Q. Is the current standard of care has changed in just one year? Docetaxel may now be considered in low volume and de novo disease together with an AR pathway inhibitor and radiation therapy indications should be extended not only to low volume but also to high-volume de novo disease?
A. Yes, there have been some significant updates in the treatment landscape for prostate cancer, particularly in the context of high-volume and de novo metastatic disease. Recent guidelines and studies suggest that combining docetaxel with an androgen receptor (AR) pathway inhibitor (like abiraterone, enzalutamide, or apalutamide) may offer substantial benefits even in patients with low-volume disease. Additionally, the use of radiation therapy has been extended beyond low-volume disease to also include patients with high-volume de novo metastatic disease.
This approach is based on evidence showing improved survival outcomes and better disease control when these therapies are used in combination. It reflects a more aggressive treatment strategy aimed at achieving better long-term outcomes for patients with metastatic prostate cancer. However, the specific treatment plan should always be tailored to the individual patient's condition and discussed with their oncologist.
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Interesting result using ChatGPT. May I suggest adding to your prompt? And add more detail? Like specific circumstances. The studies where this came from. ChatGPT knows!
I just put the most important part of Alicia Morgan and Karim Fizazi interview because otherwise it is to long and people could easily miss the most important part. That is why I made a Post about it.
Here is the link to the interview between Alicia Morgan and Karim Fizazi on which my ChatGPT question is based:
I realised that people are missing the most important part of the interview. It is not that I am more intelligent but rather the fact that in communication less is more, hence I came to the idea to create this post with the most important part of the message.
You could ask Chat GPT to list the studies on which his answer is based etc. but I believe Dr Fizazi is competent and we could believe him. We don't have to check his conclusions. Just to add that instead of just simply radiation I could say radiation to the primary. Radiation to the prostate just in case if it is not clear enough.
Ok, I asked more specific questions about radiation benefits to the primary tumour as you suggested:
Q. Could you please list the studies and results of each listed study on which you are based your answer.
A. Recent studies have indeed shown that combining docetaxel with androgen receptor (AR) pathway inhibitors and radiation therapy provides significant benefits in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC), including both low-volume and high-volume disease.
1. **CHAARTED Study**: This study initially demonstrated that only patients with high-volume disease benefited from the addition of docetaxel to androgen deprivation therapy (ADT). High-volume disease was defined as the presence of visceral metastases or at least four bone metastases with at least one outside the vertebral bodies and pelvis [[❞]](jnm.snmjournals.org/content....
2. **STAMPEDE Trial**: Post hoc analysis suggested that the benefits of adding docetaxel might extend to patients irrespective of disease volume. This trial also supported the intensification of treatment with docetaxel alongside ADT to improve overall survival [[❞]](jnm.snmjournals.org/content....
3. **LATITUDE Trial**: Focused on patients with de novo mHSPC, this trial showed significant survival benefits with the addition of AR pathway inhibitors to ADT, despite including higher-risk patients [[❞]](jnm.snmjournals.org/content....
4. **ARASENS and PEACE-1 Trials**: These trials evaluated the addition of AR pathway inhibitors to the combination of ADT and docetaxel. Both trials showed a significant improvement in overall survival with triplet therapy compared to the standard combination of ADT and docetaxel. Specifically, ARASENS reported a hazard ratio of 0.68 (P < 0.001) favoring the triplet therapy, and PEACE-1 showed a hazard ratio of 0.82 (P = 0.030) [[❞]](jnm.snmjournals.org/content... [[❞]](mdpi.com/1718-7729/29/12/747).
These studies collectively suggest that a more aggressive treatment strategy involving the combination of docetaxel, AR pathway inhibitors, and radiation therapy can offer better outcomes for patients with both low-volume and high-volume metastatic prostate cancer. This approach represents a significant shift in the standard of care, aiming to improve long-term survival and disease control [[❞]](jnm.snmjournals.org/content... [[❞]](mdpi.com/1718-7729/29/12/747).
Q. Which particular study concluded that radiation therapy to the primary is beneficial in both low and also high volume de novo metastatic hormone sensitive cancer?
A. Recent studies have provided insights into the role of radiation therapy for both low- and high-volume de novo metastatic hormone-sensitive prostate cancer (mHSPC).
1. **STAMPEDE Trial**: This study indicated that adding radiation therapy to the primary tumor in men with newly diagnosed metastatic prostate cancer resulted in improved survival for patients with low-volume disease, but not for those with high-volume disease. However, subsequent analyses and additional data have begun to suggest potential benefits for certain high-volume cases as well [[❞]](urotoday.com/library-resour... [[❞]](urotoday.com/conference-hig....
2. **HORRAD Trial**: This trial evaluated the effect of prostate radiotherapy in metastatic prostate cancer and suggested that while there was no significant benefit for the overall population, subgroup analyses indicated potential benefits in patients with low-volume disease. Again, further insights have proposed reevaluating high-volume cases [[❞]](urotoday.com/library-resour....
3. **PEACE-1 Trial**: Although primarily focused on the addition of abiraterone to standard therapy, this trial also provided data on the benefits of combining local radiotherapy with systemic treatments, indicating potential survival benefits in various patient subgroups [[❞]](urotoday.com/library-resour....
These studies collectively support a nuanced approach where radiation therapy is considered for both low- and potentially high-volume de novo metastatic hormone-sensitive prostate cancer under specific circumstances, particularly when combined with systemic therapies like androgen receptor pathway inhibitors.
Thank you, this makes me so sorry that I didn’t radiate my prostate bed mass, based on my orginal medical oncologist of 1.8 months advice. He talked me out of radiation after my prostectomy, from 03/2023, and just stick with systemic therapy.
Found prostate tumor mass reoccurrence in 05/2023, PSA was not rising.
I had a 1cm mass show up 05/ 2023 and he kept talking me out of radiation, all about systemic therapy. I believe it seeded my now liver metastasis, 06/2024, now it’s 7cm, abutting rectum. And growing, as it grew, I now have liver tumors, as the prostate tumor grows, the liver metastasis progressed and I also have a lung nodule to address.. I heard all about micro mets and circulating tumor. I would like some hard evidence based on fact with this phenomenon.
Now I have multiple liver tumors.
Orginal medical oncologist offered chemotherapy and possible a clinical trial.
Did liver biopsy but not enough tissue left for a solid staining.
I left and secured a new medical oncologist at a cancer center and did two chemotherapy in six weeks which I Did Not respond too.
Did two more biopsy’s one to liver and one to prostate bed tumor. Both are prostate cancer adenocarcinoma.
So, now I’m treating the pca adenocarcinoma to prostate bed tumor and pca adenocarcinoma in liver metastasis.
I’m doing Keytruda once every three weeks, starting 3D Confirmal Radiation to prostate bed tumor in the next 5 days, 5 sessions of treatment, and Y-90 Sir Spheres to Liver Metastasis
Keep our fingers crossed. You are at least in good hands now. Did they find you s clinical trial for liver mets? Benkaymel from UK had liver metastasis and he left us. I believe liver metastasis are the worst. Hopefully Enzalutamide is still working for you? Did you change over from Abiraterone? Enzalutamide usually comes after Abiraterone if Abiraterone fails (or even before it fails).
I see. Are you still getting chemotherapy? Are you getting cabazitaxel amd how many cycles of chemotherapy did you get? I assume you will try nubeqa after the chemotherapy? Did they also give you carboplatin with cabazitaxel?
Why don't you add 50 mg of Bicalutamide to degarelix and are you still taking Metformin plus crestor? Once your cancer is hooked on Bicalutamide you can stop Bicalutamide and the cancer will collapse.
Continuing bicalutamide after it has failed in combination with androgen deprivation therapy (ADT) is generally not recommended. When prostate cancer becomes resistant to bicalutamide and ADT (i.e., castration-resistant prostate cancer, or CRPC), the cancer cells are no longer responding to the treatment effectively, and continuing it might not provide any further benefit.
After Bicalutamide failure with ADT for how long can we continue on Bicalutamide?
However, here are some considerations:
1. **Switching or Adding Treatments**:
- Oncologists typically consider switching to other therapies like enzalutamide, abiraterone, or other second-line hormonal agents.
- Chemotherapy, radiopharmaceuticals, or newer treatments like PARP inhibitors might also be considered based on the patient's specific situation.
2. **Bicalutamide Withdrawal Syndrome**:
- Sometimes, stopping bicalutamide can paradoxically result in a temporary reduction in PSA levels (bicalutamide withdrawal syndrome). This suggests that continuing bicalutamide beyond its failure might even be counterproductive.
3. **Clinical Trials**:
- Patients might be considered for clinical trials testing new treatments for CRPC.
Continuing bicalutamide after confirmed progression typically provides little benefit. The oncologist would usually reassess the treatment plan and consider alternative therapies tailored to the patient's condition and disease characteristics.
What is your ethnic background? Maybe you are metabolizing Bicalutamide differently? In Japan 80 mg of Bicalutamide is approved. Here it is only 50 mg recommended. I am Hungarian therefore I was thinking maybe I have some Mongolian in me from Gingis Chan? (Nice theory)
And I am on 100mg Bicalutamide now with Metformin, crestor (if you are Asian start with only 5 mg crestor), Mebendazole, Silymarin (exclusively from seeds of the plant) 500 mg (just started), Nexium 20 mg, doxycline 100 mg,
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