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Abiraterone Acetate Plus Prednisone in Newly Diagnosed High-Risk Metastatic Castration-Sensitive Prostate Cancer: Final OS Results

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•The authors report long-term survival outcomes among patients with newly diagnosed high-risk metastatic prostate cancer treated with abiraterone/ prednisone plus androgen-deprivation therapy (ADT) and those treated with ADT alone. Abiraterone/prednisone plus ADT was associated with longer overall survival compared with ADT alone (53.3 months vs 36.5 months).

•Among patients with newly diagnosed, high-risk metastatic prostate cancer, the use of abiraterone acetate plus prednisone is associated with significantly longer overall survival compared with placebo.

– Neil Majithia, MD

Advanced Prostate Cancer 

Written by Brian E Lewis MD, MPH

Final Overall Survival Analysis of LATITUDE

A total of 1199 patients were randomized in a 1:1 fashion to either ADT plus abiraterone with prednisone or to ADT and placebo. Patients were required to have two of three high risk features consisting of Gleason greater than or equal to 8, three or more lesions on bone scan, or measurable visceral disease with the exception of lymph node metastasis.

After a median follow up of 51.8 months, there continued to be an improvement in overall median survival in the abiraterone group (53.3 months vs 36.5 months; HR, 0.66; P < .001). There was also improvement across multiple secondary endpoints, including time to pain progression (47.4 m vs 16.6 m), time to chemotherapy initiation (NR vs 57.6 m), and PSA progression (33.3 m vs 7.4 m). There was improvement in overall survival across most subgroups evaluated except for patients greater than 75 years of age, ECOG performance status of 2, and a Gleason score of <8. Although given the large confidence intervals, I think the lack of effect in the patients with Gleason <8 is due mostly to the small size in this subgroup.

Abiraterone was well tolerated; adverse events leading to treatment discontinuation occurred in 16% of the abiraterone group vs 10% in the placebo group. The most common grade 3-4 adverse events were hypertension (21% vs 10%), and hypokalemia (12% vs 2%).

Post hoc analysis evaluating effect on high- vs low-volume disease status reveals an improvement in survival in the high-volume disease group with a median overall survival of 49.7 m vs 33.3 m in the placebo group. The median overall survival was not met in either group in the low-volume disease subgroup.

abstract

This abstract is available on the publisher's site.

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BACKGROUND

In the interim analyses of the LATITUDE study, the addition of abiraterone acetate plus prednisone to androgen deprivation therapy (ADT) led to a significant improvement in overall survival and radiographic progression-free survival compared with placebos plus ADT in men with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (mCSPC). Here, we present long-term survival outcomes and safety of abiraterone acetate plus prednisone and ADT from the final analysis of the LATITUDE study.

METHODS

This is a multicentre, randomised, double-blind, phase 3 trial done at 235 sites in 34 countries. Eligible patients (men aged ≥18 years) had newly diagnosed, histologically or cytologically confirmed prostate cancer with metastases, Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, and at least two of the three high-risk prognostic factors (Gleason score of ≥8, presence of three or more lesions on bone scan, or presence of measurable visceral metastasis except lymph node metastasis). Patients were randomly assigned (1:1) to receive abiraterone acetate (1000 mg) once daily orally plus prednisone (5 mg) once daily orally and ADT (abiraterone acetate plus prednisone group) or matching placebos plus ADT (placebo group); each treatment cycle was 28 days. Randomisation was done by a centralised interactive web response system in a country-by-country scheme using permuted block randomisation, stratified by presence of visceral disease and ECOG performance status. The coprimary endpoint of overall survival was assessed in the intention-to-treat population.

FINDINGS

Between Feb 12, 2013, and Dec 11, 2014, 1209 patients were screened, of whom ten were ineligible because of study site violations. 1199 patients were randomly assigned to either the abiraterone acetate plus prednisone group (n=597) or placebo group (n=602). After the results of the first interim analysis (cutoff date Oct 31, 2016), the study was unmasked to patients and investigators, and patients in the placebo group were allowed to cross over to receive abiraterone acetate and prednisone plus ADT treatment as per a protocol amendment (Feb 15, 2017) in an open-label extension phase of the study (up to 18 months from the protocol amendment). This final analysis (data cutoff Aug 15, 2018) was done after a median follow-up of 51·8 months (IQR 47·2-57·0) and 618 deaths (275 [46%] of 597 in the abiraterone acetate plus prednisone group and 343 [57%] of 602 in the placebo group). Overall survival was significantly longer in the abiraterone acetate plus prednisone group (median 53·3 months [95% CI 48·2-not reached]) than in the placebo group (36·5 months [33·5-40·0]), with a hazard ratio of 0·66 (95% CI 0·56-0·78; p<0·0001). The most common grade 3-4 adverse events were hypertension (125 [21%] in the abiraterone acetate plus prednisone group vs 60 [10%] in the placebo group vs three [4%] in the 72 patients who crossed over from placebo to abiraterone acetate plus prednisone) and hypokalaemia (70 [12%] vs ten [2%] vs two [3%]). Serious adverse events of any grade occurred in 192 (32%) of 597 patients in the abiraterone acetate plus prednisone group, 151 (25%) of 602 in the placebo group, and four (6%) of 72 in the crossover group. The most common treatment-related serious adverse event was hypokalaemia (four [1%] patients in the abiraterone acetate plus prednisone group and none in the other groups). Treatment-related deaths occurred in three (<1%) patients each in the abiraterone acetate plus prednisone group (gastric ulcer perforation, sudden death, and cerebrovascular accident) and the placebo group (sudden death, cerebrovascular accident, and pneumonia), with none in the crossover group.

INTERPRETATION

The combination of abiraterone acetate plus prednisone with ADT was associated with significantly longer overall survival than placebos plus ADT in men with newly diagnosed high-risk mCSPC and had a manageable safety profile. These findings support the use of abiraterone acetate plus prednisone as a standard of care in patients with high-risk mCSPC.

The Lancet Oncology

Abiraterone Acetate Plus Prednisone in Patients With Newly Diagnosed High-Risk Metastatic Castration-Sensitive Prostate Cancer (LATITUDE): Final Overall Survival Analysis of a Randomised, Double-Blind, Phase 3 Trial

Lancet Oncol 2019 Apr 12;[EPub Ahead of Print], K Fizazi, N Tran, L Fein, N Matsubara, A Rodriguez-Antolin, BY Alekseev, M Özgüroğlu, D Ye, S Feyerabend, A Protheroe, G Sulur, Y Luna, S Li, S Mundle, KN Chi

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pjoshea13 profile image
pjoshea13

Thanks for posting.

I notice that the term "ADT" continues to be used for castration therapy. Abiraterone (Zytiga) is ADT too & targets androgen production everywhere - even in PCa cells - not just in the gonads. Abi+ADT is just a more comprehensive form of ADT.

I'm sure that many fans of conventional therapy are jumping up & down with joy over the improved overall survival stats:

"53.3 months vs 36.5 months"

Elsewhere recently, another attack on supplements.

Fifteen years ago, I took a look at the statistics & realised that I needed to look beyond the few medical options available.

Some seem to view conventional options as giving the best survival, & that those who use supplements are engaged in magical thinking, because there are no supplements that work, & there will never be a supplement that will be beneficial.

My view is that a man faced with extinction within 5 years would be foolish to believe the naysayers.

"For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%." [1]

I'm uncomfortable with that.

-Patrick

[1] cancer.net/cancer-types/pro...

FCoffey profile image
FCoffey in reply to pjoshea13

I was 50 when this journey started, and all that the uros would talk about was 5-year disease-free survival stats. Not acceptable, I wanted 25- and 35-year results.

Magical thinking is submitting to RP and RT with well-documented effectiveness of stopping progression after 10 years of 3% to 4%. You can get better odds in Vegas.

When informed that I had an incurable, fatal disease with no effective treatments, I did the only logical thing.

"Quick! Find me a quack!"

TEBozo profile image
TEBozo in reply to FCoffey

More explanation, please?

FCoffey profile image
FCoffey in reply to TEBozo

The truth is that neither RP or RT are very effective.

The results are from the PROTECT trial, whose results are consistent with previous trials over the past 20 years, and so more likely to be correct. PROTECT showed no difference in overall survival, no difference in cancer-specific mortality, for surveillance vs RP vs RT after 10 years. The odds of RP or RT treatments preventing metastases after 10 years are between 3% and 4%. The odds of life changing negative effects are close to 100% - its more a question of how bad than if.

Those are dreadful odds. If I developed a supplement that performed like that, I would expect to be put in prison, and I would accept that punishment as just. But RP is the gold standard, because the urologist keeps the gold, patient benefit be damned.

nejm.org/doi/full/10.1056/N...

Direct quote:

"On the basis of our results, we estimated that 27 men would need to be treated with prostatectomy rather than receive active monitoring to avoid 1 patient having metastatic disease, and 33 men would need to be treated with radiotherapy rather than receive active monitoring to avoid 1 patient having metastatic disease. "

I'll do the math: if 27 are needed to be cut in order to prevent one man from having metastatic disease, that means, in terms of preventing metastases, that 26 men suffered all the horrible, life changing effects of the surgery without any benefit. If one in 27 men benefits, that means just under 4% odds any particular man gets that benefit.

If 33 have to get RP for the same benefit, 32 get no benefit, and the odds of any one man benefiting are 3%.

One of the reasons those numbers are so dreadful is that most of the men who were harmed without benefit were never going to have their cancer progress anyway.

The primary defense of current practice is that there is no sure way to tell a benign tumor from a dangerous one. That's true, and although a lot of people are working on that problem, the cancer industry needs patients, benefits be damned.

farmanerd profile image
farmanerd in reply to FCoffey

First the link to the mentioned article, which may not have displayed well above:

nejm.org/doi/full/10.1056/N...

A review of the definition of Numbers Needed To Treat (NNT) may be valuable:

cebm.net/2014/03/number-nee...

"The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.)."

The key word is "additional". From the link on NNT:

"Example

The ARR is therefore the amount by which your therapy reduces the risk of the bad outcome. For example, if your drug reduces the risk of a bad outcome from 50 per cent to 30 per cent, the ARR is:

ARR = CER – EER = 0.5 – 0.3 = 0.2 (20 per cent)

therefore

NNT = 1/ARR = 1/0.2 = 5"

So NNT is used to compare two treatments and one treatment can be 'do nothing'. The stats cited by FCoffey are those comparing AS to RP and comparing AS to RT -- we all know that AS is not 'do nothing' and that AS can lead to eventual RP or RT. High NNT is associated with equivalency of treatments being compared, not effectiveness of the treatments. An example of vastly different treatment effectiveness but yielding the same NNT:

Imagine Treatment 1 being 99% effective and Treatment 2 being 98% effective -- fairly equivalent treatments. NNT for Treatment 1 vs 2 would be 1/(.99-.98) which equals 100. Imagine Treatment A being 37% effective and Treatment B being 36% effective -- again fairly equivalent treatments. NNT for Treatment A vs B would be 1/(.37-.36) which equals 100. Now let's look at NNT for Treatment 1 vs. Treatment A which is 1/(.99-.37) which equals 2 (NNT gets rounded to the nearest whole number). So now you see how low NNT indicates one treatment is more beneficial than another and that high NNT indicates equivalency of treatments. It simply states the numbers needed to be treated to get one ADDITIONAL person to benefit, not the rate of people gaining benefit.

NOTE! Near the very end of the article is its summary:

"At a median follow-up of 10 years, the ProtecT trial showed that mortality from prostate cancer was low, irrespective of treatment assignment. Prostatectomy and radiotherapy were associated with lower rates of disease progression than active monitoring; however, 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.[5] Men with newly diagnosed, localized prostate cancer need to consider the critical trade-off between the short-term and long-term effects of radical treatments on urinary, bowel, and sexual function and the higher risks of disease progression with active monitoring, as well as the effects of each of these options on quality of life."

Not the dire results for RP and RT that FCoffey is asserting.

FCoffey profile image
FCoffey in reply to farmanerd

Spin them however makes you feel better. I didn't create those numbers, the people who did the study calculated them.

Similar numbers were reported by the Scandinavian study, which has been following men for 18 years.

The authors of the PROTECT paper admitted to being surprised by their results.

The results show that death from prostate cancer in such men remained low at a median of 10 years of follow-up, at approximately 1%, irrespective of the treatment assigned, a rate that is considerably lower than was anticipated when the trial commenced.

The treatments are nowhere close to 98% effective. A recent thread discussed What percentage of men have recurrence?

healthunlocked.com/advanced...

Approximately 20 to 30 percent of patients with prostate cancer will show signs of recurrence at some point in their lives.

moffitt.org/cancers/prostat...

In the reference you cited, the equation is

NNT = 1/ARR

Equations work both ways. That equation can be re-written

ARR = 1/NNT

Which is exactly what I did. The absolute risk reduction of clinical progression after 10 years is about 4% for RP and 3% for RT.

I'm not making up imaginary numbers; I'm quoting studies.

It's understandable than men who take RP or RT and urologists and ROs who give them want to deny these numbers. They are pretty depressing. Most doctors want to help people, but a sober, honest look at these results proves that they are hurting the overwhelming majority of their patients.

If they dispute this, let them marshal evidence and present their arguments.

farmanerd profile image
farmanerd in reply to FCoffey

Perhaps I wasn't clear in my explanation of NNT, so I'll take your statement:

"The absolute risk reduction of clinical progression after 10 years is about 4% for RP and 3% for RT."

Which should be correctly stated as:

"The absolute risk reduction of clinical progression after 10 years is about 4% for RP compared to AS and 3% for RT compared to AS."

AS%-RP%=4%

AS%-RT%=3%

[EDIT: Had to correct the equations above]

If you wish, I could go through the numbers in this part of the article:

"Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison)."

FCoffey profile image
FCoffey in reply to farmanerd

From the paper: "The purpose of active monitoring was to minimize the risk of overtreatment by avoiding immediate radical intervention and by monitoring disease progression regularly, so that radical treatment with curative intent could be given as necessary. Triggers to reassess patients and consider a change in clinical management were based largely on changes in PSA levels.

...

Serum PSA levels were measured every 3 months in the first year and every 6 to 12 months thereafter. Changes in PSA levels were assessed. An increase of at least 50% during the previous 12 months triggered a review. Management options included continued monitoring or further tests and radical or palliative treatments as required."

AS was not a curative treatment. It was surveillance. They checked PSA levels, and if they went up they re-assessed the situation. The authors (and hopefully their patients) did not expect AS to change the course of the disease. It was a strategy to avoid mutilating men whose cancers would never become dangerous.

Again from the paper:

"Numbers Needed to Treat

"On the basis of our results, we estimated that 27 men would need to be treated with prostatectomy rather than receive active monitoring to avoid 1 patient having metastatic disease, and 33 men would need to be treated with radiotherapy rather than receive active monitoring to avoid 1 patient having metastatic disease. A total of 9 men would need to be treated with either prostatectomy or radiotherapy to avoid 1 patient having clinical progression."

So you can have your blood drawn 1-4 times a year for a PSA test, or you can opt for RT or RP. If you go for the burning or cutting, the odds of those treatments preventing metastasis are 3-4% after 10 years. After RP or RT the odds of avoiding any form of clinical progression (not metastasis) as defined in the study are 11%.

The odds of major degradation in quality of life are nearly 100% for both procedures.

Risk is probability times consequences. The risk of not developing metastatic disease within 10 years of RP or RT is 3-4%. The change in risk of not dying from prostate cancer is zero - there was no statistically significant difference between RT, RP, and AS.

The risk of incontinence after RP or RT starts at 100% in the first few months. Some men recover more control, others don't. Most of the ones that do recover still need to wear pads. Surgeons lie about this and call using 1 pad a day or less "full recovery." After 10 years, the risk of incontinence is still very high compared to the AS group.

Similar for impotence. It starts at close to 100%, some men recover some function after a year or so. Most require aids, many just give up.

Impotence bothers a man now and then; incontinence is a problem 24x7. Some men become socially isolated, depressed, and even suicidal.

As a urologist recently wrote after his RP:

Recovery of urinary continence and sexual function was satisfactory. However, I believe it is accurate and appropriate to advise patients that it is highly unlikely that sexual function will recover to match preoperative baseline, and that even urinary function; in the best of circumstances, may have occasional lapses.

ncbi.nlm.nih.gov/pmc/articl...

So the risks of good things happening are 3-4%, if you relax the standard to just clinical progression it might go to 11%.

The risks of severe, life-long bad things happening start at 100% and may or may not improve, but the chance of no serious negative outcome is close to zero.

I'll say it again: were I to develop and market a supplement that had a 4% chance of doing what I claimed, and it grievously harmed almost everyone who took it, I would expect to be jailed. I would accept that punishment as just. But if I get a license and do it in a hospital, I can charge tens of thousands of dollars and do it over and over again.

farmanerd profile image
farmanerd in reply to FCoffey

May need to also use this data:

"We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545)."

Question to ponder: How many of the men in all three groups would have had mets with absolutely no treatment?

farmanerd profile image
farmanerd in reply to pjoshea13

We never know where our data point lies on the survival curve and unless efficacy is 100%, we never absolutely know whether or not a treatment helped us as an individual since we cannot follow two separate treatment paths. Probability and one's risk tolerance both play roles. It is also very beneficial to consider that there is a huge gray area between the polar labels that get tacked onto posters on the subject of supplements.

pjoshea13 profile image
pjoshea13 in reply to farmanerd

With supplements, or any complementary treatment, it is "buyer beware", which is why I have been reading PubMed studies for over 15 years.

Based on cumulative evidence, I have rated supplements in my mind as having "probable benefit", "possible benfit", "not enough studies" & "unlikely benefit". You would need to read the literature to decide for yourself - I'm not setting myself up as a supplement guru - I simply post & comment on the literature.

I was 54 when a nodule was found on my prostate. Since joining groups such as this, I have been struck by the number of members diagnosed with mPCa at younger ages. We don't always write about our fears, but one deceased member worried that he wouldn't live to attend his daughter's bat mitzvah, & we can all perhaps relate to that.

I'm not saying that it's any easier for men diagnosed after age 70 (the majority), but getting to age 70 can seem to be unlikely for a 49 year old man with young kids.

We should think ourselves lucky that there is such a vast PCa literature for natural agents, & that in the U.S., most are available to us as supplements (that may change). The equivalent literature for pancreatic cancer, non-small cell lung cancer, etc. is scant.

-Patrick

farmanerd profile image
farmanerd in reply to pjoshea13

I appreciate your posts on the forum and appreciate your posting style. I am an engineer, so I can sometimes take an overly data driven analytical approach to things, but I try to balance this out by attempting to also address my experience with the human aspect and not just the body aspect of this disease. Hope that comes through in some of my posts.

Two daughters in high school and a son in 8th, so I know that fear all too well -- especially with a wife who went through breast cancer treatment in the last few years. Statistically, I've had a bit of the less probable experience with a RARP for being age 58: bladder infection, osteitis pubis, continuing incontinence and complete ED. Even if the stats are in your favor, you don't know what your data point will be.

I'm sure that most posters would acknowledge that supplements are not a silver bullet or silver shotgun pellets to kill PCA. Part of a treatment path an individual may chose to take.

After another PT session, I will be posting on my experiences with pelvic floor therapy -- fearful at first, different than I thought, very helpful, some of the exercises are quite meditative.

Schwah profile image
Schwah in reply to pjoshea13

The natural question to your last post is what supplements did you determine to have “probable benefit”? I’m guessing a lot of the guys on this site are also waiting for that answer. Thx so much.

Schwah

pjoshea13 profile image
pjoshea13 in reply to Schwah

Well, I prefer to let the curious study the literature.

I do not mind saying whether I take a particular supplement & naming the brand.

-Patrick

Schwah profile image
Schwah in reply to pjoshea13

I’m confused. The two sentences in your post seem contradictory. You say let the “....curious study the literature”. And you say you “do not mind saying whether I tahd a particular supplement & making the brand.” If you don’t mind, can you tell us what you take ?

Schwah

pjoshea13 profile image
pjoshea13 in reply to Schwah

I'm not going give a list, but if the subject of curcumin came up, say, I would admit to taking it every day, & suggest that Longvida® be considered.

The case for curcumin is in the study papers:

healthunlocked.com/advanced...

-Patrick

Longterm101 profile image
Longterm101 in reply to pjoshea13

Which one ? The 285x?

Thank u

pjoshea13 profile image
pjoshea13 in reply to Longterm101

swansonvitamins.com/now-foo...

Longterm101 profile image
Longterm101 in reply to pjoshea13

Many thx !!

Have a healthy weekend

TEBozo profile image
TEBozo

"with the exception of lymph node metastasis." So none of the participants were considered highly metastatic if they were a G* and ONLY had LNs involved?

FCoffey profile image
FCoffey in reply to TEBozo

I think the term is "high risk." The study enrolled men with Gleason score of ≥8, presence of three or more lesions on bone scan, or presence of measurable visceral metastasis except lymph node metastasis. These guys were pretty sick when diagnosed, which is one of the reasons the survival numbers are so short.

alangeorge profile image
alangeorge in reply to FCoffey

I like the way you write things from a different perspective.

I think I can say all the numbers and stats and trials and... and... can be a bit much, to say the least. I had my first blood test for PSA on the 5 Mar 19 (2220), Had it repeated next day (2200). A biopsy followed with a (G 4+4). It was a whirlwind and I was on a fast-moving - seemed like no stopping it treadmill. At this point, I changed my lifestyle and thinking on many levels, making new affirmations. After the Biopsy I was given 10 days of Antibiotics At this point I did an independent PSA was (PSA >1000). After 30 days ADT (Bicalutamide) followed by Zoladex injection 2 weeks (seems like Roladex) 15/5/19 PSA was 360.

So that's a little background but my point is this... I asked My GP and the Urologist how long as this PCa been there "oh most likely 15 yrs + or minus.

Hey, I'm 71 my wife is 34 For the last 15 yrs we have had high q of life in the Greek Islands, Spain, China, The Philippines, and NZ. Great physical exercise and sex (before we got married I had on average sex once a day) after we were married we had sex regularly. So you can see I am a good case for your stories here in reverse. let's say I was 50 - 55 when this was benign and now it's Mets. spread just outside the prostate ( as per the bone scan two days ago) Will go for CT Scan 27/5/19. so you see my point I didn't know what I had ( was concentrating on thin/weak arteries, had I been screened and gone through the Med Mill I may have been dust?? and had a piss poor Q of life? I used to Be the Director of a personal development Co. so I am right on top of a PMA. I was looking at all 3 ways of attack and my thinking now is down to 2. You guy helped me an awful lots. Thank you so much :))

Alan

FCoffey profile image
FCoffey in reply to alangeorge

That's a great story, thanks for sharing. Good luck to you going forward.

My case is similar to what you described when you wrote "let's say I was 50 - 55 when this was benign and now it's Mets. spread just outside the prostate." I had just turned 51 when I got the news. It's been 12 years and if anything my QOL is better because the cancer focused my mind on what is truly important, and taught me to live every day like it might be my last. I'm in better shape, stronger, lost weight, eat better, have great sex, and piss like a racehorse.

I'm not in the PSA>1000 club yet, I have "locally advanced disease" and no symptoms.

There's no one on this forum, or on planet Earth, who can tell me that I made the wrong choice, or the right one. I am the sole judge of that.

I don't write here to tell men what to do. I write to tell them that they have choices, that some of those choices will not be offered by the medical industry, and that doctors lie and withhold information from patients, making informed choices and informed consent impossible.

What each man does is up to him and perhaps his partner. But if their choice is to be a wise one, a choice that they will be content to have made 10 years later, they must know and consider these hard truths.

Longterm101 profile image
Longterm101

Many thx

j-o-h-n profile image
j-o-h-n

Tired of all the numbers? Then listen:

youtube.com/watch?v=BlDgQOd...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/19/2019 12:38 PM DST

alangeorge profile image
alangeorge in reply to j-o-h-n

Forever J-0-H-N...

One of my favourite songs :)) Along with my girl and Sitting on the Dock of the Bay

Cheers

Mate

j-o-h-n profile image
j-o-h-n in reply to alangeorge

I'm glad you enjoyed it.... Love "My Girl" and "Sitting on the Dock of the Bay"...

GMTA

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/18/2019 8:47 PM DST

monte1111 profile image
monte1111

I awake to Saturday confusion. What about the 2 posts yesterday re Lu-177 and actium 223. Are they at least bending the statistics? Or am I talking different statistics? My eyes are blurring. Side effect of the Gabapentin. Wouldst that the FDA get on the fast track here. Doesn't work for everyone, but everyone should get their shot. (Pun unintended). Enough BS. Clear it for everyone and force insurance to cover it. I am almost half way to the 5 year mark and do not have a lot of illusions. It just pisses me off to see so many younger men fed into the meat grinder. (Pun unintended). Didn't someone mention a million flaccid men march on Washington? Add another million wives/partners/others. Can't we force a change in the statistics? Enough ranting. Everyone enjoy your weekend.

j-o-h-n profile image
j-o-h-n in reply to monte1111

I mentioned a million man march for Pca quite awhile ago... It went over like a lead balloon... I'm in for #1 of a million, you wanna be #2?

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/18/2019 8:45 PM DST

monte1111 profile image
monte1111 in reply to j-o-h-n

Sure. I'll be #2. A million men and I'm the one that's shit on. Why should today be any different than yesterday or tomorrow? Have a good night everyone.

j-o-h-n profile image
j-o-h-n in reply to monte1111

Okay then just the two of us....

I'll write to the President for a special meeting....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/18/2019 9:52 PM DST

j-o-h-n profile image
j-o-h-n in reply to monte1111

I could make you #1 1/2 if you want?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/19/2019 1:54 PM DST

monte1111 profile image
monte1111 in reply to j-o-h-n

Great. Thanks. Anything is better that being number 2.

j-o-h-n profile image
j-o-h-n in reply to monte1111

Okay #0 it is....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/19/2019 3:57 PM DST

TEBozo profile image
TEBozo

Gleeson 7, 3 of 14 lymph nodes removed positive. No other mets. Gallium PSMA scan showed 3 additional spots all look localized in pelvic area. Removal at UTSW Dallas on June 4th, 9th IMRT of 39 today. Monthly Firmagon shots. Last PSA was .19 and headed down. Dallas group says we are "throwing the kitchen sink at it." Says hold Zytiga in "back pocket." Both UTSW surgeon, RO says 50-50 chance what we are doing will cure this younger than most 67 YO. Dr. Scholz' group, Prostate Oncology Specialists, in Marina del Rey, CA disagree, says take it now.

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visit I was given the choice of adding either Abiraterone or Doxetaxel to my just initiated...

Newly Diagnosed Metastatic Prostate Cancer

suddenly you receive the diagnosis. Received my first ADT therapy shot last week with Lupron. I...

Newly diagnosed Stage IV Metastatic Prostate Cancer

cancer was outside the prostate but confined only to the area around the prostate. I had...