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Joey Wahler (Host): Our guest, Dr. Sean Collins. He's Professor of Radiation Oncology and Vice Chair of Faculty Affairs, Radiation Oncology at the University of South Florida. This is Community Connect presented by Tampa General Hospital. Thanks for joining us.

I'm Joey Wahler. Hi there, Dr. Collins. Welcome.

Sean P. Collins, M.D., PhD.: Thank you for having me. This is an important topic.

Host: Absolutely. Let's get right to it. Great to have you aboard. So first, there are multiple forms of prostate cancer. Some may not be aware of that, including an advanced one called castrate-resistant metastatic prostate cancer. So, in a nutshell, can you tell us what that is?

Sean P. Collins, M.D., PhD.: So the primary treatment for metastatic prostate cancer is androgen deprivation therapy. Men have high levels of testosterone. Testosterone is important in maintaining muscle mass, bone density, and sexual function. Unfortunately, it allows prostate cancer to grow. Castrate-resistant prostate cancer has learned how to grow in the absence of testosterone, and it has limited treatment options, and it's an aggressive cancer.

Host: And so one treatment option, and it's relatively new, Pluvicto. So what is it and how does it work?

Sean P. Collins, M.D., PhD.: So Pluvicto or lutetium PSMA 617 is a new targeted radioactive medicine used to treat castrate-resistant prostate cancer that has spread to other parts of the body. It is a radioligand therapy, so it combines a targeting molecule or a ligand with a radioactive material, lutetium 177. The targeting molecule binds to the PSMA receptor. A protein found abundantly on prostate cancer cells, and then the radioactive material emits radiation that damages and kills those cancer cells.

Host: So how exactly is Pluvicto administered?

Sean P. Collins, M.D., PhD.: So it is given as an IV infusion. Patients don't need to fast, do not have to do any other preparation before receiving the infusion. Generally, an IV is placed in the arm to deliver the treatment. The injection only takes a few minutes. There's a period of observation for approximately one hour, and then the patient goes home.

Patients are radioactive following the treatment and need to limit direct contact with their friends and family for a few days to a few weeks. The treatment typically involves six separate infusions given approximately every six weeks. We typically check patients every three weeks to assess response to treatment with the test called the PSA blood test.

We also, every three weeks look for side effects, and that includes taking a blood sample. If you're doing well and responding well to the treatment, you continue the therapy for the six sessions.

Host: And so what are the benefits for the patient compared with traditional treatment?

Sean P. Collins, M.D., PhD.: Right so a lot of these patients don't have any other options. They've already failed traditional hormonal therapy. They failed second line treatment with androgen receptor pathway inhibitors, and their only option is really chemotherapy. But these men are in their seventies, 80 years old, and chemotherapy has a lot of side effects. A lot of them aren't even candidates for chemotherapy.

Host: Well speaking of being a candidate. Who's a candidate and who's not?

Sean P. Collins, M.D., PhD.: So if you have castrate-resistant prostate cancer and you failed treatment with androgen receptor pathway inhibitors, and you're not a candidate for chemotherapy, or it's appropriate to delay chemotherapy, then you're a candidate for Pluvicto. You would get this special type of scan called a PSMA PET Scan to verify that your cancer expresses the PSMA receptor, and the vast majority of prostate cancers express this receptor. So most patients are candidates.

Host: So we mentioned at the top doc that there are various forms of cancer. Where does this one fit on the spectrum in terms of how common it is? And you mentioned age. Does it typically affect older men?

Sean P. Collins, M.D., PhD.: Prostate cancer is a disease of aging. It's not your fault. You did nothing wrong. Men as they get older, if they live into their seventies, eighties, they have a very high chance of getting prostate cancer. There are some groups of patients that are more at risk. If you have a family history of prostate cancer or you're of African-American descent, you have a higher risk of prostate cancer.

One in six men will get prostate cancer in their lifetimes. So especially with the aging population where we're living into our eighties and our nineties, it's becoming a bigger and bigger problem every year.

Host: And having said that, what about this particular form of prostate cancer?

Sean P. Collins, M.D., PhD.: So unfortunately, 200,000 men in the United States get prostate cancer a year. But only the ones who develop castrate-resistant prostate cancer die from it. So the 30,000 men a year in the United States that die of prostate cancer usually die from castrate-resistant prostate cancer that has become resistant to all available therapies. And this gives them an option to at least control this cancer for months to years.

Host: How about the potential side effects here?

Sean P. Collins, M.D., PhD.: This drug's actually really well tolerated. Common side effects are fatigue, dry mouth, dry eyes, constipation and nausea. But these usually don't limit the therapy. It can also cause drops in your blood counts, so we do check your blood every three months, but these are usually only small drops in the blood counts and usually don't cause you any symptoms.

Host: Of course, before any new treatment option is available, it has to undergo extensive clinical trial testing.

Sean P. Collins, M.D., PhD.: It's been shown to be very effective in clinical trials. The biggest trial was the VISION trial that showed significantly improvement in overall survival in patients with metastatic castrate-resistant prostate cancer. So it's not just about how long you live, it's also about the quality of life.

So men with castrate-resistant prostate cancer can have symptoms like bone pain, decreased mobility, and this medication can decrease bone pain and improve mobility.

Joey Wahler (Host): And getting the PSA test to get screened on a regular basis, starting when you're in your forties is generally recommended and just give people an idea joining us Doc, how important that is and how lifesaving that can be. Right.

Sean P. Collins, M.D., PhD.: So one of the saddest things I have in my life is when someone comes to Tampa General Hospital with back pain, they get a PSA and it's 2000. And they have prostate cancer in every bone in their body. Because I just think, I mean, if they just would've gotten a PSA test in their forties, if they have a family history or in their fifties, if they don't; this could have been prevented. So to me, get your PSA once a year. If you're over the age of 50, make sure you don't ignore it. Because to me, I don't want to have to tell you that you're not curable.

Joey Wahler (Host): How rewarding is it for you to be able to offer this relatively new treatment that, as you pointed out, could be so big in this area?

Sean P. Collins, M.D., PhD.: One of the main reasons why I moved to Tampa General Hospital, is because I knew that I would have the ability to provide this treatment for my patients. It was one of the most important factors in my move to Tampa General Hospital.

Host: Well folks, we trust you are now more familiar with treating advanced prostate cancer. Dr. Collins, please keep up all your great life-saving work, life-extending work, and thanks so much again.

And for more information, please visit tgh.org/cancer. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect presented by TGH on your favorite podcast platform. Also share it on your social media. I'm Joey Wahler, and thanks again for being part of Community Connect presented by Tampa General Hospital.