Treatment of local and oligometastatic PCa

[Horse12888]

Tall_Allen: May I get your feedback on this video in which Mayo's Eugene Kwon discusses the validity of PET scans and (radiation/surgery/cryo) for local and focal recurrences. He says, in summary, that these are highly effective in improving OS.

youtube.com/watch?v=Q2joD36...(Not working as expected?)

[Tall_Allen]

I've written about it many times. He has no evidence for that unfounded assertion. Mayo has never done a randomized clinical trial - if he believed what he says, he should do one. In fact, the retrospective data from Mayo says quite the opposite:

prostatecancer.news/2020/12...

[Spyder54 in reply to Tall_Allen]

TA did you write that piece in Prostate Cancer News?Hard to argue with the lack of human trials to prove the statements. McBride of MSKCC said the SBRT 3x 8Gys to my T5 was more to avoid spinal compression. The 5x 8 Gys to Prostate was to extend life (not curative). Which was backed from the Stampede Trial.Still, I find Kwon more compassionate than many, and always going for cure whenever possible. I did like what Kwon said about the superiority of PET Scans, sometimes 8 years visible before MRI or CT. Also on PET….he said hard to fight what you cant see. Part of his rationale why everyone with Advanced PCa should have a PET Scan.

[Tall_Allen in reply to Spyder54]

Yes, that's my blog.

He is absolutely wrong that it's hard to fight what you can't see. We do it all the time - docetaxel, Zytiga, Xtandi, Xofigo, etc. - all systemic therapies fight what we can't see. You have to fight what you can't see. It is also a mistake to think that what you can see (metastases bigger than 5 mm) is all there is.

Promising a cure when medical technology cannot yet provide one is not compassionate, it is lying to patients. No doubt there will be better scans (or combinations of scans) in the future - but what is the medical use of a scan that makes no difference in treatments and outcomes? Is there any known value in finding every met>5 mm? >4mm? >3mm? >2mm? clumps of thousands of cells instead of 10s of millions? every metastatic cell?

Don't get me wrong - I like PET/CT scans and think they will one day replace bone scans/CT for staging and for tracking the effectiveness of therapies. But they have to be used strategically.

BTW- I think highly of Sean McBride. I even think highly of the work Kwon has done in his research lab. I wish he'd stick to research rather than make misinformative youtube videos.

[Spyder54 in reply to Tall_Allen]

TA,I have to respect you. Your passion came thru on this post and your Research Paper. If you listen to Kwon you will also hear his passion. I believe when he says all men should try for cure, that he is sincere. We all know cure does not exist yet w Metastatic Stage 4 PCa, but he believes we should always make that our target. Sometimes it feels close, sometimes cure seems far off in the distance. We just need to live long enough, and enjoy life as we go.

Thanks,

Mike

[tayninhtom in reply to Tall_Allen]

Yes, I went to Kwan in 2015, and for 3 years thereafter, primarily to get the C-18 Petscan. It revealed lesions in the iliac and paraaotic lymphs. After chemo/IMRT radiation treatment, I went 2 years without apparent disease. It returned in a few places. By then, the Axumin Scan was available at home in Florida. Also, ogliometastatic treatment was being performed with SBRT at Shands, Gainesville, by Dr. Paul Okunieff. He wrote the original report on Ogliometastatic disease which captured Kwan's interest. As I understand it, the premise is that if one has less than 9 lesions, longevity can be extended through active treatment. Needless to say, I bought the coolaid. Last treatment was July 2020 on a new lesion between the prostate and the bladder wall (right on top of a radiation seed!). Again, it was treated with SBRT. I get an Axumin scan each year. Now that the LU scan is available in Florida (Ft. Lauderdale), I may get it next time. Also, my Radiation Oncologist has patients who have successfully been treated at a Texas private clinic with LU177. PSA currently below 1 (I have a prostate). Every 3 months I'm checked to see if Androgen Deprivation treatment is called for. I've been on/off Andorgen deprivation in the past. My experience is that Kwan is a smart, caring doc who works hard to give guys like us some hope. I don't think he's in it for the fame and fortune. I've been fighting this disease since 2007. At times, It's kicked my ass but I'm still here enjoying life, in spite of Covid.

[Spyder54 in reply to tayninhtom]

I asked Sean McBride if he had seen before and after LU-177 scans.He said yes, and some had amazing results. Some after only 1 treatment showed big improvement on scans. Again, not for everyone.

[Blackpatch]

The closest I’ve seen to evidence in respect of PET PSMA scans correlating with curability is an Australian paper about 3 years ago that said BCR men with no visible PCa on PSMA PET scans were significantly more likely to be “cured” by eSRT than those with detectable mets… the biggest problem is that the post-eSRT observation period was only a couple of years, so hardly definitive in terms of establishing a durable “cure”.

PSSMA PET is widely available in Australia and is frequently used to stage new and recurrent PCa - but it is not viewed as providing definitive prognoses.

Kwon’s pitches always seem beguiling because he uses the “cure” word frequently and is very logical in setting out his propositions - I imagine he is a very skilled doctor, but don’t think he does people any favours by publicising unproven views….

[maley2711]

I watched the video...at what time does he make that claim? I don't see that he makes that claim. He does give examples of certain cases where certain treatments are associated with good results...he makes no claim as to results with large number of such cases. I am impressed with the , I believe, 6000 or so cases that have come thru that clinic? As TA states, no claim to a randomized improvement in outcome. This is like patients who undertake a certain diet, have a good outcome, and then claim the diet led to that outcome?

[Horse12888 in reply to maley2711]

Check out 18:35.