Three Big Challenges in Metastatic PC

[marnieg46]

Common themes that often emerge from the posts and responses on this particular hub of HU are intermittent and alternative therapy, the use of testosterone replacement and the various associated issues.

In the latest GU podcast, co-hosts Dr Declan Murphy and Renu Eapen from Peter MacCallum Cancer Centre in Melbourne, are joined by Dr Alicia Morgans, Medical Oncologist and Director of Survivorship at Dana Farber Cancer Institute, to discuss these and other such issues. This episode explores escalation, de-escalation and those times when cessation of treatment might be the preferable course of action. The issue of testosterone replacement is also discussed.

All three members of the podcast are considered to be recognised leaders in either the treatment of prostate cancer or prostate cancer research in Renu's case. What might be somewhat surprising and refreshing is that their comments and observations throw a positive light on what some consider a deviation from strict SOC of the issues discussed.

youtu.be/UP_4zoVUXmk(Not working as expected?)

[Mascouche]

Excellent video. I was shocked to learn that the number of men whose testosterone does not come back once ADT is stopped is around 30%!!!

I often heard the less dire/more vague "for some men, T may never come back" but hearing that almost one in 3 won't recover their T is powerful as that could play a factor in the decision on whether to start ADT right away or to first ensure that you can get your hands on replacement testosterone in case you are a part of those 30% that won't benefit much from their vacation as their T does not come back.

[NPfisherman]

Lady of Oz,

Great video.....sounds like they are on FPC..... Escalation and de-escalation and testosterone therapy in IADT... along with precision therapy... Clearly, the times are changing... For those that are oligometastatic, did they say metastasis directed therapy and "cure"..???

Long Live the Science !!!

DD

[marnieg46 in reply to NPfisherman]

Yes I thought that too Dave. Very positive input and observations for those 'juggling' medication or thinking of a pause. I also thought something that really stood out was the recognition, by all three, of the effect loss of testosterone has on QOL across so many areas. They didn't just brush it off, in the way some doctors tend to do, as an inevitable outcome of ADT. The podcast seemed to me to be an enlightened 'take', by three well known, respected and globally recognised in their field on issues often explored on FPC

[NPfisherman in reply to marnieg46]

Marnie,

The discussion of the heterogeneity of prostate cancer, and how different cases require an approach that varies based on initial status and response to treatment.. We are seeing an evolution/revolution in treating PCa... The concept of testosterone replacement for IADT patients being something to consider is refreshing. Not something that would get consideration on other forums.

DD

[Concerned-wife]

thanks for sharing. I admire these three and listen to this podcast often

[AlvinSD]

This is a great podcast and I really enjoyed this episode. It is very relevant to me, diagnosed 2 years ago (52) with Gleason 9 oligometastatic disease (lymph nodes and one bone met). I had triplet therapy and finished it all off with radiation to prostate, lymph nodes and the bone met. I’m still on ADT and darolutamide and extremely interested in going off everything at 36 months (assuming my PSA stays undetectable).

[NPfisherman in reply to AlvinSD]

Alvin,

With 36 months of treatment, you may not recover testosterone. Were you oligometastatic on a PET/CT like Pylarify or a bone scan?? Some things to consider..

Glad you made it to the "undetectable " club...there is good news in that alone...

DD

[NanoMRI]

I do not understand the reference to "strict SOC". This term is widely used, yet it is undefined and foundation is legal protection encompassing care that ranges from minimal to ultimate.

[NPfisherman in reply to NanoMRI]

Agreed..... SOC per NCI:

cancer.gov/publications/dic...

The podcast goes away from "strict SOC" in discussing topics like Escalation/de-escalation of treatment, and testosterone replacement in men on "drug vacations"/IADT for QOL, and to negate some of the SE's of ADT... Precision therapy-should everyone get triplet therapy if they have a less developed/aggressive form of PCa...looking at genetic testing before determining the plan forward is not always done, but should be...

Some will tell you that PCa is a homogenous cancer, and that the treatment paths are clear, but I would argue otherwise.

DD

[NanoMRI in reply to NPfisherman]

Appreciate the reply. Agreed treatment paths are not clear. I stopped ADT after one year, that was April 2029. I would say my de-escalation of that treatment was within the broad spectrum of what is called SOC. I believe my continued ultra-sensitive testing is within SOC; whilst other members disagree. I would also say the salvage extended pelvic lymph node surgery I had is within SOC - although it is rarely done here in US. All the best to all of us fighting this beast.

[NPfisherman in reply to NanoMRI]

As I like to say, listen to your MO/experts, read multiple sources of information, and remember this is your journey, so plan it well... SOC is evolving based on new discoveries/trials, and the change in thinking on subjects like TRT, use of SBRT in MDT, etc... The treatment paradigm has changed rapidly since I started treatment...

The concept that one treatment fits all is what some push as the only legitimate way.... Triple therapy for all.... No ADT vacation unless you can not go on with treatment due to issues... using SBRT for MDT is "whack a mole" and "treating PSA" which does nothing.....

As my Mom used to say, "That is s--t for the birds"... let the buyer beware...

Best of luck on your path....

DD

[NanoMRI in reply to NPfisherman]

good chat! As I like to say, SOC has a legal foundation, inclusive of so many methodologies - not a singular method - intention is not ultimate care but rather protecting doc's and medical centers. It was determined Dr "Jack" Kevorkian was outside of SOC - so he went to jail. As stated previously, screening and not screening for this disease are both within the broad spectrum of SOC.

[cujoe]

Ms M - One of the best videos I've even seen on anything related to PCa. That may be partly the result of the coverage of the expansion of treatment options and the continuing fast-pace for development of those options. As usual, Declan and Renu are superb hosts and we should all know Alicia Morgans from her many, many conference interviews at UroToday. The PM GU podcasts make me feel like I'm getting to eavesdrop on a collegial discussion among experts sharing insights from their own professional lives.

As expressed here several times before, I have been dismayed at the lack of regular testing for a possible "durable response" to ADT - before committing a patient to the SEs of long-term treatment + the potential for driving cancer to "early" CR status. Therefore, it is especially refreshing to see the oncology community finally recognizing the debilitation QOL effects of continuous ADT - and the potential value of DE-escalating treatment when possible. The fact that was a major topic of discussion indicates that the times they are truly changing.

This video is another validation for PeterMac's GU Podcast being an invaluable resource for our patient community - and hopefully, also for the oncologist that we rely on for treatment advice.

Many Thanks to the Lady from OZ - You and Ron keep it S&W,

Ciao - Capt'n cujoe