Did the approval of lutetium Lu 177 vipivotide tetraxetan (Pluvicto) change how you image and manage patients with metastatic castrate-resistant prostate cancer?

The FDA approval of Pluvicto was a welcome addition to a growing list of treatments for patients with mCRPC. Logistical issues with administration have slowed the routine implementation of this therapy in the US. In terms of imaging, a PSMA-PET is required prior to the administration of Pluvicto to demonstrate adequate PSMA expression within the tumor. From a practical perspective, I tend to obtain a PSMA-PET in patients with mCRPC that may go on to receive Pluvicto within the next 6 months. This allows time for the scans to be performed and the patient scheduled for Pluvicto therapy which can take weeks to months. I caution patients that it is likely that a PSMA-PET may show new areas of disease that were not present on a CT or bone scan. ...