Provenge has been flagged to me on more than one occasion now so thanks to those.
I was wondering if anyone could point to clinical trials in its use for the metastatic hormone sensitive APCa patient such as me.
Considering all options for whilst PSA now undetectable ( third month) on ADT and Apa combo following Lu-177, Docetaxel, SBRT, 20 x VMAT aNd 2 x Brachi in 7 months aware of micromet
If i do get a reoccurrence and I’ll know it was just being hormone suppressed and the cancer as ever has won v the hormones but there was nothing else I could have done and Hormone resistant was inevitable.
Would provenge help whilst I am stable with undetectable PSA ?
Trying to follow where the science is and where it’s going for the hormone sensitive stage of the disease.
I’m UK based but can travel.
Appreciate I have blessings to be counted, know you don’t poke a sleeping bear but also that ADT is no fun and have faith something better will come!
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Brysonal
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There are no open trials for earlier use of Provenge. There is no point in creating a dendritic cell vaccine when there aren't metastases to provide cancer antigens. In fact, many therapies only work when cancer macroscopic and is actively growing:
The link in your blog led to an article that says:
“Sipuleucel-T patients had a 48% increase in PSADT following testosterone recovery (155 vs. 105 days, P = 0.038). With only 16% of patients having developed distant failure, the treatment effect favored sipuleucel-T (HR = 0.728, P = 0.421)”
That seems pretty promising for it working? Right?
Maybe. PSA is just not a good biomarker for Provenge. The trial found that the time to bF was the same whether patients got Provenge or not, but the prolongation of PSADT is encouraging. PSADT was prolonged more with more treatments and so was immune response. How long does it last? What is the best time to use it? Are there combinations that increase its effectiveness? Those remain open questions.
I found this old clinical trial about Provenge. I don't know what are the results:
The PROTECT-PROvenge Treatment and Early Cancer Treatment trial was a Phase III trial for patients with hormone sensitive prostate cancer.
Brief Summary:
The PROTECT-PROvenge Treatment and Early Cancer Treatment trial was a Phase III trial for patients with hormone sensitive prostate cancer. The study was conducted at over 15 participating centers throughout the US. The purpose of the study was to determine if sipuleucel-T was effective for treatment of early stage, non-metastatic prostate cancer. The study compared the active vaccine to control to determine whether the product delayed the time until cancer progression.
The link you found from TA’s blog article, stating 48% increase in DT, appears to be the PROTECT results. Here’s another article calling it out explicitly with trial name, and talking about a number of other early-stage tests with Provenge:
i don't really know, but i believe that ones you are castrate resistant it should be covered, but I am not really sure. I am in Australia and only see what people are writing. Can you contact your insurance and ask them. You could be covered so better find out. It is better to do when psa is still under 5.
I was told by my oncologist here in Australia that for 120 k USA Dollars i could probably organize it in LA. (Probably elsewhere). Find out more from the official website or maybe from your oncologist.
I know that some oncologists (my including) don't recommend Provenge as it doesn't lower PSA. It extends life by 4 months.
I personally think (as a possibility) that maybe Provenge is killing (or reducing) the cancer stem cells and it has survivor benefits but without a direct immediate reductions of the PSA.
I would do it but the cost is prohibitive and it is not approved in Australia.
I did a lot of my own research on this subject and talked to numerous doctors involved in Provenge treatment. The study they did indicated much better results for use earlier (with lower PSA) in the disease. But TA is right below. . For Provenge to work best it needs cancer antigens. I’m still hormone sensitive. So I went on a drug vacation and when my PSA went up and they found a new met from a PSMA scan, I zapped it with SBRT to create antigens and then started Provenge. I Also immediately thereafter went back on adt and Zytega. One study showed if you added adt right after Provenge, it seemed to have a synergetic affect. Problem is insurance doesn’t cover it for HSPC. Out of pocket is not for the faint of heart. It cost over $50,000 for each of the three sessions. Ouch. Hope it was worth it.
I believe the statement: "For Provenge to work best, it needs cancer antigens," is incorrect. The antigen operational in Provenge is PSAP, which is universal on prostate tissue, i.e., prostate-specific. The vaccine primes T cell activation and expansion to PSAP epitopes. Period. No other Protein is used. The immune response, if it takes off, naturally produces antigen spread. The prostate cancer does not need to have a lot of neoepitopes. Indeed, as you stated, and it is known Provenge works best with lower PSAs and indicators of lower disease progression.
Brysonal, you went “all-in” to fight the beast from every angle possible. Bravo! Smart to pair it with SBRT for antigen exposure. Knowing you left nothing on the table is priceless -For those that are able to cover the tab anyway. I see no reason not to think Provenge would work as well or perhaps better in mHSPC.
I, like many, continue to recognize that ADT even paired with AAR drug is not curative but kicks the can down the road fairly well. Probably so too with Provenge. And with no side effects other than the hit to the wallet. Insurance and Medicare cannot afford to open the gates to the HSPC. Perhaps a knock-off when the patent on the process expires?
My first oncologist was a research MO at Moffitt Cancer Center in Tampa, FL. When he discussed my disease and treatment plan with me, he mentioned that when ADT had failed and my PSA rose above 2.0 it would be time for Provenge. He said that Provenge improves QOL and extends life a few months more than going straight to chemo.
Provenge did create a dip in my PSA for a month or so, then I went back on Xtandi which also only lasted a month or so.
Chemo did drop my PSA, but I couldn't tolerate it so had to stop after 4 cycles.
Next is PSMA scan (only one in area so it takes a while to get one) in mid October, then another meeting with current MO to discuss treatment plans.
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Doctor wants to move on to Provenge.
Post-hoc of ARASENS for metastatic hormone sensitive prostate cancer
Metastatic Lymph Node, Recurrent PCa 
If PSA decreases in MHsPC but ALP increases , is one still castrate sensitive ? 
Targeting Mets w SBRT- what’s your experience?
