2015 PCRI Conference in Los Angeles - Report

I attended the Prostate Cancer Research Institute conference in Los Angeles this past weekend. It is hosted by Drs. Scholz-Lam-Turner, Marina Del Rey, CA one of the best prostate oncology practices nationally. This was my first conference and here are some impressions:

1. The conference demographic was long term, high risk patients and partners. I'm 12 years out, which around here is long, but in this group, average.

2. Immunotherapy research is a mixed bag. On the one hand it does not work as mono-therapy, but is proving to be beneficial when combined with other treatments. There are two approaches that target the T-Cell to PCA cell linkage.

3. Dr. Beer is doing promising research applying Zytiga and Xtandi earlier in the treatment cycle. These are costly medicines until his approach is approved by the FDA.

4. End game. When a prostate cancer patient is out of options, hormones and drugs fail, consider getting a genetic test of a tissue sample. Once genes are identified, there is possibly a drug that can be useful. A drug intended for breast cancer may work for selected pCA patients.

5. Never give up. Dr. Scholz presented a case history of a patient who failed everything, hormones, chemo, old drugs, new drugs. However his cancer was purely bone based, so they gave him Xofigo, the radium 223 isotope that attaches to the bone and his PSA went to undetectable. The doctor panel was speechless.

6. Dr. Moyad touted Michigan football, heart health and supplements for heart heath. He stated that something like pomegranate juice, even if prostate effective, would never be useful since it is sugar laden and a heart hazard. However, extracts of same may be useful. Always the entertainer, he grilled presenters with audience questions.

7. Sexual function: it appears that surgery does have more negative side effects initially, compared to radiation, but after three years; roughly the same effects as radiation. However, 4-6 months of hormone therapy will induce permanent loss of muscle tissue in the penis, as the muscle turns to collagen. Injections are the most effective remedy, though most people cringe at the word injection and penis in the same sentence (a big laugh).

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Age 64 in 2015
12/02 PSA 2.9 age 51
9/03 BX/DX, Gleason 6, 4 of 12 cores
9/03 Brachytherapy
5/08 PSA nadir 1.1
12/08 PSA 1.8
2/09 BX/DX, Gleason 8, 1 of 12 cores
6/09 Hyperthermic Radiation, Hormone (short term), IMRT (10 fractions) spring 2009
10/09 PSA nadir < 0.1 10/09 through 01/12
4/12 PSA 0.2
3/14 PSA 2.9
5/14 C11 Acetate PT/CT, found 2.0 cm lymph node
5/14 Lupron/Casodex (9 months)
8/14 nadir <0.01
2/15 SBRT to node, at UCSD
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=105 (yippee!)

I attended all day Saturday, this was my 2nd year. Last year I was still on AS and had not made a treatment decision so I was very much information gathering. But this year I've been treated and have no decisions on the horizon, so I was there just to stay informed.

Here are some impressions:

1. I was thoroughly impressed by some of the young doctors involved in PC research. Particularly Charles Drake from JH on immune therapies, Matthew Cooperberg from UCSF on active surveillance, and Daniel Margolis from UCLA on imaging. It was really encouraging to listen to these young men.

2. Dr Moyad speaking on immune therapies mentioned that a simple tetanus shot given before immunotherapy served to "prime" the immune system and increased the effectivity of the treatment.

3. Dr Margolis had to abbreviate his presentation on imaging as the conference was running late. This topic was of particular interest to me as Dr Margolis did not see my G9 tumor on MRI; I may start a separate thread. Correct me if I got any of this wrong.

a. tumors of 1/2ml or smaller are mostly invisible to MRI.
b. 25% to 31% of tumors are invisible to MRI, but usually smaller and lower grade tumors.

I plan to attend every year that I can. I learned something even from the topics that didn't seem relevant to my situation.

Redirected thoughts:

1. Dr. Moyad proposed that immune health = vaccinated health, and that we should be vaccinated for tetanus, shingles, flu and two other diseases that escape me.
2. The immune therapy is called a "Checkpoint Blockade" where the cancer cell reaching out to the T-Cell as friendly neighbor is blocked. This is combined with Provenge.
3. No mention of a polio virus test, that I heard of.
4. Dr. Scholz presented six difficult test cases, revealing results after the panel voted on what to do next. Very interesting.
5. In a breakout group, my doctor, Turner handled a long line of patients presenting a rapid fire case presentation. Turner handled them calmly, intelligently and articulately.