LU-177 as a first line treatment in castration resistant non netastatic prostate cancer

[sdor]

did anybody hear about a study where they treat somebody with castration resistant prostate cancer(without any metastasis) with LU177 instead of the good old way?

[Tall_Allen]

Why would anyone do that? It sounds dangerous.

[sdor in reply to Tall_Allen]

because he gets a lot of money.... as it is a private institution

[tango65]

My understanding is that they do not treat anybody without metastases. If the PET/CT PSMA does not show metastases they do not treat. There are centers treating hormone sensitive metastatic cancer. I was hormone sensitive when I got the treatment in Munich in 2016.

[Sxrxrnr1 in reply to tango65]

Many believe,,,count me as a long believing suspect,,,that as PCa can have a 15 or more year development period from mutation occurs creating of very first cancerous cell to diagnosis,,,even longer if not detected by only screening,,,.

That from the very earliest get go, that metastasis can commence(a requirement to be a full fledged cancer cell is to have the ability to metastasize),therefore let’s say at least 15 years of lymphatic and blood fluids flowing over and eroding cancerous cells throughout a man’s body,,,just stacking up and peacefully snoozing just as the PODS in an old scifi movie. Somewhat as a mother lode of gold at the top of the Sierras millions of years ago, and then in 1848 gold is found at Sutter’s Mill in Calyfornua.

Hence we see many years post local intrusive therapies with perfect outcomes of negative margins, undetectable PSA etc. suddenly we find 10 plus years later with Mets in ribs, spine, skull, lungs,,,with zero sign of local to prostate spread of the disease.

My point,,,from soon after the first tumor is born, that undetectable micro Mets are already throughout the body. Now whether they would display PSMA the Lu177 can glom onto that is another question,,,however with current PSMA imaging, we are beginning to see previously undetectable tumors much sooner. So why not, early Lu177,,,once proven and approved?

[tango65 in reply to Sxrxrnr1]

If the cancer cells do not produce enough PSMA the treatment could fail. It is known that localized cancer areas in the prostate could be missed by Ga 68 PSMA.

[Blackpatch]

There are no restrictions on Lu177 in Australia and my RT mentioned that he knows of people who have done it with PSAs as low as 0.2... apparently with no lasting success....

[Chask]

There are trials being established in Australia at the Peter Mac cancer centre in Melbourne. This includes treating “earlier” in the diagnosis, but not sure it is at the exclusion of other treatments.

See petermac.org/news/new-radio...

Although......one comment from the article - taken out of context -

“Peter Mac and Australia are leaders in this field and this study will for the first time anywhere in the world, allow men with high-risk prostate cancer the opportunity to receive Lutetium PSMA therapy prior to surgery or hormonal therapy,” Prof Murphy said.

You should read the entire article to get the full context.

[GP24]

The MO CRPC situation is determined using CT/bone scan. However, as this abstract shows, the more sensitive PSMA PET/CT will detect mets in 98% of M0 CRPC patients:

sciencedirect.com/science/a...

[Blackpatch]

Just to join the dots between my earlier comment and Chask’s more informative post above... theranostics is lightly regulated in Australia, perhaps because we have a fairly minimal nuclear industry, so you have been able to rock up in Perth for several years and have Lu177 treatment pretty much at will - and that remains the case. As I noted above, anecdotal reports of people who’ve used it for treating BCR have been that it’s not worked.

Peter Mac is now starting a research project that will look at whether or not Lu177 administered to men prior to RRP can improve the outcome for those who are likely to end up as pT3 or worse. This is quite different to the DIY Lu177 available over in the west.

I was at a Peter Mac R&D presentation this evening and they said they have the largest PSMA PET capability in the world - when you consider the small size of Australia’s population (25m) this says something about the extent to which PSMA PET has become standard down this way. It looks like Lu177 could go the same way, given the life extension they are now achieving. Whether it proves to be of any value further back up the chain (pre-RRP, for example) remains to be seen, but they’re certainly getting after it.

Stuart

[Flydoggy in reply to Blackpatch]

Did they talk about the types of outcomes they are experiencing with wider use of this treatment? Curious to know if/how it is effecting rates of recurrence.

[Blackpatch in reply to Flydoggy]

No, it’s just started recruiting. There seems to be a lot of related R&D at Peter Mac,but it’s mainly associated with late stage PCa.

[JoelT]

the treatment relies on the cancer generating PSMA which would not be generated in adequate levels to provide a target. The result would be to become sick with side effects and not touch the cancer. Not a good idea.

[j-o-h-n]

Tell us more about this "HE".... age? location? scores psa/gleason? where treated? treatments to date? Doctor's names(?).. All info voluntary...Thank you...

Next time you can use the front door...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/22/2019 11:52 PM DST