Finding the Right Patient for Lutetium-177 PSMA Treatment - Kara Cossis

October 13, 2023

Phillip Koo converses with Kara Cossis about the critical aspect of patient selection for PLUVICTO® (lutetium Lu 177 vipivotide tetraxetan) treatment. Ms. Cossis outlines the criteria for identifying suitable candidates, emphasizing the role of castrate-resistant metastatic prostate cancer, disease burden, and eligibility based on scans. She also discusses the logistics of obtaining PSMA PET scans, mentioning that every geographic location they serve has a referral center for these scans. Ms. Cossis reveals the use of a data analytics system called PPS, which functions to flag potential candidates based on rising PSA levels or key phrases in imaging reports. She notes that PLUVICTO has generated significant patient interest, with many inquiring about the treatment's logistics, side effects, and precautions. The conversation concludes with an optimistic outlook on the newly initiated PLUVICTO service line at Chesapeake Urology.


Kara Cossis, PA-C, MPH, Director of Advanced Practice Providers, Chesapeake, Urology

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Arizona

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Phillip Koo: Hi, welcome back to our special feature looking at the integration of a PLUVICTO program into a large urology group practice. Patient selection is a very important piece to this puzzle, and we're very fortunate to have with us. Kara Cossis, who's the Director of Advanced Practice Providers here at Chesapeake Urology. Welcome.

Kara Cossis: Thank you.

Phillip Koo: So you see a lot of these patients in the advanced prostate cancer clinic here. What's your approach to finding the right patients to undergo treatment with Lutetium-177 PSMA?

Kara Cossis: So usually what we're looking for is patients who are identified now as castrate-resistant metastatic prostate cancer. We look at what their disease burden may look like, and we evaluate their symptoms and their eligibility based on appropriate scans.

Phillip Koo: At what point do you consider getting a PSMA scan and can you talk us through some of the logistics of obtaining a PSMA PET here in your community?

Kara Cossis: So we're using a lot of PSMA PET for initial staging, but the approval right now only seems to be for rising PSA, so as long as there's not any restrictions with their insurance coverage, we're trying to move to that as a next step to get an idea of how their imaging is changing and whether or not there's findings that are being picked up on the PSMA imaging.

Phillip Koo: Is there a local PET center that you refer to, or do patients find these places on their own?

Kara Cossis: So we actually have a great system and process, and we're pretty geographically vast. Every location that we have does have an equivalent center for which we're able to refer. Some are a little bit of a distance, but every geographic area we do have, which is fantastic. In this area particularly, we have two that we refer to where we're able to direct our patients.

Phillip Koo: Can you tell us a little bit more about some of the technological tools that you have to help identify some of these patients who might be candidates for PLUVICTO?

Kara Cossis: So we use a system called PPS. I don't specifically use it myself, but we have a team that's able to navigate these patients. So there's certain alerts that they'll be given if we notice a patient has a PSA that begins to rise sequentially, or there's certain key phrases that are input on their imaging to identify these patients as being metastatic. So we have a team that does that and they communicate their findings to one of the physicians or one of our advanced practice providers if it's not something that we have noticed ourselves or something that was missed. So it's basically through the data analytics system that has been very useful for helping to act as a safety net for these particular patients.

Phillip Koo: And in your experience treating many of these patients with advanced prostate cancer, what has the response been to PLUVICTO as a treatment option?

Kara Cossis: So I think this is one of the first treatment lines that people are asking for. They seem to have read about it in various literature. They have heard about it. I have not seen people coming asking for the treatments like they have specifically for PLUVICTO. We don't have too many people who have gone onto the treatment just yet since we're newly starting, but so far the experience and the service line I think has gone extremely well.

Phillip Koo: And are there any common questions or concerns they've brought to you with regards to PLUVICTO?

Kara Cossis: So usually I think the patient wants to know what this looks like overall. How many treatments does this consist of? What are the typical side effects they'd be concerned about? Is there any special precautions that they need to know about with respect to being at home and their family and disposable items.

Phillip Koo: Well, thank you very much for your time, and we look forward to learning more about the program here at Chesapeake Urology.

Kara Cossis: Thank you.