Questions to Ask Your Doctor After 4 Pluvicto Infusions
Immediate Assessment Questions
Ask your doctor to review your PSA response and imaging results to determine if you should complete the standard 6-cycle course or transition to alternative therapy now. 1
Treatment Response Evaluation
Request your current PSA level compared to baseline - A ≥50% PSA decline indicates good response and supports completing the full 6 cycles, while rising PSA suggests early progression requiring treatment change 2, 3
Ask about recent PSMA PET/CT findings - High PSMA uptake with responding disease supports continuing Pluvicto, while new FDG-avid/PSMA-negative lesions indicate resistance and need for alternative therapy 2, 1
Clarify your symptom trajectory - Improved or stable pain and functional status favor completing treatment, whereas worsening symptoms despite therapy suggest progression 2, 1
Planning for Cycles 5 and 6
Confirm the schedule for remaining infusions - Standard protocol is 6-week intervals between cycles 2, 4
Discuss monitoring bloodwork frequency - Thrombocytopenia occurs in approximately 13% of patients and requires monitoring before each cycle 2
Ask about managing dysgeusia (altered taste) - This affects 87% of patients but rarely requires treatment discontinuation 5, 2
Post-Treatment Strategy Questions
If Treatment is Working
Ask if extended therapy beyond 6 cycles is appropriate - Patients with responding disease but high residual tumor burden may benefit from additional cycles 1
Clarify surveillance imaging schedule - Routine imaging is not mandatory without PSA rise or new symptoms, but periodic assessment helps detect early progression 6, 1
If Treatment is Failing
Request molecular testing for BRCA1/2 and homologous recombination repair genes now - This determines eligibility for PARP inhibitors like olaparib, which should be considered before other options if mutations are present 1, 7
Alternative Systemic Therapy Options
Androgen receptor pathway inhibitors - Ask about abiraterone, enzalutamide, apalutamide, or darolutamide if not previously used or if significant time has passed since prior exposure 1, 6
Taxane chemotherapy - Docetaxel 75 mg/m² every 3 weeks for 6 cycles is standard if not recently used 1, 6
Radium-223 - Specifically ask about this for symptomatic bone metastases without visceral involvement, as it can be combined with other therapies 1, 6, 4
Clinical trial enrollment - Request referral to trials, particularly those combining therapies or testing novel agents 1, 7
Bone Health and Supportive Care
Ask if you should start or continue denosumab or zoledronic acid - These prevent skeletal-related events in patients with bone metastases 1, 6
Request spine MRI if you have vertebral metastases - This detects subclinical cord compression before neurologic symptoms develop 6, 7
Discuss palliative radiation for painful bone lesions - Single-fraction external beam provides effective pain relief 1, 6
Critical Safety Monitoring
Clarify neurologic symptom reporting - While severe problems are rare (stroke occurred in 1% of patients), report new headaches, dizziness, weakness, or paresthesias immediately 5
Confirm ADT continuation plan - Testosterone suppression must be maintained throughout all subsequent treatments, even if disease progresses to castration-resistant state 8, 6
Ask about managing long-term ADT effects - Request bone density screening and metabolic syndrome monitoring 6, 1
Common Pitfalls to Avoid
Do not stop ADT even if Pluvicto fails - Castrate testosterone levels remain essential for any subsequent therapy to work 8, 6
Do not delay molecular testing - BRCA1/2 testing takes time and results determine optimal sequencing of therapies 1, 7
Do not assume PSA alone indicates progression - Imaging and clinical status provide critical additional information, particularly as neuroendocrine differentiation can occur with low PSA 6, 7
Do not wait for severe symptoms before imaging - Early detection of oligometastatic progression may allow targeted therapies rather than systemic treatment changes 7, 1