Moving into the new area of Expanded use of Radiotherapy

[MateoBeach]

This is the short take from Practice Update this morning. Link to the abstract is included. The three practice changing points included are worth noting. Makes me happy. (Came off of wonderful 3 day backpack around Grand Teton yesterday. Today, back into it in Yellowstone. Pic is of the Grand Teton. Stood on top back in 2006, one year before PC.)

practiceupdate.com/c/139708...

TAKE-HOME MESSAGE

In this review, the authors outline the evidence to date from clinical trials assessing the utility of radiotherapy in patients with oligometastatic prostate cancer.

Primary prostate radiation in the de novo metastatic setting prolongs biochemical progression–free survival (BPFS) and may provide a survival benefit in patients with less than five bone metastases.

Metastasis-directed therapy in the form of stereotactic ablative body radiotherapy (SABR) may provide benefits beyond local control in both patients with hormone-sensitive and hormone-resistant prostate cancer, including longer BPFS and radiologic PFS.Radiotherapy, particularly SABR, should be considered in patients with oligometastatic prostate cancer. Highly-sensitive imaging modalities, such as PSMA PET, are essential to identify patients most likely to benefit from radiotherapy.

[jdm3]

Thanks for posting. And... great photo. Love the Tetons!

[Grumpyswife]

Thanks for this. Don’t see the usual comments from those that don’t believe in whack a mole to go negative on this report as a misinterpretation of the trial results. Maybe they will just ignore it.

Love your gorgeous pictures of how you enjoy life!

[mrssnappy]

This is really interesting, thanks for sharing. An important analysis performed within the OPeRATIC study was the collection of peripheral blood mononuclear cells before and after radiotherapy, making it the first study to directly measure an indicator of antitumor immunity in the context of SABR. These patients also experienced improved median local and distant progression-free survival. These data demonstrate that there may be a subset of patients with hormone-resistant prostate cancer and enhanced antitumor immunity who would particularly benefit from radiation therapy. This benefit may not be limited to local tumor control, but also encompass improved systemic control resulting in better survival outcomes.

[20PeteG16]

Thank you for this encouraging post. As Zytiga was failing in 2022, my oncologist referred me to the Medical University of SC for a clinical trial. Now that the trial is unsuccessfully completed, back to local MD. Labs and scans are recent, so in consultation to the principle investigator (at MUSC) and local radiology oncologist it was recommended that I undergo focal radiation of the two prostate cancers now in a hip bone. Today I completed the 9th of 10 focal treatments. Also now on Xtandi. Bone pain is not for sissies!

Hoping for and preparing for improvement.

PeteG

[Seasid in reply to 20PeteG16]

If your PSA is still high (above 10) could you ask for a liquid biopsy?

From the liquid biopsy you could see if you have actionable mutations and maybe Olaparib or Keytruda would work for you.

I personally would try chemotherapy if you still have a high PSA and bone pain.

I believe you can't just simply change to Xtandi without chemotherapy.

You can try Xtandi without chemotherapy but it will probably fail soon.

I am not a doctor but i believe you should press a reset switch with the chemo if Abiraterone failed.

I understand that you had a radiation and hopefully you will be better, but cancer can spread and chemotherapy is the most effective if a PSA doubling time is short.

You could have lots of mets with high PSA. The PSMA PET scan only shows the mets bigger than 4 mm in diameter.

Chemotherapy treatment sometimes work even just only one cycle by removing the pain.

I would go with the chemo at least 4 cycles and than introduce Xtandi.

I am replying here to you personally as I see that you had a bone pain and a PSA 150.

You can always stop the chemo if you develop side effects. This is my personal interpretation. I don't have a link.

[garyjp9 in reply to 20PeteG16]

Was there an MO at MUSC that you would recommend for PCa?

[20PeteG16 in reply to garyjp9]

I would recommend Dr. Michael Lilly, but he announced retirement to research only.

[garyjp9 in reply to 20PeteG16]

darn it. I have a friend in SC who needs one.

[garyjp9 in reply to 20PeteG16]

Pete, was there an MO at MUSC that you would recommend for PCa?

[monte1111]

I don't understand medical jargon much, but that is one great picture.

[Seasid in reply to monte1111]

Here is doing well.