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Advanced Prostate Cancer
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I-131-MIP-1095, a new radiopharmaceutical, will enter a phase 2 randomized clinical trial

I-131 is a strong beta emitter that has a longer reach than Lu-177, but is not as powerful as the alpha emitter Ac-225. It will be interesting to see which emerges as the winner, or if some combination turns out to be best.

pcnrv.blogspot.com/2018/10/...

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In general, alpha emmiters are better because of their shorter range and higher energy. They predominately cause double strand DNA breaks when they hit the cancer. I think Ac-225 has the highest potential because it's an alpha emitter and because of the PSMA ligand which Radium 223 doesn't use.

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We shall see. I-131-MIP-1095 has a lot of things going for it - very powerful beta particles; longer range; not chelated i.e, difficult to detach the radio-emitter from the ligand, which keeps toxicity low and effectiveness high; easier to manufacture; and lower cost. They are combining it with Xtandi for radiosensitization. Combining them seems ideal to me.

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Looks hopeful!

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I wonder more about the ligand used. The damage to salivary glands and such might be mitigated with a more selective ligand

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And because it isn't chelated, there's less danger of radioactivity breaking loose to random places.

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sounds great. keep them coming!

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I wonder if this is going to end up being one of the treatments that should be pushed forward, meaning done earlier in the course of the disease.

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There are a number of different ligands being explored that attach to cell proteins other than PSMA. GRPR looks promising, as does hK2. A lot of work needs to be done on the natural history - when do these proteins begin to appear in the cancer and in whom. Fortunately, the work on radiopharmaceuticals goes hand-in-hand with the work on PET detection, so we can actually see clinically when and in whom the various proteins become avid. Recently some researchers tested a mixture of ligands:

pcnrv.blogspot.com/2017/03/...

Maybe one day the mixture of radiopharmaceuticals will be tailored to the proteomics of every man's cancer.

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Great and useful insights Allen. Thanks. I really admire your relevant posts and holistic look on the things we're up against.

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As you note in your pcnrv.blogspot.com post (referred to above), the Heidelberg folks are now using a Lu-177/Ac-225 combination. (We were there last month and that's what my husband received for the first cycle.) When we go back for the second cycle in November, we're hoping to have a conversation about any preliminary findings. So far, this note is all that we've found about this dual approach: jnm.snmjournals.org/content...

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Hi

We are hoping to go to Heidelberg shortly my husband had PSMA scan today in London and we hope that he will be suitable for the treatment.

Can I ask a few questions?

How long did you need to stay there?

Did you stay in a hotel or at the hospital?

Was it easy to travel to Heidelberg from Frankfurt?

Any help or advice would be much appreciated, we are travelling from UK

Also how advanced was your husbands cancer?

Kind regards

Jan

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Jan,

Of course! Others helped us before we went; glad to be able to pay it forward.

1. How long did you need to stay? Because of German laws about radiation, your husband will stay in the hospital for 48 hours. Patients arrive in the morning of day one, get the injection that afternoon, stay in the hospital for day two, and are "released" the morning of day three. Because we were flying in from the US, we arrived a day early, to acclimate to the time change. We did not leave until the day after he was released -- "just in case."

2. We got a hotel room. Again, because of the German laws, I could not stay in the hospital room with my husband. I could visit, but had to stay behind a shoulder-height wall to shield me from the radiation. Even the nurses are restricted as to how much time they can spend with each patient. We did not realize how much radiation was involved until going through customs on the return home. My husband set off the radiation detector all throughout the airport! I hear that we (the US) are particularly paranoid about this. For example, the folks at the Frankfurt airport did not seem to care. Still, the hospital will give you a letter describing everything that happened + a letter for the airlines. Once the customs/security folks read the report letter, all was ok.

3. Travel between Frankfurt and Heidelberg was quite easy. There are several options: train, bus, and shuttle service.

4. The hospital international office folks are great! They'll send you an email with links to a Heidelberg office that then links to a variety of hotels. They also provided information about transportation options from Frankfurt. There are several hotels within walking distance of the hospital. Ours was about 1.3 miles (2 km) away. An easy walk, with good views. Also a great way for me to walk off nervous energy!!

5. My husband has mCRPC (metastatic, castrate resistant prostate cancer). He's had just about every treatment, except for chemo. He had a radical prostatectomy in 2002.

Please feel free to ask other questions. I'm relatively new to this site, but I think there is a way to ask questions via chat if you have more personal questions. On the other hand, others may have similar questions, so I'm happy to respond either way.

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Would you mind telling me what your husband's Gleason score was? Also, if he had the Radical in 2002, how many years later was his first treatment and what was his PSA at that time. I'm in year 12 after my Radical and mets have just now appeared. I've had no treatments other than supplements. Thanks and wishing you both the best!!!

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Tennis4Life,

Hi. Sounds like you have been handling the PC quite well!

I think the Gleason score was 7 before the surgery, with the pathology report post-surgery saying 8. Also, we knew at the time that while the margins were clear, it was very likely that the cancer had "escaped." Thus, we were not surprised when the PSA started rising.

His first treatment was Casodex at 150 mg as a mono therapy. He resisted doing anything for about 6 months post-surgery. Again, I do not recall what his PSA was, but it was steadily rising. Casodex worked relatively well for about 3 or 4 years (toggling between 150 mg and 50 mg, depending on how he was feeling). He next took Prostasol + various supplements, especially during the times when Prostasol was not available. It now turns out, of course, that the reason Prostasol worked so well was that it contained DES! Still, it kept him off Lupron for many years, which was his primary goal.

All the best to you, too.

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Thank you ever so much so informative. When we know the result of my husbands PSMA scan I may ask you a few more questions if that is ok

Kind Regards

Jan

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Did your husband have any side effects from the Lu like salivary or tear duct damage,

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Sammamish,

It's too soon to tell about long-term impacts, as it's just been over two weeks since the first cycle. In the very short-run, significantly decreased saliva production and some sores in the mouth. The sores have now resolved and saliva production seems to be starting to come back. Still even eating pudding is not easy without sips of liquid in-between bites. Tonight, though, scrambled eggs went down more easily than before <grin>.

We've read through several sites with recommendations for dealing with Xerostomia and are heeding the advice about lots of liquids, using oral spray, washes, lozenges and toothpaste made just for those with dry mouth. Hopefully it will get better.

No tear duct issues so far.

Like everything, there are trade-offs and this was one we thought would be worth it. Others' experiences are likely to be different, of course.

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