Is this true ......: businesswire.com... - Advanced Prostate...
Is this true ......
Looks real....Sept 4, 2019.... Dendreon has been looking to push Provenge forward for marketing...people who had PSA <5.27 with MCRPC...median survival 47.7 months... Good news...It is part of my question with Provenge whether earlier administration would not be beneficial in MHSPC...With several new classes of drugs coming--add ons for abiraterone and enzalutamide, I believe OS and PFS will be increasing dramatically in a few years... Lots of Phase 3 testing coming....
Don Pescado
Dendreon Pharma likes to cherry-pick patients, those with low PSA, because this makes the treatment look better than if advanced patients with higher PSA numbers are given the treatment..You can only get Provenge at select treatment centers set up by Dendreon so they pretty much call the shots..I was turned down because my PSA was too high for the treatment to be effective. They recommended I try chemo instead...
Yes, but in this case they're specifically comparing patients by PSA levels:
<5.27 ng/mL – 47.7 months
>5.27 to ≤15.08 ng/mL – 33.2 months
>15.08 to ≤ 46 ng/mL – 27.2 months
>46 ng/mL – 18.4 months
Unfortunately, they don't have an untreated control group, and it's reasonable to expect men with a lower PSA will live longer regardless of the treatment they are given.
Your statement " it's reasonable to expect men with a lower PSA will live longer regardless of the treatment they are given", is somewhat true. However as a 5 year and counting stage 4 survivor, I have seen countless numbers of men with low PSA numbers succumb to our cancer. Many, many pass on with very low PSA numbers. Conversely, many men with relatively high PSA numbers continue to remain stable for many years. It's nearly impossible to compile a finite statistic related to a Provenge study to due the nearly unlimited variables involved. In any case, these statistics are very encouraging regardless of the "lower is better" train of thought. Being that I recently finished my Provenge treatment with a PSA that topped out at 2.4, (it's currently 0.08) I'm thrilled at the possibility of nearly four more years of life.
I agree, absolute PSA numbers are most useful when comparing large groups of men. But, even as an individual, a super high PSA value in the three or four digit range almost certainly indicates out of control disease.
BTW, I think you're short changing yourself. If the median survival is 47.7 months, that basically means you have a coin flip chance of exceeding four years. But there's more! Included in those statistics are men that don't respond to treatment and die well short of the median. If you do get a good response, your chance of exceeding the median goes up dramatically.
If you don't mind my asking... how long have you survived this far with Stage 4 ?? I get the impression that the fellows in our group represent a longer lived subgroup of Stage 4 survivors ( thank goodness).... but Docs still keep quoting 2-5 yrs to me as the average survival rate ( still don't know if this is the mean , median or modal survival rate with Stage 4.
I'm finishing my fifth year. When first diagnosed my PSA was 850, extensive lymph node involvement and 4 bone mets. I started Lupron (still taking), and went through six courses of doxetaxel. My PSA went to a low of 0.04. My lymph node involvement seems to be resolved, I have one met remaining that shows on scans. Two months ago I finished my Provenge treatment. My PSA is stable at 0.8. I'm sure i have many micro mets however I just had a psma pet scan which showed nothing. I'm an exercise freak, run, lift, etc. I also maintain a mostly vegan diet, eating a small portion of wild caught sockeye salmon twice a month. I have yet to start zytiga or any other drug as my oncologist and me are on the same page as far as waiting until further treatment is needed before starting it. Hey, it's working for me, i feel great, live a normal life and plan on my more years of quality living. Your doctor and his quotes are behind the times.
I agree that they are behind the times re: THIS group. Don't know re: the larger group of PCA Stage 4 folks.... Glad to hear that you are able to keep up with your exercise.... that is a big concern once I start on ADT... how much fatigue and muscle loss I'll experience.... tried mightily throughout my life to maintain reasonable body weight and toned body... would hate to see that all go out the window....
Thank you for sharing your story. Remarkable!
I received Provenge this past spring because I could, but I still don't know what to believe.
I am exactly 3 years to the day post-diagnosis with PSA <1.0. So, this study seems to mean that I've pushed our combined 5-year 50/50 chance to my own 7-year 50/50 chance....putting me today 4 years to the median.
While this is encouraging, I'm not betting the farm! There are simply too many variables.
We know that the study group was not only on Provenge....what, if any, are the synergistic or antagonistic effects of those other treatments on the outcome for individuals or classes of individuals? Did some of them opt for chemo, which I think would diminish if not wipe out the effects of Provenge? Are there other factors such as diet?... etc.....etc...
Provenge is a tool in this fight; a tool that has some data to support its use. But it is certainly no Lupron. As for me, I will try to let everyone know in 47.7 months +/- 1 standard deviation, whatever that may be! 
Cheers. - Joe M
I had Provenge 4 years ago for nodules in my lungs. The nodules shrank and have been stable since. Does it work? Who knows. But it is another weapon in the arsenal.
Yes it's true. Here is another article on the same subject... onlinelibrary.wiley.com/doi...
I looked at the article that Nonamelame cited. Near the bottom of the page there is a section on conflict of interests of the authors. I don't remember seeing a list of conflicts as long as this one before. The people who wrote the article all seem to be employees or consultants of the drug companies.
That doesn't mean the information is false but, along with what others have said above about cherry picking and lack of a control group, it adds to the grains of salt we need to add before swallowing the information.
Personally, I am mostly persuaded that sipuleucel-T (Provenge) can be of help in prostate cancer, and this article adds to other evidence that it helps most for patients who don't wait too long to take it. I've seen arguments that patients shouldn't wait for castration resistance to take it, but should take it while their ADT is still working. Here are two related arguments for this.
First argument: combinations of different kinds of drugs attack the cancer with different kinds of attacks. Tumor cells resistant to one kind (e.g., Lupron), may be killed by the Provenge, and vice versa. The theory is that it's easier for the tumors to evolve resistance to one drug, then evolve resistance to a second drug, than it is to evolve resistance to two drugs at the same time. We've seen that with ADT + chemotherapy.
Second argument: The immune system is not strongly effective at fighting prostate cancer, even when stimulated with Provenge, it's a weak cancer killer. Therefore it's most likely to be effective in killing weak cancer cells - i.e., cancer cells that are suffering the effects of androgen deprivation.
I'd like to see a trial of ADT + Provenge vs. ADT alone followed by Provenge. I suspect that the results will be similar to what we saw with ADT + chemo vs. ADT followed by chemo. Men will live longer with the combination therapy.
Alan
The real question is are they claiming you get an addition +4 years from previous lines that fail like Zytiga etc.
Their wording seems confusing
The report details look good, but are fairly simplistic because men's conditions would vary a lot when beginning such IT, with age, fitness, and previous Pca treatments not clearly spelt out and just what % of men get a benefit is a bit unclear, so my initial conclusion is that the article is Dendreon marketing. All marketing is shy about explaining the Real Facts and they emphasise benefits and often understate side effects, and there is no mention of a price or what a course of Provenge IT involves. Anyone who comes up with a "disruptive" treatment that seems to offer a better outcome than anything else seems to be able to charge enormous sums of dough.
If men who did get a benefit did post here we might be able to more readily understand all about Provenge and the real story.
My Psa is now 0.41, following 4 x Lu177 shots, and continuing ADT and enzalutamide, so theoretically I should get big extension of life as a fairly healthy 72yo.
What Dendreon should be doing is to allow men to go to a website page where they can type in say 20 facts about their history, then let an app work out likely outcome.
There was such a website page run by a Sydney uro surgeon where men could explain all things with tick a box input, then you would get an answer about whether the RP being offered by the doc would be a good idea. This doc charged about 4 times the rate of most other doctors and claimed he had best record in Australia for nerve sparing during RP and lowest number of patients having Pca continuing to grow after the ops.
One man in the Canberra Pca support group said the op cost total was usd $28,000 in 2014. Medicare paid back about usd $1,750. I had had a quote in 2009 for laparoscopic surgery at usd $5,300. I recall filling in the questionnaire and its conclusion was I was not suitable because my Pca was too locally advanced.
If there is a lot of Pca outside the capsule the docs cannot see what they are cutting into, and there's a huge danger of causing Pca to spread far and wide. So this is not cherry picking, its just good doctoring to know when some treatment would be a waste of time, and endanger a patient.
But there was no real evidence to support claims of this docs high level skills.
There's never any list of say the doc's last 200 patients with contact details so you can talk to any of them.
Doctors never seem to document the survival of patients after treatment, and have files for all treated; this is the work of a research doctor. Its a shame that much info could be available but isn't, and surely patient histories indicate the efficacy of treatment.
Patrick Turner.
It is "true" for those 1975 men. I ponder over the frequent use of "real world" phrasing. Sounds like a PR trope to me and appears also in the paper in Cancer. Maybe a distraction; maybe a company eager to please its investors. As one has said already: another arrow in the quiver. Not a magic bullet except for this very select cohort of low PSA older metastatic men.
I think they could have done abetter job of reporting on this study. There's no mention of microsatellite instability in these patients (MSI-High responds better to immunotherapy), prior therapies, or genetic profiles. I think it's great news that a subset of patients respond so well to it, but I think there's more at work here than just "low PSA".
Prior studies showed much smaller benefit for Provenge. Here's the IMPACT study:
ncbi.nlm.nih.gov/pubmed/235...
and another one:
ncbi.nlm.nih.gov/pubmed/208...
Again, I cannot see detailed profile of patients. I hope someone here may have it.
Only comment I can make is that the Keytruda treatment of my lung melanoma is working. Keytruda is a Immunotherapy drug...
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 09/08/2019 8:00 PM DST
I am really Charlie Brown on this issue. Kinda like coffee is bad for you, coffee is good for you. I will do it, with a port, if it comes to it. Sure my insurance co gets a big reimbursement from medicare. They mentioned it a year and a half ago as next step. They were practically drooling. Believe I have messed their timeline up a little. Really would like to know how the pie is sliced. They do have an interest in keeping us alive as long as possible. On this cheery note I must leave, Monday night football, and the Oakland Raiders, for the last season, call me. Enjoy that cup of coffee.
Probably of greater importance than Provenge, was another report out of Prostate Cancer News yesterday, indicating that the onvansertib Phase 2 trial (NCT03414034) on patients who have developed resistance to Zytiga (abiraterone + P), are responding well to this PLK1 Inhibitor. Trovagene’s onvansertib is a first-in-class, 3rd generation, oral and highly-selective adenosine triphosphate competitive inhibitor of the serine/threonine polo-like-kinase 1 (PLK 1) enzyme, which is over-expressed in multiple cancers, including leukemias, lymphomas and solid tumours like prostate cancer.
There are other compounds that are expected to overcome Xtandi (enzalutamide) resistance as well.
If they both achieve this then BINGO - Happy Days are here Again.
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