A special treatment for advanced prostate cancer patients is now available on Cape Cod

Cape Cod men with advanced prostate cancer can now seek treatment with a unique nuclear medicine infusion, Pluvicto, close to home, rather than traveling to Boston for it.

Gregory Miller, 76, of Sandwich is the first patient with stage 4 prostate cancer to get the treatment locally, which he started at Cape Cod Hospital in Hyannis in January 2026. He was diagnosed with stage 3 prostate cancer in 2020, which was discovered during hip replacement surgery. According to the National Cancer Institute, stage 3 cancer may have metastasized from the prostate to the seminal vesicles or nearby organs or tissues.

Miller said he was thrilled about not having to spend long days driving to and from Boston for treatment, the ease of getting Pluvicto infusions, and his quick results.

“I really have hope now,” he said.

Miller’s Journey

After his initial diagnosis, Miller began a series of approaches to slow his progressing cancer. He said he received 21 treatments of external beam radiation, then brachytherapy (implantation of radioactive “seeds”) and five-to-six weeks of leuprolide injections, one of a class of drugs to inhibit production of testosterone, the male sex hormone that feeds prostate cancer growth. These methods lowered his PSA (prostate-specific antigen, an indicator of amount of prostate cancer) from 12 to 0.016 – “undetectable,” he said. He had previously had a Gleason score of 9, 10 being the worst score and indicating a high-grade cancer.

“My PSA stayed low, but I had to come off these drugs – they can damage organs,” he said.

Three months after stopping leuprolide, his PSA started going up again.

A doctor in Boston offered to do “a very unique form of brachytherapy,” Miller said, but he was “ very uncomfortable about more radiation; concerned about damage to neighboring organs.”

He was given a PET (positron emission tomography) scan for PSMA (prostate-specific membrane antigen). This molecule occurs on the surface of normal prostate cells but is found in amounts 100 to 1,000 times greater in prostate cancer cells, according to July 26, 2023 article in Abdominal Radiology. This showed he was a candidate for Pluvicto, which is designed for men whose metastatic prostate cancer is positive for PSMA, and who have already undergone hormone therapy and either have had chemotherapy or for whom chemotherapy may be considered later on.

How It Works and Side Effects

Pluvicto is not a systemic treatment that affects the entire body. It is a targeted radioligand treatment, using a radioisotope (lutetium 177) given in injections or infusions. It attaches to the PSMA molecules on the surface of cancer cells and kills the cells, according to Ethan M. Glazener, MD, the radiation oncologist who pushed to bring the treatment to Cape Cod Hospital.

Because PSMA is found in lower amounts on some normal cells, it may damage some healthy tissue, Dr. Glazener said. One of the most common side effects of Pluvicto reported by patients is dry mouth caused by damage to the salivary glands. The glands can recover after treatment, he said. Patients will have blood work done to monitor their liver and kidney function and other health indicators during treatment.

According to Novartis, Pluvicto’s manufacturer, side effects include: fatigue, nausea, joint pain, back pain, constipation (Miller reported diarrhea, instead) and lower blood cell counts.

Pluvicto may not be appropriate for patients who have numerous tumors in their bones, as treatment could harm the marrow that makes blood cells, Dr. Glazener said.

Procedure and Precautions

Michele Dayton, lead nuclear medicine technologist at Cape Cod Hospital, described what it’s like to receive a dose of Pluvicto.

“It’s not a long process, probably 30-40 minutes,” she said.

A patient is connected through an intravenous line to a bag of saline solution to keep him hydrated. The actual infusion of the radioisotope takes only a few minutes.

“This isotope is washed out of your body with your urine,” Dayton said. Patients are advised to “drink, drink, drink” fluids to flush out the excess isotope not absorbed by the tumor cells.

Post-treatment precautions to limit radiation exposure to others include:

• Maintaining a minimum of three feet distance from people and pets
• Sleeping by yourself and using a separate bathroom for the first three days
• Avoiding being near children for seven days
• Staying away from pregnant women for 15 days
• Showering daily
• Washing laundry separately

Benefits of Pluvicto at Cape Cod Hospital

“It’s so great” to offer stage 4 prostate cancer patients a way “to live longer,” Dr. Glazener said. “We keep them in remission as long as possible.”

A former Army flight instructor, Miller said he lost his father at age 31 to cancer, and his own diagnosis “took the wind out of my sails for a little bit.”

When Pluvicto became available locally, “I was OK to try it,” he said, after having already endured other treatments and their side effects, especially the anti-androgen drugs that can cause impotence, hot flashes, pain, fatigue, joint problems and other issues, such as skin reactions, problems urinating, high blood sugar and increased risk of heart attack or stroke, according to LupronDepot, the maker of leuprolide. Miller praised his wife for having patience with mood changes caused by the drug and supporting him throughout the process.

The temporary damage to his salivary glands made his voice raspy and “nothing tastes good,” Miller said.

Fatigue, joint and hip pain also affected him. Miller said exercise helps him keep the joint pain away and taking short naps fights fatigue. He has had external radiation for bone pain and knows chemotherapy may lie ahead. He maintains an upbeat attitude and says just giving up to cancer is not an option.

“I just went into my sixth year since diagnosis,” Miller said. “I’m demanding of them for five more.”

The Push for Pluvicto and Beyond

Elaine Cabral, executive director of radiology at Cape Cod Hospital, and Dayton credited Dr. Glazener for spearheading the drive to get Cape Cod Hospital to offer Pluvicto, and Dr. Glazener said their efforts were also key.

“This doesn’t happen here at Cape Cod Hospital without them. I’m super proud,” he said.

Cabral said “My piece is more ensuring whomever needs to be included is on board. The logistical process on special equipment” and how it will be paid for. In the case of Pluvicto, a special shield was needed to hold the syringes of radioactive liquid.

Dayton said she hopes the hospital will continue to expand its nuclear medicine options, such as Pluvicto.

“They’re always coming out with new drugs,” she said.

“We want to be an early adopter rather than a late adopter,” Dr. Glazener said. He added he hopes to offer Pluvicto at Falmouth Hospital soon. As of March 18, 2026, about seven men on Cape Cod were either in treatment or under consideration for it, he said. PSMA PET scans, part of the screening process for eligibility, can be done at Cape Cod Healthcare’s Fontaine Outpatient Center in Harwich and Stoneman Outpatient Center in Sandwich.

Miller praised Dr. Glazener and his medical team for educating him about Pluvicto and giving him the option to try it. He urged other men not to be afraid to try it.

“I have three incredible doctors. They get it. Every decision, I make it.”

As for the effectiveness of the drug, “No one’s saying the word ‘cure,’ but it’s holding it back,” he said.