Members of HU who are following developments of treatments involving Lutetium may find the information in this video of interest.
The link below provides access to a Webinar that was streamed on Thursday 21st July 2022 globally to 58 countries. Some 705 participants took part coming from the various fields of specialisation that are involved with the treatment of prostate cancer including urologists, radiation oncologists and nuclear medicine technologists.
The expert presenters included Professor Michael Hofman and Professor Declan Murphy (Australia), Professor Ken Hermann (Germany), Professor Silke Gillessen (Southern Switzerland) and Dr Louise Kostos (Australia).
The various sessions provided information that was interesting and clearly delivered by experts renowned in their various fields.
One area I found of particular interest was the session given by Professor Silke Gillessen who is the founder and chairperson of the Advanced Prostate Cancer Consensus Conference (APCCC). This meeting, held every two years is attended by many hundreds of experts in PCa who vote on a number of contentious issues on the basis of - if they had everything available for their patients what would they choose. The issues and choices offered are contentious in that they are management situations involving patients with PCa where there is no high-level evidence to support a decision. The situations posed are interesting and would reflect situations either presently faced, or to be possibly faced in the future by many who visit this forum.
While there is already much information available on theranostics and the use of Lutetium, if it is one area of prostate cancer treatment that you have been following, as I have, I think you'll find the time spent well rewarded.
Watching the video of the excellently done webinar has been very informative. It shows not only the evolving nature of this newest method of radiation treatment, it also shows how far the US is behind you Australians and the Germans in its development and application. When the discussion got to the personalization of the treatment regime and dosing, I couldn't help but see the US adopting the same sort of one-size-fits-all approach that seems to rule the current treatment landscape here - due to reduced liability for bad outcomes and monkey-level coding for insurance purposes.
Thanks a lot for posting. Everyone reading here should make time to watch the entire video, as someday your life might depend on this type of treatment.
Thanks for posting...Had to wait until Friday night and Saturday to watch the video, but great stuff. A lot I didn't know about Lu-PSMA 617 and treatment. I did not realize that patients with lesions with an SUV >10 got 12x the benefit from treatment than those with an SUV<10. The APCCC info is interesting and further backs up my comments that the leading Oncologists everywhere are discussing what treatment regimens should be for patients and comparing notes. It is on an international basis. Also, the fact that DNA defect patients like those with BRCA2 defect may be more sensitive to treatment and possibly should get a PARP inhibitor with treatment.
We are at the beginning of a new era in radiation treatment/ Delivery system. Who knows how far advanced they will be in 5 years??
Yes it was well worth watching wasn't it. Long... but so much info I need to watch again.
You might remind me to do this - once all the questions and answers from the APCCC panel are posted in the European publication (didn't quite catch the name during the video) we should collect them and post. I thought for many men at the crossroads of 'where to next' these gave great insight , at least into what the leading experts in the field across the world voted for...even though you might chose something else for yourself.
A couple of interesting things about the SUV's did come up didn't they! For Ron, the one you mention <10. In 2019 his metastasis at T3 was 8.6 and then in August 2021 56.7 and one month later 66.8, and although he had SBRT Lu 177 wasn't offered, but we could have accessed it, I do wonder if maybe he should have gone down Paul's road at that time. When you have choice to go off SOC it's always a quandary...
The second thing that was discussed by Michael Hoffman, and he gave some weight to it, was the importance of having the mean of the SUV. This also came up on a podcast series I watch - GU Cast that Declan Murphy (whom you might have seen and heard on the video) discussed at some length. It seems that most facilities just don't have the software to be able to gather this information. You're the science guru so you'll know why it's important ...can't say I picked up the reason but obviously important.
Like you've often said before, probably the answer will come with some combination or other and that's what they seem to be doing with the future trials with Lutetium.
As you always say....the science is coming...we live in interesting times...take care I'll message later...
You bring up an issue that caused me consternation with my Plarify scan done earlier this year: That no SUV values were provided, just terms like "intensely avid" and "moderate uptake" in the initial reading and "tracer avidity greater than liver" and "avidity less than liver and greater than blood pool" in the second reading done at another cancer center.
I got the distinct feeling that both places were still on a learning curve with PSMA scan interpretations. That said, there was no doubt that PSMA provided definitive confirmation of the metastatic disease I had anticipated from my initial final biopsy results (2013) and 1st BCR (2016). Fortunately, the several areas of "moderate uptake" have been eliminated as concerns based on subsequent MRI and CT scans. The need to do those scans also confirms the less that perfect nature of the Plarify PSMA tracer.
Thanks ago for posting the video. It is worth multiple viewings as were the ones you recommended to me prior to my scan. The Europeans (esp Germans) and you Aussies are hands-down where the knowledge base currently resides when it comes to PSMA.
I did wonder if you'd had an SUV reading on your scan. Since Jan 2019 when Ron's PSMA showed metastases for the first time - some 13 lymph and bone - I've become familiar with what they indicate.
In relation to your comment about the accuracy of the reading and interpretation of your scan- that has come up as an issue especially in the US now that they are so widely available and as we discussed previously, issues of false positives. Also a problem in many of the less developed countries. I think towards the end of the video Michael Hoffman mentions that education and training really is what's needed.
When watching the Webinar it reminded me of a podcast from GU Cast where there was a lot of discussion about the mean of the tumour burden being so important, not just the metastasis with the hottest uptake and how a much better outcome can be achieved by finding the mean but the facilities that have this software are few and far between. You would have read Fish raised the significant different response rate for those with a SUV max of >10.
I've included the link to the podcast mentioned above and I think if you watch it, when you have time, you'll find it very interesting especially the discussion about the importance of the mean but there are other parts too that give insights into areas that I know you'll find relevant. Also there was a specialist mentioned from DUKE who had given a presentation... I thought you might want to check him out.
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