Immunology clinical trial vs. Radiation?

[KeyboardGuy]

Surgery in 2009, biochemical recurrence beginning 2017, and my slow-rising PSA is now up to 0.63, although my overall doubling time has remained pretty consistently over 2 years on average. My MO has a clinical trial in Phase I using a Listeria monocytogenes based vaccine, which supposedly seeks out PCa cells and attacks them like white blood cells attack bacteria. Possible side effects are fatigue and other flu-like symptoms, but so far my MO says none of the patients in the trial have reported any.

I questioned whether the slow-rising PSA could be the result of benign residual tissue, and my MO said that is possible but highly unlikely. So I requested a PSMA PET/CT (Ga68) scan before doing anything. The PSMA scan revealed "a 0.9 cm focus of intense PSMA uptake in the prostate bed, adjacent to the left posteroinferior bladder wall, corresponding to an ill-defined soft tissue nodule on CT (SUV max 40.5, average Hounsfield units 50, 4:81, 3:47)." Based on the radiology report, my MO said that I should seriously consider salvage radiation instead of his clinical trial, being that salvage radiation has been proven to be curative, and he strongly suggested that I consult with a radiation oncologist.

The first of two radiation oncologists I spoke with did a DRE and claims to have felt a nodule in the prostate bed. The second radiation oncologist ordered an MRI to complement the PSMA scan. The MRI found "a 0.9 x 0.4 cm nodule, which demonstrates marked diffusion restriction and early enhancement."

After considering radiation, I told my MO that, given the reasonable stability of my PSA, which would seem to indicate an indolent, if not benign, tumor, I would be comfortable participating in his clinical trial and keep the salvage radiation as a backup plan, should the PSADT ever become 12 months or less. My MO was not comfortable with my decision, and he asked me to re-reconsider radiation, and have the clinical trial be the backup plan. As to the first radiation oncologist's claim that he felt the nodule during the DRE, my MO said that if I wanted to pursue surgery instead, I should consult with a surgeon.

While I understand that image-guided radiation targeted to the nodule would be the regular standard of care at this point, I am concerned about having unnecessary treatment, where the treatment can result in unwanted side-effects or potential long-term collateral damage to the bladder or colon.

Looking to the group for suggestions, feedback, analysis, etc. on how to proceed from here -- to include whether to maintain active surveillance for now.

[tango65]

The radiation therapy is a proven treatment which could offer a good control of the cancer. The clinical trial is an unproven treatment..

Radiation therapy to the prostatic fossa plus whole pelvis radiation and ADT, is something you should consider to discuss with a radiation oncologist.

One has to remember that they need to treat what they don't see since even using a PSMA PET/CT will miss lesions smaller than 4 mm. The cancer may have already extended to the lymph nodes and consequently they need to irradiate the whole pelvis.

thelancet.com/journals/lanc...

astro.org/ASTRO/media/ASTRO...

[Spyder54]

Go for Cure. Anytime you have a shot at Cure, make it your highest priority. Your Onco thinks you have a shot w Radiation. Take the shot!

Can you do SABR/SBRT over 5 days vs IMRT over 28 days? Should be no pain. Just 15-20 minutes of setup, and 15 min of Radiation. I would use a major center with tons of repetitive experience. Been there done that. Flew up to NYC from Tampa and MEM SLOAN KETTERING for their MSK PRECISE. Best of luck to you and yours, Mike

[KeyboardGuy in reply to Spyder54]

Weill Cornell in NYC (affiliate of Columbia & NY Presbyterian) also does the 5-day SBRT using the MRidian ViewRay machine. That's where my prospective RO is (he's the one who ordered the MRI). I will be speaking to him about all this on Monday.

[TwilightZone]

I have three prostate cancer tumors that metastasized to my lymph nodes 8 years after prostate was removed 12/2015. One near-under collarbone on leftside front, other two near my aorta. The latter two are problematic because risk/reward for surgical removal (believed the best option) is BAD, while tumor under collarbone is a radiation candidate. After discussing with doctor, here is plan of attack: PROVENGE, (immunotheraphy). Scheduled for this summer, will update all with results.

KeyboardGuy, in yourcase I agree with the others, go with the radiation knockout punch. I'm NOT a doctor, it's just my personal opionion after 8 years since my surgery.

[KeyboardGuy]

Thank you all for your responses, but let me ask my question a different way: if the cancer is indolent, is there a need to do radiation right now? My post-surgical pathology Gleason score was Group 1 (3+3), and my doubling time has always been >2 years, thus the cancer is not aggressive as I see it. This is the thing I am still struggling with. The benefit in waiting is that both diagnostic techniques and treatment options continue to evolve every year, and I would want to pursue a path that provides the least side effects or collateral damage that impacts long-term quality of life. I have longevity in my family history, so for me, long term means another 40 years.

[Anesthesia966 in reply to KeyboardGuy]

That is a tough question, you are wanting to do surveillance on a suspected tumor recurrence that does not behave aggressively. What is the time frame for results on the vaccine? Will you know within a few months if it’s working?

[KeyboardGuy in reply to Anesthesia966]

During Phase I of the clinical trial, I would be receiving the vaccine once every 4 weeks, and each time the PSA will be checked. This will go on for 24 weeks (6 doses total). If the vaccine works, my PSA will go down as the PCa is attacked by the vaccine.

Here is information about the study: onclive.com/view/adxs-504-s...

[Justfor_ in reply to KeyboardGuy]

You can stall progression with a Minimum Effective Dosage of Bicalutamide. Only SE gynaecomastia that can be taken care against very easily. This is just what I am doing and have gained 2+ years now and counting. Details in my bio.

[Fightinghard]

my vote - beam it while the radiation can still be curative. Waiting on a trial to play out could give the cancer time to spread micro metastasis that will not show up until farther down the road.

[j-o-h-n]

Can you Key again on your computer keyboard and tells us what did your Grandfather and Uncle who both had Pca finally leave us to join my Comedy Store in the Sky? Their ages when they passed?

You are 68 + 40 = 108..... God Bless you I'm pushing 87.....(21 more for me WOW... better chances of me getting laid).

Ok now here is my experience of getting my bed fried (which I've posted many times).

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Greetings: Radiation - I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the space oar and make sure you ask here on this forum before getting fried.

Footnote: Go to MSKcc across the street from W,C. you're better off there (see Dr. Zelesky).

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/13/2023 7:01 PM DST

[KeyboardGuy in reply to j-o-h-n]

Why do you say that MSK is better than WC? I understand that MSK has their "PRECISE" method of CT-guided SBRT. But WC's MR-guided SBRT MRidian ViewRay has a feature that automatically disables the delivery of radiation if the body moves out of sync with the image tracking. When I reviewed MSK's information I did not find such a feature.

[j-o-h-n]

Stockholder.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/14/2023 7:13 PM DST

[LowT]

can they do a needle Bx of nodule?

[KeyboardGuy in reply to LowT]

I am going to ask my urologist about that when I talk to him next week. It would be good to know if the BCR Gleason score is the same as the original one.