Advanced Prostate Cancer

"Researchers Develop New Strategy to Target Breast Cancer Metastasis in Bones"

I wonder if this could work for prostate cancer bone mets, including those who have already had chemo. Given they are using the same chemo commonly used in 1st line treatment for Stage 4 prostate cancer, what is the difference, if any, using this same chemo in nanoparticles, as discussed in the article below:

"....researchers developed a nanoparticle containing the chemotherapy Taxotere (docetaxel)..."

Researchers Develop New Strategy to Target Breast Cancer Metastasis in Bones

October 11, 2017 Alice Melãoby Alice Melão

In News.

breastcancer-news.com/2017/...

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There is some interesting work being done in nanotization. Allowing molecules of drugs to get down to the lowest molecular weight, that can instead of hitting the cancer cells on the outside, but may also penetrate the cancer cell and blow it up{apoptosis].

You are right since most of women's Bca's are hormone refractive---men's Pca's for the most part are also. One drug developed for women with ovarian and breast cancer, is Oliparib---which is approved for women but not men yet. Doctors are using it off label for Pca. Does not make sense--that our great FDA, cannot recognize that men and women with their hormone sensitive cancers most likely are carrying the same Gene Mutations, of BRCA-1 and BRCA-2.

Now back to nanotization. Dana Farber, has taken the Oliparib drug and nanotized it. And the 30% positive reaction with men with Pca--as defined as having a greater than 50% decrease in PSA, with regular Oliparib, ---that this nanotization, has increased the effectiveness from 30% to more like 50%. This is great news for me as I have the BRCA-2 Gene Mutation, and my Geneticist, thinks I am a great candidate, for its use---if I go further into my journey, looking for selective treatment.

So yes nano particles are being studied in many areas, for cancer treatment--the Chemo drug does not surprise me.

Nalakrats

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Thank you so much for all of your very informative and encouraging posts.

My husband was admitted to the ER last Jan, 2017, for every test possible after suddenly having trouble with his tongue. It was going sideways and effecting his speech. Long story short, it turned out to be a bone met in one of the canals of his skull that houses one of the nerves to his tongue. He was diagnosed last Feb. with Stage 4 PC with numerous bone mets (pelvis, spine, skull, femur...) , which was surprising given his psa was only 5.8. fwiw, doctors were at first thinking he had multiple myeloma, "MM", because all of his other tests indicated he was otherwise very healthy. It wasn't until they did the bone biopsy that we got the shocking diagnosis. His gleason scores are: 7 (4 + 3) & 8 (4 +4), and he does have the BRCA gene. His first oncologist (at a top hospital in the country!) was horrific (another story) -and he should have started hormone treatment IMMEDIATELY, to prevent the totally incapacitating pain he developed soon afterward!! Fortunately we found a wonderful prostate cancer specialist team who got him in quickly and started him on the hormone treatment. Amazing how quickly the bone pain improved after taking the casodex! A few weeks later he started chemo and had 6 rounds of Docetaxel, every 3 weeks, with tolerable side effects (extreme fatigue being the worst). This brought his PSA to below 1. I think the lowest was 0.09, and when he went in for his 3rd lupron shot 2 months ago, his PSA was 0.10. So we were very happy!! -and he was really looking forward to working harder on his exercise program which he just started earlier in the fall, with the help of a personal trainer. All was good until.......

About 3-1/2 weeks ago he suddenly developed what he thought was sciatica pain, which he assumed was from something he was doing at the gym. (supposedly common after being on chemo). The pain was in his R butt cheek and was/is worst, excruciating, when he stands up after sitting or laying down. PT wasn't helping, so he had an MRI last Friday. On Sat. morning the orthopedic oncologist called to tell us the MRI revealed a tumor growing in his spine at the L2-L3 area. (fwiw, sciatica originates at the L4-L5 area) He suggested radiation. Given my husband had a bone met at the L2-L3 area before he was diagnosed, we're hoping this isn't something 'new', and maybe this area was more 'stubborn', and didn't respond as well to the Docetaxel chemo and hormone therapy. My husband can now barely walk. This morning he woke up with numbness in his shin. The only way to get relief is to lay in bed on his L side. He has pain meds, NSAIDs, but the only thing that seems to really help is tramadol. However the tramadol knocks him out. This afternoon he got an e-mail from his oncologist agreeing with the orthopedic oncologist (who called 2 days ago), and said to schedule an appt with him asap. He said there are "numerous" other treatments to consider, in addition to radiation. I wonder what the other treatments might be? Any idea? TIA.

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Yes for example, there is Xofigo[radium 223] which in the Elemental Table, sits below Calcium, acts like calcium, and goes right to the bone mets, and fits itself in with the tumor of the bone. The radiation kills the Pca mets. Not perfect but there have been good results. Also there is Lu-177 another radiation, material that has shown nice results--not approved by the FDA, but is being used by some oncologists---you can Google Lu-177 and Prostate cancer--I think you will find one or 2 clinics using Lu-177---one is in Manhattan. Besides Platinum based Chemo--which you typically hold off on--the possibility of using Oliparib in combo with standard Chemo is being looked at in test--and remember it is the only PARP Inhibitor at this time that goes after BRCA Mutations.

I do not see where Xtandi or Zytiga has been used, yet, If your Husband is not carrying the AR-V7 gene splice variant in the turned on position, they can be effective ---but the order of use of the things I mentioned above, is not for me to even guess on; as I am not a Doctor---just reporting. There are about a 1/2 dozen PARP Inhibitors and Checkpoint Inhibitors in the middle of Phase Trial testing--I cannot name them as these drugs have been assigned numbers.

And lastly there is a test to determine if the Pca cancer has as its make-up Neuroendrocrine Pca cells--commonly referred to as Hormone Refractive, not Hormone Sensitive. Personally I think this is important to know---because with low PSA values, with lots of bone mets, I would be suspicious. You usually see very high PSA's with the amount of Bone Mets now in discovery. All I have for now.

Nalakrats

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I assumed my husband's PC is hormone sensitive given he responded so quickly to the Casodex alone, weeks before starting chemo. (he went from being unable to walk - bedridden in pain, to being able to walk the dog again, within days after starting the casodex!!) I also remember the oncologist implying this at one of our first appointments. Does that make sense, or do you still need the blood test to be certain?

Also, do you know if this 'flare up' of the bone met/tumor usually means it's time to switch from casodex to the next drug, or could this be an isolated 'stubborn' bone met that needs additional treatment and after that, he can stay on the daily casodex pills + lupron shots every 3 months until a rising PSA indicates otherwise?

Thank you so much for all the information. A bit overwhelming, but VERY helpful while deciding what to do next.

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Just discuss the different things I mentioned with the Oncologist--Remember I am not a Doctor---Since the Doc. already brought it up--seems to me he has it in his mind as a possibility.

Most Prostate Cancers have both the sensitive and refractive cells together---you can have success early on because refractive cells are lazy and it takes usually a long time before they get active and start to search for bone. I know men who were PSA undetectable for 10 or more years, and are now considered 4th stage--late to be exact. And Xtandi is the next step up from Casodex--as to anti-androgens.

So while everyone is searching for an answer, as a retired researcher, I checked out all possibilities in my work--which was not medical---so yes I would have the blood test---because the results help develop a line of treatment.

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I meant Hormone Sensitive not refractive--sorry.

Nalakrats

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HI, my husband has stage 4 prostrate cancer, he did go through the chemo this past year. Plus six weeks of radiation on a tumor that had blocked his kidney tubes. PSA started to rise again ,after chemo.put on Zitaga, did not work, now cat scan found one lymph node. Going to surgeon this Friday to schedule a biopsy. Than see what the next course of treatment.?? I've heard of the treatment you are speaking of , where would you get this treatment , nano patricians ? Is this a clinical trial ?? We live in Pa.

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These are in trials---I think you can go to Trials.gov. The Oliparib is specific to BRCA Gene Mutations--you have to be Gene Mapped to know what Genes if any have Mutated.

I suggest you get a Oncologist at a Center of Excellence that specializes in Prostate cancer.

Examples: MD Anderson, John Hopkins, Memorial Sloan, Mayo, Levine Cancer Inst. UCLA Medical.

Nalakrats

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He's with the U of Chicago prostate cancer team. We also went to Johns Hopkins late last winter for a 3rd opinion, and saw Dr. Eisenberger. He personally knows our oncologist at U of C and said we're in good hands, so we didn't gain much by going there, except that they ran the AR-V7 test, and my husband does not have it. Still, I agree, esp at this point, that it may be helpful to get more opinions, to compare notes, esp if they offer more treatment options- ie., as you say Dana Farber has with Oliparib.

U of C did some genetic counseling but I'm not sure if it was "Gene Mapping". This is when we discovered he has the BRCA2 gene. There was some mention of P-10 (doesn't matter with germline tumors???, or something like that?) and VHL (von Hippel-Lindau) which my husband said weren't really important. When we see the oncologist, I'll have to ask if it's possible to get one consolidated 'easier to read' report listing the details of all the test results.

U of C does have quite a few clinical trials now - some using the Oliparib: clinicaltrials.uccrc.org/Di...

Nalakrats, again, I can't thank you enough for sharing so much valuable information!

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Facilities you have been to are quite good-Eisenberger is well known and many on this site use him.

Appears your husband has been Gene Mapped--The BRCA, combined with the PTEN, are the same mutations, I have. Also Suggests your Husband may be an Ashkenazi Jew. Many men with eastern European backgrounds have this combination, of gene mutation.

The work Dana Farber did, was probably against the BRCA gene mutation, in Pca. I would call and find out if they have any on-going tests. The paper I read was from a news release from Dana Farber, as to Nano Oliparib.

Another outside shot is the PDL-1 test---this determines if Keytruda can be used--I have a friend in Florida on it now, for Pca. This is the melanoma drug that they used on Jimmy Carter to cure his Brain Cancer.

Nalakrats

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Nalakrats, yesterday while meeting with the oncologist, I learned my husband's BRCA2 is not germline, it's he's somatic. His PSA test yesterday came back at 1.33 (from .1 a month ago, where it's been since he finished chemo in July, 6 months ago. His oncologist said to stop the Casodex now. His last Lupron shot (which he gets every 3 months) was December 19th, a month ago. He's now on a lot of pain meds with severe pain from the tumor activity in his lower lumbar area. The oncologist said it's wrapping around his spinal column. He started radiation last Tuesday for this area and has so far had 3 of 10 consecutive treatments. (fwiw, he got extremely sick after his 2nd radiation and is now also on anti nausea) His oncologist said we need to finish the radiation treatments before going to a new med. This 'waiting' concerns me!!!!

Oncologist wants us to consider a clinical trial at U of C in which 50% of the patients will receive only olaparib, 25% will receive only Zytiga and 25% will receive both Zytiga and Olaparib. When I brought up the reports of extreme success with Olaparib on patients with BRCA, he said something to the effect that the very high results are only with germline. So now I'm wondering what is the benefit is of this trial vs starting Zytiga NOW, and isn't this trial risky, should my husband be put with the Olaparib only patients if it's known to not work as well with those who have somatic BRCA2? I'd greatly appreciate hearing your thoughts on this. I can't stand seeing my husband suffering so much - this all came on so quickly.

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Time for another opinion in between the radiation---first off Radiation is Front line for this type of tumor, wrapping around the spinal column. Dana Farber in Boston, has the new Nano Technology on Olaparib. Where they get better results than regular molecular sized Olaparib.

You are getting into an area---when asking my opinion, that this is outside my purview. I do not know where you live, But a Center of Excellence, such as John Hopkins, MD Anderson, MSK, Mayo, Levine Cancer Institute, Duke, UCLA Medical, Dana Farber, and others, that have all technologies in one place+ Research, Super Scanners, and Clinical Trials.

Put out a post asking for recommendations for another Opinion--By asking people here to recommend, a Center of Excellence, that is near you.

Nalakrats

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Once again, thank you so much for your input, Nalakrats.

fwiw, Blood test results from last Thursday, Jan 11 came in:

PSA @ 1.33 (from 0.10 on 11/10/17, and 0.09, nadir, on 8/8/17)

glucose - 118 (it's always been high)

alk phos up to 555 (highest was 1141 day of 1st chemo on 3/28/17)

platelet count down to 145 (due to radiation to lower lumbar spine?)

We are currently with the U of Chicago Prostate Cancer team. When we went for a 3rd opinion at Johns Hopkins we saw Dr. Eisenberger who told us we are in good hands with Dr. Stadler at U of C, as they are good friends and talk regularly and are on the same page. That gave us some needed peace of mind. However, Dr. Stadler does not believe in trying to help treat via diet and supplements. I would love to know how many other top CRPC specialists agree with this.

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Not getting into this argument--there is a historical, Medical-Government Complex---that has taught Doctors to Respond in Certain ways--once a topic gets off the rails of Surgery, Drugs, and Chemo---and that goes for any disease. The Drug Detailers continue the Education of the Doctors from the Pharmaceutical Industry, and the FDA point of view view, and the FDA has been lobbied in a way that makes talking about supplements hard to do.

I had in the past 2 Great Doctors, who do not Practice anymore or they may have passed. They were Internal Medicine Doctors with over 15 years of traditional Internal Medical Practice---who then switched to Naturopathy, and Natural Healing. They had to switch, as they could not live the lie anymore. To some up their thought---you use traditional Medicine when other forms fail. So both the Traditional and the Natural Healing medicine protocols are used interchangeably.

You have a good team in Place--as I know of Eisenberger, and some on this site use him.

As to supplements, I do not even talk to Doctors about them--I list them in my medical records--no one wants to discuss with me.

There is always the initial visit--and they question, why I do it--my answer is I have 50 years of experience, self experimentation, and inter-reaction with the Natural Healing Community, and then cite my 5 degrees---and you Mr. Doctor have 6 credits in diet and nutrition--we would not be in the same pew---and for that matter the same Church. If what I do does not fit with your views driven by the Medical-Gov't Industrial complexes view--I can always get another Doctor---and that shuts these uneducated purveyors of mis-information down.

And this leads me, being in control of what my treatment protocol will be---not as a Doctor, but I do have over 5,000 hours of Prostate Cancer Research, absorbed, and get 50 papers a week from around the world. So I may get things wrong--as many Doctors do--but I control the whole deal. When I agree with the Doctors, there are no issues, when I do not agree, I become the default position.

Guess you can tell I have a bit of passion on this subject.

Nalakrats

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Great post Nalakrats, Thank you!

You should write a book to share your valuable knowledge.

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You and my husband have a very similar diagnosis - yes, he is an Ashkenazi Jew.

Thank you for suggesting looking into Keytruda. I've read a few articles regarding possible use in other cancers. My mother may be taking this down the road (she's starting round #2 of chemo, a different chemo, Doxil, after being in remission a few months and her cancer started coming back). She was diagnosed with stage 4 ovarian cancer, just a few weeks after my husband was diagnosed with stage 4 prostate cancer, last winter - both were shocking diagnosis. Totally unexpected.

fwiw, This all began last winter - beginning the night I slipped on ice and broke my R arm (I'm R handed) last Jan, on Friday the 13th! (I ended up having to have an osteotomy 4 months later - Dr's at 1st hospital screwed up) Little did we know that was a sign of what was to come! That night after we returned from the ER my husband started having trouble with his tongue - his first serious symptom that sent him to his Dr and then to the ER. (eventually diagnosed as a bone met in his skull - the story I told you a couple days ago, above) Makes me wonder if the extreme stress my husband was under, getting me to the ER (I went into shock) may have contributed to/worsened the bone met that affected his tongue. Maybe it is true that extreme stress can feed/accelerate cancer - bone mets esp??

Hoping 2018 brings good news with a turn of the tide for all of us!

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