New guidelines for salvage radiation dimensions

It has always been troubling that only about half of all salvage radiation treatments after failure of radical prostatectomy are successful. Usually, only the prostate bed is treated. But sometimes recurrent patients (or those with persistently elevated PSA) receive salvage radiation to the pelvic lymph nodes as well, or subsequently. … READ MORE …

First of six FREE webinars on making well-informed prostate cancer decisions

On Wednesday, May 26, the Cancer Support Community together with Prostate Cancer International will be holding the first of a series of six FREE educational webinars for patients and family members. … READ MORE …

First clinical trial of Lu-177-PSMA-617 in recurrent, hormone-sensitive men

While we expect only a few months of extra survival from the VISION trial of Lu-177-PSMA-617 in heavily pretreated, metastatic, castration-resistant men (see this link), we hope to get more out of the radiopharmaceutical if used earlier.

Privé et al. reported the results of a pilot trial in 10 recurrent men treated with Lu-177-PSMA-617 at Radboud University in Nijmegen, The Netherlands. They were all:

  • Recurrent after prostatectomy ± salvage radiation (PSA > 0.2 ng/ml)
  • Rapid PSA doubling time (< 6 months)
  • Between 1-10 metastases detectable on a PSMA PET scan or USPIO MRI
  • At least 1 metastasis > 1 cm
  • Unable to receive SBRT to metastases
  • No visceral metastases
  • Have not begun salvage ADT
  • Treated with a low dose (3 GBq) on day 1; second treatment (~6 GBq) after 8 weeks (compared to dose in VISION trial of 7.4 GBq in each of 4 to 6 cycles)

After 24 weeks of follow-up after Cycle 2:

  • 5 patients had PSA reduced by > 50 percent (1 undetectable)
  • 2 patients had stable PSA
  • 3 patients had PSA progression
  • 6 patients had a radiographic response
  • 4 patients had radiographic progression
  • ADT-deferred survival was 9.5 months (median)
  • Those with lymph node only metastases had the best response
  • Those with any bone metastases had lesser response

After a second dose, comparing their 24-week PSA to their 12-week PSA:

  • PSA was continuing to decline in 3 patients
  • PSA was rising again in 6 patients
  • Side effects were mild (no grade 3) and transient:
    • Fatigue in 7;nausea in 3
    • Dry mouth (xerostomia) in 2

There are lots more questions than answers:

  • Would a higher dose and more treatments be more effective?
  • Would a higher dose and more treatments be more toxic?
  • Is it like Xofigo in that it’s more effective with micrometatases? If so, would a combination with SBRT targeted at the larger metastases be more effective?
  • Since it was more effective on lymph nodes, would it make a good combination with Xofigo for patients who have both lymph node and bone metastases? (See also Th-227-PSMA.)
  • Because there seems to be a continued abscopal effect for some patients, would combining it with Provenge be optimal?
  • Would pretreatment with ADT or a new anti-androgen (Xtandi, Erleada or Nubeqa) increase expression of PSMA, and increase radiosensitivity?
  • Can we predict who will benefit?

Use in other patient populations remains to be explored: high-risk, newly diagnosed metastatic, castration-resistant but chemo-naive. Optimal sequencing with other therapies remains to be explored.

Editorial note: This commentary was written by Alan Edel for The “New” Prostate Cancer InfoLink.

A revolutionary advance in patient-centric prostate cancer advocacy/support

For those who have not already heard about it, two of the very largest patient-centric prostate cancer advocacy organizations have agreed to merge into one.

… READ MORE …

Are we closer to automated pathological assessment of prostate cancer biopsy slides?

According to a recent article in Modern Pathology, a team of researchers at Yale University and at Memorial Sloan-Kettering Cancer Center (MSKCC) have been able to show that an artificial intelligence (AI) system designed and validated at MSKCC could be used to diagnose prostate cancer as either “suspicious” or “not suspicious” based on data from nearly 2,000 slides of prostate tissue acquired at Yale Medicine. … READ MORE …

Lutetium-177 PSMA-617 in treatment of mCRPC: trial results

According to a media release, issued earlier today by Novartis, the company has provided preliminary data about the results of the international, multi-center, Phase III, randomized, VISION trial, which has been evaluating the efficacy and safety of lutetium-177 PSMA-617, a targeted radioligand therapy, in treatment of men with progressive, PSMA-positive, metastatic, castration-resistant prostate cancer (mCRPC) … READ MORE …

Active surveillance and related research: a new research initiative

As some of our readers will already be aware, Prostate Cancer International has been working in concert with Dr. M. Mihaj Siddiqui at the University of Maryland School of Medicine and the PATIENTS program at the University of Maryland School of Pharmacy to put together a grant request for funding for a program to identify evidence gaps to guide future research on the use of active surveillance to monitor low-risk prostate cancers. … READ MORE …

Modulating personal bias in provision of prostate cancer “support” services

As Howard Wolinsky has been learning over the past few years, not all prostate cancer support groups are “equal” — in the sense that individual support group leaders may be seriously biased by their own personal experiences (which may have occurred many years ago). … READ MORE …

How does your doctor do prostate biopsies?

So (in our opinion) the time has come — for a whole bunch of reasons — for actual and potential prostate cancer patients to start asking their urologists about whether they are able to carry out transperineal as opposed to transrectal biopsies. … READ MORE …

Major new survey on active surveillance and prostate cancer

In February, a group of researchers initiated a major new survey of patient knowledge about active surveillance as an initial management option for men with lower risk forms of prostate cancer. … READ MORE …

Xofigo 2.0

Xofigo (radium Ra 223 dichloride) is a systemic radiopharmaceutical. Radium is chemically similar to calcium and is taken up by bones in places where bone is actively growing, as in prostate cancer bone metastases. … READ MORE …

Another new urine test for risk of prostate cancer

As we have mentioned previously, data on the use of a variety of methods of urine testing in assessment of risk for clinically significant prostate cancer (and therefore the need for a follow-up biopsy) continues to evolve. … READ MORE …

Lu-177-PSMA-617 vs Jevtana (cabazitaxel): which should I do next?

We saw recently (see this link) that of chemotherapeutic and hormonal medicines for treatment of metastatic castration-resistant prostate cancer (mCRPC), Jevtana (cabazitaxel) is the preferred third-line treatment after Taxotere (docetaxel) and Zytiga (abiraterone acetate) or Xtandi (enzalutamide). … READ MORE …

AS and management of Grade Group 2 prostate cancer

The abstract of a presentation to be given by Egan et al. — from the National Institutes of Health (NIH) at Bethesda, MD — at the upcoming, virtual Genitourinary Cancers Symposium has indicated that active surveillance (AS) seems to be a very reasonable option for first-line management for compliant patients initially diagnosed with Grade Group 2 prostate cancer. … READ MORE …

Risk for and detection of clinically significant prostate cancer in previously unbiopsied patients

The “best” way to identify clinically significant, localized prostate cancer continues to evolve. But there is still no consensus about what that “best” way might be to do this, let alone any consensus about the detection of “clinically insignificant”, localized prostate cancer. … READ MORE …