‘Dilbert’ Cartoonist Scott Adams, 68, Who’s Battling Metastatic Prostate Cancer, Says Doctors Are Trying to ‘Radiate Pesky Tumor’ Around His Spine as He Says He ‘Can’t Move Muscles’

“At this time, the only people getting radioligands are those with metastatic castration resistant prostate cancer, and most of these patients have failed an ARPI [another form of hormone therapy], such as abiraterone, apalutamide, darolutamide, or enzalutamide. These patients have a choice of getting chemotherapy or a radioligand therapy,” Dr. Sumit Subudhi, a medical oncologist at University of Texas MD Anderson Cancer Center in Houston, tells SurvivorNet.

“I’m paralyzed below the waist in the sense that I can’t move any muscles. I still have sensation — I just can’t move anything,” Adams added.

WATCH: The Promise Of Radioligand Therapy

The U.S. Food and Drug Administration (FDA) approved Pluvicto, a radioligand therapy (RLT). Think of RLT as a highly sophisticated, guided missile system designed to target and destroy cancer cells while leaving healthy tissues largely untouched.

Pluvicto may be helpful for anyone with prostate cancer that has spread beyond the prostate and has not responded to hormone therapy.

A common first step in treating advanced prostate cancer is hormone therapy, also known as androgen deprivation therapy (ADT). This treatment aims to lower or block testosterone, which fuels the growth of most prostate cancer cells. Hormone therapy can be incredibly effective, often slowing or halting the disease’s progression for many months or even years.

However, for many patients, the cancer eventually becomes “castration-resistant. This means that even with very low levels of testosterone, the cancer finds ways to continue growing and spreading. When this happens, it becomes metastatic castration-resistant prostate cancer (mCRPC).

WATCH: How Pluvicto Finds and Fights Cancer

“Pluvicto … has been shown to have a survival benefit, and that’s really helped pave the way for other agents and using it in other disease states. Currently, for example, there was a clinical trial that led to the FDA approval of Pluvicto being utilized in people pre-chemotherapy with metastatic castration resistant prostate cancer,” Dr. Aihua Edward Yen, medical oncologist at Baylor College of Medicine, tells SurvivorNet.

Dr. Andy Chen, a Radiation Oncologist at Sugar Land, Texas Oncology and Texas Medical Center, explains to SurvivorNet that Pluvicto works by coupling a radioactive source to this marker, and the drug can be directly delivered to these cancer cells that reside in bone. It’s another tool in our toolbox when it comes to treating advanced prostate cancer, in addition to chemotherapy or hormone therapy. This is another option that has been very helpful.”

Adams remains hopeful his current radiotherapy treatment with standard radiation is successful, so he can eventually return to Pluvicto.

“If all goes well and it gets more of the tumor, I might at least have the ability to get some strength back in my lower body. That’s the hope,” Adams said.

“In a week or so, I should have been getting the second Pluvicto treatment. I can’t really combine that with the standard radiation I’m getting.”

Adams’ Prostate Cancer Diagnosis

Adams says former President Joe Biden’s prostate cancer diagnosis prompted him to go public with his own diagnosis in May 2025.

During a video blog, Adams told his viewers, “I thought to myself, ‘You know what? I’m going to slide under his story, and he’s going to take away a lot of the attention because, you know, [he’s the] ex-President.’

 

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Prostate cancer, the most common cancer among men, begins in the walnut-sized gland located between the bladder and rectum. This gland produces fluid that nourishes sperm, and regular screenings often catch issues before symptoms appear.

Metastatic prostate cancer means the disease has moved beyond the prostate, making treatment more complex. Yet even in the face of advanced cancer, there are still paths forward—options that offer patients and their families not just care, but hope.

Pluvicto Isn’t For All Prostate Cancer Patients. How to Know If You’re a Good Fit?

Pluvicto isn’t designed for everyone with prostate cancer, Dr. Subudhi notes. It is specifically approved for men with metastatic castration‑resistant prostate cancer (mCRPC)—a stage in which the disease has spread beyond the prostate and no longer responds to traditional hormone therapy, also known as androgen deprivation therapy (ADT).

Pluvicto was originally limited to patients who had already received chemotherapy. But in March 2025, the FDA broadened its approval. It can now be used earlier in the treatment course for adults with PSMA-positive mCRPC who have previously been treated with an androgen receptor pathway inhibitor (ARPI) and are considered suitable candidates to delay taxane-based chemotherapy.

WATCH: Long-term Impact of Androgen Deprivation Therapy

This update significantly expands access—potentially tripling the number of eligible patients—and allows more men to receive this therapy sooner.

In general, patients must meet several criteria to qualify for Pluvicto:

• Confirmed mCRPC: The cancer has spread and no longer responds to hormone therapy.
• Progression after at least one ARPI: The disease has continued to advance despite prior hormone-based treatment.
• PSMA‑positive disease: Cancer cells must express the PSMA protein, verified through specialized imaging.

Pluvicto is not intended for newly diagnosed or localized prostate cancer and does not replace definitive treatments such as surgery or traditional radiation in those cases.

For patients with PSMA-positive disease, Pluvicto is often preferred over bone-targeted radioisotopes like Radium‑223 (Xofigo). While Xofigo is used for symptomatic bone-only metastases, Pluvicto generally has a more favorable side‑effect profile and carries a lower risk of severe bone marrow suppression, which can preserve future treatment options such as chemotherapy.

The treatment plan usually involves up to six doses, given once every six weeks. Your care team will monitor your progress closely, and if you are responding well and tolerating the treatment, it will continue.

WATCH: Why The Targeted Approach Is Providing So Much Hope

What Are the Side Effects?

“Side effects of Pluvicto, in general, depend on the radiation and where the medication goes,”  Dr. Aihua Edward Yen, medical oncologist at Baylor College of Medicine, tells SurvivorNet.

“Radiation potentially can cause your blood counts to come down, so we’ll usually have to watch that very carefully. It can also go to other areas of your body, where PSMA is expressed, and these would be considered off-target effects,” Dr. Yen continued.

Common side effects can include:

• Dry mouth (xerostomia)
• Feeling tired or low on energy (fatigue)
• Stomach upset
• Constipation or mild diarrhea
• Decreased appetite
• Anemia (low red blood cell count) or low white blood cell count
• Arthralgia (joint pain) or back pain

What to Know About Prostate Cancer Screening

Prostate cancer is highly treatable, especially when caught early. And thanks to major advances in medical care, even cases diagnosed at more advanced stages can often be effectively managed.

How Prostate Cancer Is Found

Most prostate cancers are detected through routine screening exams. However, prostate cancer doesn’t behave the same way in every man. In some cases, it’s slow-growing and considered “low-risk,” meaning treatment may not be immediately necessary. In others, the cancer can be more aggressive and require prompt intervention. Because of this variability, there’s ongoing debate about when and how often men should be screened.

Who Should Get Screened?

The U.S. Preventive Services Task Force recommends that men between the ages of 55 and 69 who are at average risk talk with their doctor about the benefits and risks of prostate cancer screening. Most experts agree that men over 70 generally do not need routine screening.

SurvivorNet experts also advise men to consider personal risk factors—such as family history, genetics, and age—when deciding on a screening plan.

WATCH: What to Look for in Prostate Cancer

Possible Symptoms of Prostate Cancer

While early prostate cancer often has no symptoms, more advanced cases may cause:

• Frequent urination
• Waking up at night to urinate
• Blood in the urine
• Difficulty getting or maintaining an erection
• Pain or burning during urination
• Pain in the back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

If you notice any of these symptoms, it’s important to talk to your doctor. Early detection can make a significant difference in treatment outcomes.

Questions to Ask Your Doctor

Here are some questions you may consider asking your doctor about your risk of developing prostate cancer:

• How does my family history affect my risk of developing prostate cancer?
• Are there tests available to determine my genetic risk of developing prostate cancer?
• Based on my history, genetic test results, and other factors, when do you recommend I begin screening for prostate cancer?
• How can I prepare for prostate cancer screening

Learn more about SurvivorNet's rigorous medical review process.

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