Hopkins Oligometastatic Paper (kitchen-sink approach, NEWLY Dx’d, not retrospective) released.

[are2yvr]

This one is important. This is the first prospective cohort. Early results led to the creation of the TED-1 and 2 trials at JHH. Aspects of these results have been mentioned at conferences last year and in the context of ORIOLE and other JhH trials

link.springer.com/article/1...

[Tall_Allen]

What do you think is important?

[Schwah in reply to Tall_Allen]

Interestingly, this is Similar to the protocol that Dr. Scholz initiated for me about three years ago. SBRT (to my 3 mets), chemo, Lupron and Zytega. They call it total eradication therapy. Dr. Scholz calls it “ kitchen sink” therapy. So far so good for me 12 months into my “vacation”. This seems to me, preliminary evidence that such an approach for ogliometastatic men, Can provide long-term remissions or dare we say a cure. Why do you not find that important Tall Alan? What am I missing ?

Schwah

[Tall_Allen in reply to Schwah]

The problem is exactly what you inferred when you wrote "Can provide long-term remissions or dare we say a cure. " - a conclusion the authors did not (for a good reason!). The study did prove safety, and that is all it showed. The oncological endpoint was low PSA at 3 years - so what?

Remember that any of those treatments can give men with newly diagnosed mHSPC low PSA at 3 years. They report 3-yr freedom from biochemical recurrence of 67%. In STAMPEDE, metastases were counted with bone scans/CTs whereas in this study PSMA PET/CT detection was used, so men were much less progressed to begin with.

Here are the 3 year failure-free survival (3-year failure was most often PSA failure) from STAMPEDE trials:

•abiraterone: 75% (and low volume was 76% lower than ADT only)

•docetaxel: ~60% (low burden of metastases)

•debulking the prostate with radiation: 50% (low burden of metastases). Treating the whole pelvis with radiation likely reduces PSA still further.

•treating metastases with radiation will lower PSA of course, but the unknown is whether it increases survival. This study didn't address that.

So this study did not show that there was any advantage to the more intensive treatment - it only showed that it didn't harm them.

[GP24]

I do not believe that all these treatments will cause no side effects. A different approach is the new #LuTectomy trial in Australia:

up.picr.de/37234863ge.png

[TheTopBanana in reply to GP24]

But that is for localised PC? This is for mPC.

[GP24 in reply to TheTopBanana]

On the slide it says they include "high-risk localised prostate cancer +/- N1 (= with or without lymph node metastases)"