therapy. There may still be some radiation in your body, and your health care providers should take universal precautions. Most of the radiation will leave your body within 3 days.

Interacting with family and coworkers

• Try to maintain a distance of 6 feet from others for 3 days.
• Maintain a distance of 6 feet from infants, children, or pregnant women for 1 week.
• Wait 3 days before returning to work, then you may return if you feel well enough.

Interacting with pets

• Pets can be affected, too. You may want to take the same precautions with them.

Using the toilet

• Sit while using the toilet.
• Use toilet paper or wipes each time.
• Flush toilet paper or wipes.
• Flush twice with the lid closed.
• Wash your hands each time you use the toilet.
• Use separate towels and washcloths.

Sleeping

• Sleep in a separate bed and avoid intimate contact.

Driving home from the theranostics center

• The closest you should be to someone is 3 feet. So, if your spouse or caregiver is driving, consider sitting in the back seat.

Going out and about

• Minimize use of public transport and public facilities for 3 days.

Most insurance groups, including Medicare and many private insurers, cover imaging and treatment with PSMA-targeted therapy. Our team will work with you individually to determine your coverage options.

At this time, PSMA-targeted therapy is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC). To receive the PSMA treatment under current guidelines, patients will need to have been treated with androgen axis inhibition therapy.

If you are interested in finding out if you are qualified for the treatment, please fill out our PSMA-targeted Therapy Patient Intake Form. An ARA team member will contact you after you submit the form.

If you are qualified, your cancer care provider and the ARA theranostics team will work together to determine the details of your condition and the avenues for treatment.

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