PSMA 101

[Blackpatch]

Apologies if this has already been posted, but this conference presentation from Peter Mac's Declan Murphy is a real tour de force in terms of illustrating how PSMA imaging is impacting treatment decision making.

urotoday.com/video-lectures...

Stuart

[GP24]

He discusses whether prostate surgery or radiation (=local therapy) are beneficial when lymph node metastases are detected. I like this slide:

up.picr.de/36738805ej.png

it is refering to this study:

europeanurology.com/article...

So even when lymph node mets are detected, patients have a 71% survival benefit if the prostate is radiated or removed using surgery. The article mentions:

We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone.

[Blackpatch in reply to GP24]

Yep, it’s a very “big picture” sort of presentation that pulls together a lot of other work in an interesting way.

[Patrick-Turner]

Hi Blackpatch,

Everyone interested in knowing more about Pca and its detection and treatment MUST SEE the link at

healthunlocked.com/api/redi...

The info at this link compares the difference in performance between CT scans used in past to the PsMa scans now used. It becomes quite obvious the PsMa scans are vastly superior to CT scans.

For anyone suspecting they have Pca where Psa >5.5 with slight other symptoms like increased frequency for urination and ceased ejaculation of sperm, they should see this lecture with some video info.

But although the PsMa scan is a disruptive new type of scan that disrupts old scan methods it disrupts in a very favourable way for all doctors and patients.

My own experience was to have a horrible diagnosis of Gleason9, inoperable, in 2009, at age 62 while extremely fit and healthy. It was very probable there were multiple mets.

I had EBRT to PG and ADT and clear CT scans in 2010, and the first two positive lymph nodes were not seen by PsMa scans until 5 years later in 2015 and these would not have been seen by CT until another 2-3 years.

The PsMa scans were not available here until 2015, about the same year that Lu177 arrived here. If I had the normal treatments known in 2014, I'd be very dead now.

But the PsMa scans guided the doctors to conducting first trials of Lu177 at Peter Mac in Melbourne in 2016 and the results prolonged the lives of many of the 31 end stage patients selected for the trial.

The video + lecture in the link above implies that where men have extensive mets that a CT scan cannot see, but which PsMa scan can see, then they might benefit with Lu177 asap. This is not mentioned, but it seems fairly obvious. A man could have his PG removed, but all the unseen mets would then grow to kill him so the RP may not extend his OS.

Theranostics Australia were granted the licence in about 2015 to operate here to supply Lu177 because here in Australia I am able to buy whatever I like where the normal successive treatments all fail one after the other including chemo at the end. So Lu177 does not need to have phase 3 trial success, phase 2 success is enough, and hence I could buy the Lu177.

Trials have been going on that were free but often there was no choice for what was being trialed, one was for Lu177 OR Cabazataxel, a newer chemo. Patients were assigned one or the other, and could not progress from one where it failed to the other. I thought that was a bad deal, and after having docetaxel fail I did not want to risk missing out on Lu177 by being assigned randomly to Cabazataxel.

Now had I been able to have a PsMa scan back in 2009 before the biopsy showed I had Gleason 9, 9/9 positive samples, high risk, the PsMa still would not have detected any mets. But I bet I had mets. The docs did not know from the biopsy that my PG could not be removed surgically. Well, they soon found out in early 2010 during attempted open RP that I was amoung the 1% of patients they said were inoperable. I suspect the % is really much higher.

So the latest scans and the biopsies still don't tell us quite enough to make sure a man gets diagnosed early enough with a Gleason 5 max and no spread, with likelihood of successful surgery and the end of all future worries about Pca.

The answer to this problem is that men must be very fully examined well before his Psa reaches 5.0, and preferably before it reaches 3.0, and the idea that normal Psa is between 0.55 and 5.5 is quite wrong IMHO.

By the time Psa reaches 5.5+ the surgeons and medical system is often trying to catch the horse after it has bolted, and long expensive fight begins.

Men don't like the idea of having their PG removed well before any Pca is found. But if I'd had a dad and 3 older brothers who all had Pca, then I would have begged a surgeon to sharpen his scalpel and set the date.

Patrick Turner.

[Blackpatch in reply to Patrick-Turner]

Thanks Patrick - I think we are very lucky to have Peter Mac, and your own history is a good illustration of that. Australia's rather lax radiation regulatory environment has served us well in this particular instance!!

Stuart

[Patrick-Turner in reply to Blackpatch]

Well yes, but you'd think Lu177 would have full approval by now everywhere, but the reasons behind why this is not so probably is due to political goings on we are not told about, and because if Lu177 was widely available there'd be a lot of medical companies have a down turn in business. But Theranostics Australia boss doctor told me last November he had done 700 men in Australia with Lu177 since he began in 2015, and scored 70% success rate, ie, the blokes got a good extension to being alive. Some have had years of respite. These blokes all had chemo failure, there was SFA else they could have tried that would have worked.

I got the idea that TA knew a huge pile of info about Pca, because they had seen so many cases at their clinics, and I would argue the history TA has on every bloke could be analyzed to find out what works and what does not, maybe in a better way than what is being done in some research hospital with small numbers of patients. But then again TA never took any tissue samples from me to relate my DNA to treatment so there is a whole lot more research info that could be obtained from treatment clinics that is not obtained.

I'm just lucky to be around and with Lu177 available.

I still have no clue how long things will stay good. The only certainty is uncertainty.

Beautiful spring day here, nice ride on me bike, tinkered in the workshop later, life's a dream.

Patrick Turner.