Provenge criteria necessary for acceptance.

[SViking]

Apparently Medicare will pay for Provenge provided we are castrate resistant and metastatic. But are there other requirements like certain PSA parameters and lower testosterone levels?

Do we have to remain on ADT while being treated with Provenge?

[Tall_Allen]

Yes, remain on ADT. I think Provenge works better if combined with Xofigo or other radiotherapy to increase antigen presentation. Also, probably good with chemo because it amps up white blood cells.

[SViking in reply to Tall_Allen]

I just finished my fourth of four LU177 treatments on the Eclipse trial. At first clinic doctors thought my PSA had gone nondetectable but the numbers were 3.5 before the first injection and .3 before the last injection, and then .25 approximately one month after the fourth injection.

Seems like the fourth injection didn’t do much of anything unless maybe my PSA will continue to decline. I stopped Orgovyx and Zytiga right after the fourth injection. Since I still have a PSA of .25 there’s probably some tiny tumor somewhere that hopefully we can find on a PSMA scan. My plan would be to hit that with SBRT at UCLA and then go immediately to Provenge. But I did not realize that I had to be on ADT for Provenge. So far my tumors were confined to the bones and not lymph nodes or organs.

My testosterone is still zero and probably will be for another two months because I was on ADT for almost 2 years. Is it that the Orgovyx does something beneficial for Provenge or is it just zero testosterone? In other words would you recommend I go back on ADT at least while being treated with Provenge?

[Tall_Allen in reply to SViking]

I don't understand why you stopped Orgovyx and Zytiga. HT weakens cancer.

[SViking in reply to Tall_Allen]

The Orgovyx was causing cardiovascular complications, and I needed to get off it at least for a while.

[SViking in reply to Tall_Allen]

My testosterone is still zero and probably will be for another two months because I was on ADT for almost 2 years. Is it that the Orgovyx does something beneficial for Provenge or is it just zero testosterone that weakens the cancer? In other words would you recommend I go back on ADT at least while being treated with Provenge?

[Tall_Allen in reply to SViking]

Zero testosterone (T) weakens the cancer, and also is believed to enhance immune response. Provenge is only approved for men who are castration-resistant. As long as T is a castrate level and PSA is increasing in spite of that, Provenge can be approved.

[EdBar]

Provenge is most effective when your PSA is less than 5.0 per clinical trial, that was the group that did the best. And yes you stay on ADT. When it comes to Provenge you receive treatment however there is no way to determine if it is working for you, it doesn’t lower PSA, but it is another type of treatment that you can add to a multidimensional approach.

Ed

[Benkaymel in reply to EdBar]

Presumably you would determine if it's working with scans?

[SViking in reply to Benkaymel]

I don’t know because PSA doesn’t usually change with Provenge. But it might with SBRT.

[EdBar in reply to Benkaymel]

I don’t think so, I think you just look at it as another treatment in the battle and that in the long run there is a benefit.

Ed