Need a crash course in LU 177 basics

I posted elsewhere that a PET PSMA scan found 2 hot nodes (PSA started climbing). History: dx in '09. Failed surgery, then flunked SRT. Since then did VERY well with Lupron/Casodex (combined) so that after 9-12 months on I would get 1-2 year HT vacations. Twice I did scans followed by SBRT (also included 3-month HT shot) which did great...but of course the eventual PSA wake-up call.
Now my dilemma: as I posted in a different thread, just did the PSMA scan. It again found 2 hot nodes but this time close or in a previously radiated area. The RO did not advise doing radiation (that was my impression but I sent a message to him with some further questions). He did offer to tx. it "aggressively" if I so desire.

I have a video appt. with my MO, Dr. Lam in 2 weeks. I have read about LU177. As I understand it, they again use PSMA to target the cells? What all is involved? Is it 6 txs lifetime, but one or two might suffice? Is it given in the USA? I assume it is an infusion (like the PSMA scan but without the scan part)? What is the requirement to qualify for this tx? I have BCBS Medicare Advantage. They cover anything Medicare covers. Does it.

Finally, is this premature? Is HT (more modern HT drugs?) more appropriate now?

Sorry for so many questions.

Please advise

Mel

Mel,
Have you had Zytiga or Xtandi yet? The reason I ask is because three years ago after I'd been on a year-long break from ADT I had an Axumin PET scan before resuming ADT. The scan showed an enlarged lymph node that soon started impeding drainage from my left kidney. When I went back on ADT the node shrank and the kidney problem resolved. Last year when my PSA started rising even though I was on Lupron, I had a scan that showed some hot nodes in my pelvic area that they can't safely radiate. My MO added Zytiga 1000 mg daily plus 5mg prednisone in addition to Lupron. Since then my PSA has been undetectable but haven't had any recent scans. I had a quarterly appointment yesterday at Dana-Farber and PSA is undetectable and all other labs - CBC, liver function etc are in normal range.

I'm closely following LU177 and see that it is now in trials for patients who are still castrate sensitive. Hoping it will be generally available for me when it is time to move on to next steps. Also wondering results of the new trial will show benefit if it is used in patients earlier in their disease progression.
Jim

Yeah, I read a bit more after posting. As Matam pointed out, I would need to be castrate resistant and have had chemo. I CAN WAIT. LU177 seems to have a lot of promise to be in more widespread use. Hopefully, the clinical trials will suggest that. It seems good PC drugs have a faster track these days, so maybe this will happen within ... 4 years? Thoughts on that.

But every time I get answers new questions suggest themselves. For me, do I stick with the Casodex/Lupron regimen that has always worked great, or include some of the other drugs (Xtandi, Zytiga-Pred., etc.). Tough decision. This will probably be the main focus of my video chat with Dr. Lam.

Mel