Recurrent PC : Hello fellow PC warriors... - Advanced Prostate...

Advanced Prostate Cancer

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Recurrent PC

marmigs profile image
15 Replies

Hello fellow PC warriors.

In Jan 19 I completed combo treatment SBRT and Bicalutamide. My PSA started rising 5 months ago signaling BCR. Further testing PSMA PET / MRI confirmed reoccurring PC and my 15 core guided biopsy was mostly 4+5's, one 5+5 all grade group 5. Good news is that it's still contained to the capsule and there are no distant mets. Recommendation from my urology oncologist is Cryo therapy of the entire prostate.

I learned about a Clinical Trial on Cryo-Immune Focal + Systemic Immune Therapy. Are there any of you with knowledge of the trial cited below?

Thanks,

Ross

The clinical trial will evaluate the effectiveness of cryo-immunotherapy. 10 The current medical center is in Rochester, Michigan, but more sites should soon be open.

The trial design is as follows:

1. Identify an accessible location of tumor mass(es) inside or on the surface of the patient’s body.

2. Administer low-dose cyclophosphamide five days before the focal procedure to suppress a sub-population of lymphocytes (called Tregs) to further enhance T-cell destruction of cancer cells.

3. Use image-guided technology to precisely cryo-damage a portion of the malignant lesion.

4. Precisely inject into the tumor(s) two immune-therapeutic drugs:

a. Keytruda® (pembrolizumab), which is a monoclonal antibody drug that inhibits PD-1 (programmed death -1 receptor) and impedes a cancer cell’s ability to escape the body’s normal immune response. PLUS,

b. Yervoy® (ipilimumab), an anti-CTLA-4 (cytotoxic T-lymphocyte-associated antigen 4) monoclonal antibody drug that works to enhance the immune response by targeting a subset of T-cells called Tregs that inhibit the immune response.

5. The treatment also involves an immune drug called GM-CSF (granulocyte-macrophage colony stimulating factor) that has been used for decades to mobilize the bone marrow release of granulocytes and macrophages to protect against bone marrow suppression caused by toxic chemotherapy drugs. The objective in this cryo-immune clinical trial is to use GM-CSF to potentiate the effects of the immune checkpoint inhibitors Keytruda® and Yervoy®. The GM-CSF is given under the skin (subcutaneous) and is injected for about 30 days after cryo-immune focal therapy is administered.

6. Up to two cancer areas for each patient will be selected and treated during each treatment. The clinical trial will involve up to three treatments using the above approach for each patient.

By using a sequence of cryo-damaging the tumor (to release its antigens), followed by four different immune therapies (Keytruda® + Yervoy® + GM-CSF+ cyclo-phosphamide), a cryo-immune synergy is created, and some researchers believe that a clinically significant systemic anti-cancer immune response may be elicited.

Moreover, the intra-tumoral injection of drugs at a lower dose is likely to cause fewer side effects than higher-dose intravenous systemic therapy.

How to Determine if you Qualify for this Study

There is no cost to those eligible for the study other than possible travel expenses and lodging near the clinical trial study site medical facility. The study center may bill your insurance if it covers the cost of some laboratory tests and imaging, but patients are not expected to pay anything out of pocket.

If you or someone you know has a diagnosed metastatic malignancy involving a solid tumor and all available treatments have failed or the patient chooses against conventional therapy, you can register at the following website to ascertain your eligibility:

ramparthealth.com

Additional information about the trial can be found at clinicaltrials.gov/ct2/show...

If you are eligible, you will be contacted for full medical records and a trial coordinator(s) will guide you through the trial process.

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15 Replies
Tall_Allen profile image
Tall_Allen

It sounds like Gary Onik's protocol.

marmigs profile image
marmigs in reply toTall_Allen

do you know the efficacy?

Tall_Allen profile image
Tall_Allen in reply tomarmigs

I don't think anyone knows that - just anecdotes from Onik. That's why they are doing the clinical trial.

Your case is very unusual. It would be interesting to see a Decipher/PORTOS analysis of your biopsy tissue. I hope cryo ablates the cancer.

marmigs profile image
marmigs in reply toTall_Allen

It is Onik’s trial. I spoke to Dr David Bostwick about it this AM. He, Onik and others co-authored a paper on the trial. Bostwick told me I’m a very good candidate for the trial. Sounds very promising.

marmigs profile image
marmigs in reply toTall_Allen

I will look into getting Deciper/PORTOS on the tissue.

Tall_Allen profile image
Tall_Allen in reply tomarmigs

Not very important at this point. I was just curious as to why radiation had so little effect.

marmigs profile image
marmigs in reply toTall_Allen

here’s the biopsy:

 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -      MEDICAL RECORD |                   SURGICAL PATHOLOGY- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -                               PATHOLOGY REPORT         Accession No. SP 22 6472- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Submitted by: SUEK,T                        Date obtained: Sep 20, 2022 12:01- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Specimen (Received Sep 20, 2022 12:06):A. PROSTATE BIOPSY RIGHT BASEB. PROSTATE BIOPSY RIGHT MIDC. PROSTATE BIOPSY RIGHT APEXD. PROSTATE BIOPSY LEFT BASEE. PROSTATE BIOPSY LEFT MIDF. PROSTATE BIOPSY LEFT APEXG. PROSTATE BIOPSY REGION OF INTERESTH. RIGHT SEMINAL VESICLE BIOPSYI. LEFT SEMINAL VESICLE BIOPSY- - - - - - - - - - - - - - - - - - - - - - - - - - - - BRIEF CLINICAL POSTOPERATIVE DIAGNOSIS:                            Surgeon/physician: ROBERT LEE GRUBB MD=      PATHOLOGY REPORT         Accession No. SP 22 6472- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Gross/micro description:      GROSS: Austin Robbins            Fixative: Nine specimens in NBF            Specimen A: Prostate, Right base            Description: Received are two pieces of tan-white cores of tissue,      measuring from 1.7 cm in length up to 1.9 cm in length. The specimen is      entirely submitted in cassette A1.                   Specimen B: Prostate, Right mid            Description: Received are two pieces of tan-white cores of tissue,      measuring from 1.9 cm in length up to 2.1 cm in length. The specimen is      entirely submitted in cassette B1.                   Specimen C: Prostate, Right apex            Description: Received are two pieces of tan-white cores of tissue,      measuring from 1.4 cm in length up to 1.6 cm in length. The specimen is      entirely submitted in cassette C1.                   Specimen D: Prostate, Left base            Description: Received are two pieces of tan-white cores of tissue,      measuring from 1.7 cm in length up to 2.1 cm in length. The specimen is      entirely submitted in cassette D1.                   Specimen E: Prostate, Left mid            Description: Received are three pieces of tan-white cores of tissue,      measuring from 0.2 cm in length up to 1.9 cm in length. The specimen is      entirely submitted in cassette E1.                   Specimen F: Prostate, Left apex            Description: Received are two pieces of tan-white cores of tissue,      measuring from 1.5 cm in length up to 2.1 cm in length. The specimen is      entirely submitted in cassette F1.                   Specimen G: MRI region            Description: Received are five pieces of tan-white cores of tissue,      measuring from 0.2 cm in length up to 1.7 cm in length. The specimen is      entirely submitted in cassette G1.                          Specimen H: Right seminal vesicle            Description: Received are two pieces of tan-white cores of tissue,      measuring 0.3 cm in length up to 1.4 cm in length. The specimen is      entirely submitted in cassette H1.                          Specimen I: Left seminal vesicle            Description: Received are three tan-white cores of tissue, measuring 0.2      cm in length up to 0.8 cm in length. The specimen is entirely submitted      in cassette I1.            REPORT DICTATED 09/20/2022        Microscopic diagnosis:      SPECIMEN A: PROSTATE, LABELED AS "RIGHT BASE", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+4 = 9, GRADE GROUP 5            -PERCENTAGE OF GLEASON PATTERN 5: 81-90 %            -CRIBIFORM GLANDS: NOT IDENTIFIED            -2 OF 2 CORES INVOLVED, APPROXIMATELY 6-10% AND 11-20% CORE LENGTH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)            -PIN4 MULTIPLEX IMMUNOHISTOCHEMICAL STAIN CONFIRMS THE ABSENCE OF BASAL      CELLS (P63 AND 34BETAE12 STAINS) AND IS POSITIVE FOR RACEMASE WITHIN      MALIGNANT GLANDS                           SPECIMEN B:  PROSTATE, LABELED AS "RIGHT MID", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+4 = 9, GRADE GROUP 5   -PERCENTAGE OF GLEASON PATTERN 5: 91-100 %      -CRIBIFORM GLANDS: NOT IDENTIFIED            -2 OF 2 CORES INVOLVED, APPROXIMATELY 31-40 % CORE LENGTH EACH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)                          SPECIMEN C: PROSTATE, LABELED AS "RIGHT APEX", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+5 = 10, GRADE GROUP 5            -2 OF 2 CORES INVOLVED, APPROXIMATELY LESS THAN 5% AND 6-10 % CORE LENGTH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)                          SPECIMEN D:  PROSTATE, LABELED AS "LEFT BASE", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 4+5 = 9, GRADE GROUP 5            -PERCENTAGE OF GLEASON PATTERN 4: 80 %            -CRIBIFORM GLANDS: PRESENT            -1 OF 2 CORES INVOLVED, APPROXIMATELY 21-30 % CORE LENGTH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)            -PIN4 MULTIPLEX IMMUNOHISTOCHEMICAL STAIN CONFIRMS THE ABSENCE OF BASAL      CELLS (P63 AND 34BETAE12 STAINS) AND IS POSITIVE FOR RACEMASE WITHIN      MALIGNANT GLANDS                          SPECIMEN E:  PROSTATE, LABELED AS "LEFT MID", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+4 = 9, GRADE GROUP 5            -PERCENTAGE OF GLEASON PATTERN 5: 91-100 %            -CRIBIFORM GLANDS: PRESENT            -2 OF 2 CORES INVOLVED, APPROXIMATELY 11-20 % CORE LENGTH EACH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)                          SPECIMEN F:  PROSTATE, LABELED AS "LEFT APEX", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+4 = 9, GRADE GROUP 5            -PERCENTAGE OF GLEASON PATTERN 5: 91-100 %            -CRIBIFORM GLANDS: NOT IDENTIFIED            -2 OF 2 CORES INVOLVED, APPROXIMATELY 11-20 % AND 21-30 % CORE LENGTH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)  SPECIMEN G: PROSTATE, LABELED AS "MRI REGION OF INTEREST", CORE BIOPSY:            -ADENOCARCINOMA, ACINAR TYPE, GLEASON GRADE 5+4 = 9, GRADE GROUP 5  -PERCENTAGE OF GLEASON PATTERN 5: 91-100 %            -CRIBIFORM GLANDS: PRESENT            -3 OF 5 CORES INVOLVED, APPROXIMATELY 31-40 %, 61-70 %, AND 71-80 % CORE      LENGTH            -RADIATION THERAPY EFFECT PRESENT (SEE COMMENT)                          SPECIMEN H: SEMINAL VESICLE, LABELED AS "RIGHT SEMINAL VESICLE", CORE      BIOPSY:            -BENIGN SEMINAL VESICLE WITH RADIATION THERAPY EFFECT            -NO EVIDENCE OF CARCINOMA                          SPECIMEN I: SEMINAL VESICLE, LABELED AS "LEFT SEMINAL VESICLE", CORE      BIOPSY:            -BENIGN SEMINAL VESICLE WITH RADIATION THERAPY EFFECT            -NO EVIDENCE OF CARCINOMA                   

Tall_Allen profile image
Tall_Allen in reply tomarmigs

Did you ever have another kind of PET scan? FDG or NaF18? Maybe discuss getting at least an FDG before getting cryo.

marmigs profile image
marmigs in reply toTall_Allen

I had the PET Aximum 2018, PSMA PET with F18 in Jul. Both confirmed no mets

marmigs profile image
marmigs in reply toTall_Allen

MY SCAN: PET-CT PSMA PYLARIFY Reason for Studyrising PSA s/p treatment for prostate cancerClinical Historyhx of prostate cancer s/p radiation therapy now w/ rising PSA that meets criteria for biochemical recurrence Impression   Initial F18-DCFPyL (piflufolastat) PET/CT scan.  There are foci of increasedtracer uptake in the prostate, compatible with prostate cancer.  There is noevidence of metastatic disease.  ReportWhole Body F18-DCFPyL (piflufolastat) PET scan with a CT scan of the Chest,Abdomen and Pelvis

Tall_Allen profile image
Tall_Allen in reply tomarmigs

I understood that and can only repeat my advice to you.

plato123 profile image
plato123

did you have symptoms

marmigs profile image
marmigs in reply toplato123

Just rising PSA

MateoBeach profile image
MateoBeach

I would not bet my life on unproven cryo+ protocol. With cancer confined to the capsule you can be cured with radical prostatectomy or HDR brachytherapy and IMRT ro the pelvic node fields. Explore other options before committing.

marmigs profile image
marmigs in reply toMateoBeach

further radiation is not an option for me since i used SBRT the first time around 4 years ago

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