See this MUST WATCH video by Dr Eugene Kwon starting at about the 7:35 minute mark for a an eye-opening discussion about "Paradoxical Responses to Therapy" youtube.com/watch?v=IEToOBu... . I was on Erleada and the exact thing happened to me. Even though I had a PSA of 0.2 recently a CT scan showed both lungs with "innumerable" cancer nodules. Cancer was elsewhere as well.
20-40% of his patients demonstrate this shocking outcome. Stick with chemo first if you can. I now wish I had. No one knew any of this until he came forward with the info. Double agents: working for the cancer and working to drop PSA at the same time.
This is a bit shocking. I guess you shouldn't assume anything if your PSA is 'undetectable'. I asked about having a PSMA scan and was told that it really wasn't necessary. The assumption is there's no replication of prostate cancer cells going on since my PSA is undetectable. One more thing to worry about
Kwon's thing is that you never trust a PSA reading without an image to back it up. Even a simple CT scan might reveal unexpected cancer guests like mine did.
Curious, twelve years after prostatectomy I was put on hormone therapy, Lupron/Zytiga. That lasted 18 months. Moving to a Phase 3 trial. Thanks for this discussion.
Very interesting thanks for sharing. I am new to HT having just had my second injection. I didn’t realise once you were resistant you still take it for life. Why is that?
"20-40% of patients on 2nd Gen HT exhibit Paradoxical Responses" Does anyone know (perhaps from other studies) how much data or other validation there is to back up this assertion?
His patient base, or that of the Mayo Clinic overall, is something like 6000+. Mayo is the busiest clinic in the U.S. I reckon that's a pretty fair representation. Sounds like he plans to publish shortly.
Kwon is Great! Period! Thanks for post.Watched it 2nd time here.
Good summary of LU-177 at end. Like we all knew from our fellow Brothers with experience from Germany or Trials, it works well for some, and not so well with others. Think he said 1/3,1/3,1/3= good/somewhat/not much. Getting close but not end of the disease.
He also says Taxanes upfront (like the Stampede Trial), but no one addresses the mass of Men that werent offered Taxotere upfront, and now with low PSA’s and still Hormone sensitive do not qualify for Taxotere (until PSA starts to rise). My common sense says earlier is better yet Oncologists will tell you Taxotere will not find much to fix with low PSA’s.
Like TA has told us, men relying on low PSA could have metastases growing without any knowledge. Kwon shows good examples. One more reason for PET Scans.
dhccpa. The video here is 1 of 3 from Kwon on Youtube. One vid is titled everything you wanted to know about PET Scans. It is excellent. His summary is for some its Auxumin, others Gal68 ( also good for LU-177 PSMA), others Pylarify. But he says PET from an experienced RO is better than CT, Bone, or MRI Scans. Think he said on average you see Cancer 7 years before conventional scans. Mike
When PSA first becomes undetectable on ADT might actually be the best time to do docetaxel. See my previous post on “extinction dynamics” - (Evolutionary dynamics Part 2).
Hi Paul, after 14 mos since Dx I am at my low Nadir on PSA of .36 (not yet undetectable). Dr Carlos Alemany at Orlando Health said not now. If we give you Docetaxel at these PSA levels it will find little to work on. He said wait for Cast Resistance, then hit it with Doctaxel and Provenge.What you say above, is hat made sense to me.
Wish I had it upfront.
Kwon says it upsets him that so many Stage PCa have not been offered chemo
Yes Mike. So much to consider and so much is unknown. Certainly not by me. Great respect for Kwon and his perspectives. But it certainly seems that waiting for one treatment to fail and resistance to be fully evident before moving to the next is not working for so many with mCRPC. Thanks for the references to the videos I will carefully consider all he is offering. Best regards. Paul
Not all PETs are the same for low or no PSA metastasis apparently. In fact I THINK CT scans are used also.
Also check out the comments section in that Kwon video for what the Prostate Cancer Research Institute had to say (there's a link to another video -- see minute 1 to about 3 youtube.com/watch?v=57ehJkV... ). Best to go with Lupron, Zytiga AND docetaxel when you're hormone sensitive. Two and a half year advantage!
Absolutely! The PEACE-1 study protocol seems to offer the best outcome overall for advanced mCSPCa, AND regular scans plus blood work are essential. One GU MO I follow also checks T as well, to catch the not so common breakthrough which can occur even when the PSA is low.
Thanks john! I'm going with Kwon's recipe of Taxotere with Carboplatin first. That should knock the nasty mutating cancer flat. I haven't done any chemo to date. There was a PCF article back some time ago that featured a fella who used that chemo combo -- and his BRCA2 mutation -- to go into complete remission. Of course, he was cherry-picked because he also happened to be an "excellent responder". Keytruda is on my list, though.
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MRI guided radiation 
Scans look great, next step Provenge and holding off on 2nd line hormone therapies
First PSA test ever and concerning results
Looking for Alternative Treatment Successes
Anyone dealing with Small Cell Carcinoma as their prostate cancer?
