How do you manage PSA progression while a patient is on Xofigo or Pluvicto?

The tl;dr

PSA is very much an imperfect tool for these patients. The data show that PSA may initially increase over multiple cycles before decreasing, though this is a minority of patients. Most patients whose PSA increases early have resistant disease, and you should investigate further with imaging...

Change of therapy depends on evaluation after sufficient time has elapsed from the start, and on a fuller picture with ancillary studies.