Welcoming New Era of Expanded Use of Radiotherapies

[MateoBeach]

Duplicating this for my friends at FPC. This is the short take from Practice Update this morning. Link to the abstract is included. 😃

The three practice changing points included are worth noting. Makes me happy.

(Came off of wonderful 3 day backpack around Grand Teton yesterday. Today, back into it in Yellowstone. Pic is of the Grand Teton. Stood on top back in 2006, one year before PC.)

practiceupdate.com/c/139708...

In this review, the authors outline the evidence to date from clinical trials assessing the utility of radiotherapy in patients with oligometastatic prostate cancer. 

Primary prostate radiation in the de novo metastatic setting prolongs biochemical progression–free survival (BPFS) and may provide a survival benefit in patients with less than five bone metastases. 

Metastasis-directed therapy in the form of stereotactic ablative body radiotherapy (SABR) may provide benefits beyond local control in both patients with hormone-sensitive and hormone-resistant prostate cancer, including longer BPFS and radiologic PFS.Radiotherapy, particularly SABR, should be considered in patients with oligometastatic prostate cancer.

Highly-sensitive imaging modalities, such as PSMA PET, are essential to identify patients most likely to benefit from radiotherapy.

[NPfisherman]

MB,

I believe MDT is here to stay in oligometastatic prostate cancer-both MHSPC and MCRPC. The results speak for themselves, despite what some naysayers try to explain. I believe that part of what SBRT to oligometastatic lesions does is wipe out centers of resistance. While this does not address micrometastases, it reduces resistant tumor cell burden IMHO..a good thing.

Thanks for posting this information on our 1st day of the month of prostate cancer awareness.

DD

[Spyder54]

Yup, as you know, I had SABR to my primary prostate gland (much has been written about the index lesion- usually the largest lesion in the gland and hoe they see apoptosis in the surrounding lesions soon thereafter). My PSA was stubbornly going down to PSA 2.5 in Dec of ‘21. Then after molds, fiducials, tattoo’s, and multi parametric MRI’s, in Jan of this yeat 2022, had 5 sessions to prostate gland, at 40Gys, and 3 sessions to my T5 spine @ 24 Gys. Mem Sloan Kettering, Dr McBride asked me to wait at least 90 days for PSA and 6 mos for scans. PSA down to my low nadir of .022 as of last Thurs, and awaiting gal68 PSMA PET Scan results tomorrow. No side effects yet as of 7 mos, but am aware that Radiation is still in there killing bad cells up to 18 months out. Last week many discussions that SABR is of no benefit?

I said last week coffee is good for you, this week it is bad for you. Always a giant human experiment, always changing research. Mike

[Seasid in reply to Spyder54]

Coffee is good for my GGT. It drops down to 20 with coffee. Whiteout coffee it was 36. Problem come when it dehydrates you. Therefore drink plenty of water and limit the coffee to the morning. Etc.

[Brysonal in reply to Spyder54]

Good luck with the scan results

[NPfisherman in reply to Spyder54]

Good luck on scan results... I didn't see any proof that SBRT is anything but effective in oligometastatic disease.. it has worked for me so far ..

Fish

[Cooolone]

Well... When I was about to be diagnosed as StgIV but yet undetermined, the CT/MRI and even PSMA scan hadn't shown much of anything that was definitive, some suspicious spots, near the bladder and prostate bed (SV) locations. And discussion was had with my team about "spot" treating, ie, "whack a mole" and it was pretty much dismissed. Anyways, they found my source of PSA in my Peritoneal and Appendix (see bio).

And now we aren't too sure, but PSA crept up just one year post chemo... And there's still a suspicious spot shown on scans near bladder... Guess we will be talking about this once again! I'm all for drugs, but if a lesion(s) is spotted what's the problem with zapping it to Oblivion? I even would allow going in and cutting it out too... Lol

I believe there is benefit to treating spots, even repeatedly when they appear in conjunction with drug therapy. My opinion, but it probably won't change.

Thanks for posting!

[NPfisherman in reply to Cooolone]

Cool,

Indeed, there is no downside for MDT in treating oligometastatic patients. Increased median PFS and reduced BCR rates over time. A chance to reduce tumor burden in the face of treatment resistance is a good thing.

Stating there is no proof of increased overall survival is true, but ONLY because that will take a 10-15 year follow up in PCa patients, and SBRT has only been evaluated clinically for just over 5 years. As the data follow up continues, I believe that issue will be laid to rest in favor of SBRT.

The real question of SBRT benefit is in the case of 4-10 metastatic lesions and SABR COMET 10 will give us that answer in a few years.

DD

[MateoBeach in reply to NPfisherman]

True ‘Dat, Fish.

[NPfisherman in reply to MateoBeach]

MB,People need the truth, as there is much disinformation when it comes to MDT with SBRT. The 2022 APCCC voted clearly in favor of MDT for oligometastatic patients. When the leading specialists treating PCa vote in favor of MDT, then posters should not advise against it or try to muddy the waters.

DD

[cujoe]

Thanks, MB. Your contributions are always high value and we are better informed patients as a result. In this particular case, it seems to also counter some common misconceptions espoused elsewhere about the value of RT/SBRT.

Very much looking forward to our face-to-face in early Oct. Enjoy the time 'till then. Ciao - K9

[MateoBeach in reply to cujoe]

👍🏼🏕

[Spyder54]

Hi Paul, my SABR Of primary prostate and T5, 8mos ago at Mem Slian Kett in NYC, appear to be working well. PSA down to .022 last week-new low, and first Pylarify gal68 PSMA PET, showed no bone, no prostate or organ, no lung, Only 3 mets, 2 pelvic mets 6mm and 10 mm (smaller than 8 mos ago), and the one 12mm met in the Retropertoneal region near the Y artery that leads from heart. Dr McBride told me in Jan those 3 could be easily treated w SABR. I feel like I should follow in your foot steps and SABR those 3 lymph node mets, then head over to Perth for the J591 - 3 cycle treatment. Please take it as a compliment.

Have you learned or experienced more since your Perth travel? I am on the cusp of mBAT, but hv not begun. Was thinking about adding in a SARM as a compromise to start before mBAT. Still have not found anyone in the Tampa area for BAT. My MO said will support if I find someone, but he will not. Mike