The importance of Peer-Review
Prostate Cancer News, Reviews & Views
by Allen
1w ago
When I was new to prostate cancer research in 2011, I attended my first PCRI Conference. One of the presenters was Eugene Kwon. He presented some early data on an experimental new tyrosine kinase inhibitor called cabozantinib. Tyrosine kinase is an enzyme that stimulates metastatic growth. Kwon showed the following "gee whiz" images that had the whole room abuzz. It seems to show the complete resolution of numerous bone metastases on a bone scan in 3 patients in 6 or 12 weeks: Kwon presented "Cabo" as a game-changer in PCa treatment to an auditorium full of patients and on YouTube. Was it to ..read more
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Higher dose improves results in high-risk patients
Prostate Cancer News, Reviews & Views
by Allen
2M ago
GETUG-AFU-18 is another trial where the findings are obvious, and irrelevant, because radiation and hormone medication technology have improved far beyond what was available when this trial began 15 years ago, and long follow-ups are necessary to detect outcome differences in men with localized prostate cancer. A similar trial (RTOG 0126) in intermediate-risk patients found a curative benefit for the higher dose, although no increase in overall survival within 8 yearsd. The trial randomized 505 high-risk patients in 25 French centers to receive a radiation dose of either 70 Gy or 80 Gy.  ..read more
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Pluvicto does not work better if used before docetaxel in mCRPC
Prostate Cancer News, Reviews & Views
by Allen
6M ago
We have seen (see this link) that Pluvicto works better than Jevtana in men who are metastatic and castration-resistant (mCRPC) and who have already used docetaxel and failed one advanced hormonal therapy (abiraterone or enzalutamide). But would there still be an advantage in mCRPC men who have not yet had any chemo? Satapathy et al. sought to answer this question. They randomized 40 men to either docetaxel or Pluvicto who were chemo naive, and mCRPC. After a follow-up of 33 months they found that both groups survived for 15 months, based on the therapy they were intended to get. When they loo ..read more
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Xtandi (enzalutamide) +ADT slows metastases in recurrent men
Prostate Cancer News, Reviews & Views
by Allen
11M ago
It is always difficult for a recurrent patient (rising PSA after prostatectomy, radiation, or both) with no metastases to decide when to start salvage hormone therapy and, if so, which hormone therapy. That is the question that the EMBARK randomized clinical trial (RCT) sought to answer. We have recently seen that the PRESTO trial proved that a one-year course of ADT+ apalutamide (Erleada) significantly delayed biochemical progression compared to ADT alone. EMBARK Protocol This was a huge trial with 1,068 patients treated at  256 centers around the world. To qualify, patients had to hav ..read more
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Intermittent ADT
Prostate Cancer News, Reviews & Views
by Allen
11M ago
 No one likes Androgen Deprivation Therapy (ADT). Even in the short term, there are hot flashes to contend with, fatigue, and loss of libido. Longer term, there may be cardiovascular side effects, bone loss, fat gain, brain fog, low red blood cell count, blood sugar dysregulation, and mood swings. What are the potential risks and benefits of taking occassional vacations (called "intermittent androgen deprivation therapy"- iADT) from continuous androgen deprivation therapy - cADT? For a discussion of all randomized trials of iADT vs. cADT, see this link. I will focus on a few of the most i ..read more
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Duration of ADT needed with salvage radiation
Prostate Cancer News, Reviews & Views
by Allen
1y ago
No one wants androgen deprivation therapy (ADT) along with ("adjuvant to") salvage radiation therapy (SRT). We are accumulating evidence about how long one needs to stay on it to prevent the cancer from coming back, but judgment is still necessary. There are some situations where it is unclear that SRT is needed at all (discussed in this link). This includes: a very long time (>18 months) before biochemical recurrence (BCR), slow doubling time, low Gleason score, elderly, significant comorbidities, no metastases with PSMA PET, and low Decipher score. 0-6 months ADT beneficial GETUG-16 found ..read more
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Is there any benefit to early spinal radiation of metastases?
Prostate Cancer News, Reviews & Views
by Allen
1y ago
Is there any benefit to early treatment of asymptomatic men with many bone metastases? We saw that, at least in a retrospective study, there was no oncological benefit to treatment of oligo (1-5) bone metastases. But even if there is no benefit in delaying cancer progression, perhaps spinal radiation can prevent pain and crippling spinal compression? Dearnaly et al. reported the results of a large multicenter randomized trial in the UK among 420 men with castration-resistant prostate cancer with asymptomatic spinal metastases on a bone scan. The goal was to determine whether early detect ..read more
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Docetaxel Extends Enzalutamide Effectiveness
Prostate Cancer News, Reviews & Views
by Allen
1y ago
 Enzalutamide (Xtandi) is one of the two second-generation hormonal medications that has been proven to extend survival in men with metastatic castration-resistant prostate cancer (mCRPC). The other is abiraterone (Zytiga). A pilot study suggested that docetaxel can sometimes reverse enzalutamide resistance. The PRESIDE randomized clinical trial (RCT) treated 687 mCRPC patients in 123 sites throughout Europe. All of them were given enzalutamide along with ADT. 271 started to fail (PSA increase or tumor increase on scans) after 13 weeks. Then they were randomized to receive either: Triple ..read more
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Short-term androgen annihilation in non-metastatic recurrent men delays progression
Prostate Cancer News, Reviews & Views
by Allen
1y ago
 A difficult question for patients who still having rising PSA after prostatectomy and salvage radiation is: Is there any advantage to starting advanced hormone therapy before metastases are visible? Rahul Aggarwal presented the early results of the PRESTO trial. Patients (n=504) were chosen who had the following characteristics: Failed prostatectomy and salvage radiation (85%). Half of those who had salvage radiation, had adjuvant ADT at the time PSA>0.5 ng/ml PSA doubling time (PSADT) ≤ 9 month no metastases on conventional imaging (bone scan/CT/MRI) Patients were randomly assigned ..read more
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The Constitution of Medical Knowledge
Prostate Cancer News, Reviews & Views
by Allen
1y ago
Patients are often confused by seemingly conflicting findings of studies, or equally good doctors recommending different treatment plans. How are we to decide? Medical science is a process created by a “reality-based community” to help decide such questions. Science isn’t just hypothesis-testing with empirical observation, although that is a big part of it. It is also the consensus by a community of experts. In 1660, scientists led by Isaac Newton formed The Royal Society as the first institution designed to collect, encourage, and evaluate scientific knowledge. They published the first scient ..read more
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