Pluvicto (Lutetium-177): What to Expect

This page is for men with prostate cancer who are being offered Pluvicto, and their families. It covers how it works, who qualifies, the course of treatment, radiation safety at home, side effects, and when to get help.

Pluvicto is the brand name. Lutetium Lu 177 vipivotide tetraxetan is the generic name. It has two halves joined together. One half seeks out PSMA, a protein found on the surface of many prostate cancer cells. The other half is lutetium-177, a radioactive atom that fires short-range radiation into whatever it is attached to.

Because it only works where PSMA is present, a PET scan comes first. Your team uses an approved PSMA imaging agent to see whether your tumors light up. If they do not, this treatment is not for you. That scan is the gate, and it is worth asking to have the result explained.

Pluvicto is for adults with PSMA-positive prostate cancer that has spread (metastatic). The FDA label, updated in 2026, covers two groups.

• Cancer that still responds to hormone therapy, or has not had it yet. Here Pluvicto is given together with an androgen receptor pathway inhibitor (ARPI). This class includes tablets such as enzalutamide and abiraterone.
• Cancer that has stopped responding to hormone therapy. Here you must already have had an ARPI. You must also either have had taxane chemotherapy, or your team judges it right to delay taxane chemotherapy.

Ask your team which group you are in, and why.

The course is six doses into a vein, about six weeks apart, so the whole treatment spans most of a year. Treatment stops earlier if the cancer grows or side effects make it unwise. The radioactive amount in each dose is fixed by the label and measured out by the nuclear medicine team. It is not a number you handle, so it is not printed here.

The injection itself is quick. The visit is longer, because of preparation, checks and radiation handling. Blood tests and kidney function are reviewed before each dose.

You go home mildly radioactive, and the label sets out what to do about it.

• Drink plenty and empty your bladder often, both before and after the dose. This clears the drug faster and reduces the radiation dose to your bladder.
• Keep more than 3 feet away from other people where you can for 2 days, and from children and pregnant women for 7 days.
• Sleep in a separate room from other adults for 3 days, from children for 7 days, and from a pregnant woman for 15 days.
• Avoid sexual activity for 7 days.

Your nuclear medicine team will give you written instructions, including toilet and hand-washing steps. Keep them where you can find them.

The label lists tiredness, dry mouth and nausea among the most common side effects. Ask your team how to ease dry mouth.

The label warns that Pluvicto can cause severe and life-threatening low blood counts. Report unusual tiredness, pallor, breathlessness, easy bruising or bleeding, or signs of infection such as fever, chills, sore throat or mouth ulcers.

The label says to stay well hydrated and urinate often, because the drug can harm the kidneys. Kidney blood tests are checked before and during the course. The label also notes that treatment may cause temporary or permanent infertility, which is worth raising before the first dose.

• Call 911 or go to an emergency department if bleeding will not stop, you are breathless at rest and very pale, or you stop passing urine altogether. Do not drive yourself.
• Treat a fever as an emergency, not a same-day call. If your temperature reaches 100.4°F (38°C) or higher, or you get shaking chills, phone the oncology or nuclear medicine line right away. If you cannot reach anyone, go to the emergency room. CDC says to call your doctor immediately for a fever of 100.4°F (38°C) or higher during chemotherapy, and calls it a medical emergency. Pluvicto can also lower blood counts, so this holds between visits too.
• Call your care team right away, day or night, if you get a sore throat, mouth ulcers, or burning when passing urine, even without a fever.
• Call your care team within a day or two if you bruise for no reason, feel worn out beyond your usual, cannot keep fluids down, or your urine volume drops while you are trying to drink more.

Say that you have had a radioactive treatment when you call, and take your written radiation-safety instructions with you.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14908037-2892-4d98-a053-253ce35afb1a

https://www.cancer.gov/about-cancer/treatment/drugs/lutetium-lu-177-vipivotide-tetraxetan