How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?

This question is part of our collaboration with ASTRO to highlight impactful data from the 2026 Multidisciplinary Radiopharmaceutical Symposium. This question is inspired by the Plenary Session Presentation "Safety and Efficacy of Lu-177 PSMA-617 Versus Established Therapies in mCRPC: Pooled Evidence from Randomized Phase II/III Trials" by Dr. Mohammad Arfat Ganiyani

Answer from: Radiation Oncologist at Academic Institution

I generally favor starting with docetaxel, though both are reasonable options. CCTG Study PR21 did not show a difference in radiographic progression-free survival between starting with docetaxel versus starting with Pluvicto in this setting. However, OS favored patients who started with docetaxel, a...

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Radiation Oncologist at Kansas City VA Medical Center
Agree to use docetaxel upfront prior to using Pluv...

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How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?

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