Barking up the same old tree

Thank you. You posted where I meant to go. I fixed it

In humble opinion this is a marginally useful study. Maybe good news, but I'm skeptical. Where is the control group? Where are the 20 comparable cases treated traditionally, results compared by the same metrics?

How does a similar group of oligometastatic guys do with ADT + radiation to visible mets? That should be pretty well known already, so maybe comparable studies can be found?

It seems this one simply adds up-front prostate surgery, then ADT and radiation. If an undetectable PSA is reached ADT is stopped, so they basically go on intermittent ADT. If their PSA remains undetectable at 20 months, that's a success. Some did, and some persisted even longer.

So, how much improvement was attained by adding surgery up front? How does that compare to oligo guys who get radiation to their detectable 10 or less mets, and ADT until PSA becomes undetectable? Do any of them go on intermittent hormone therapy at that point today? Is that done? If so, how many have a holiday that lasts 20 months remaining undetectable?

Just citing stats for the study group itself isn't very helpful, and may be misleading.

Here's a link to a more detailed presentation of the study itself:
A Pilot Study of a Multimodal Treatment Paradigm to Accelerate Drug Evaluations in Early-stage Metastatic Prostate Cancer

Interestingly in Figure 2, they show patients achieving undetectable PSA during treatment (note, not claiming these persist at 20 months, but the reader is left to think that's so; must be very careful reading these things). Results for:
1) ADT Alone
2) ADT + Surgery
3) ADT + Surgery + Radiation

Notice anything missing? Where is ADT + Radiation? This is all biased toward favoring surgery. In fact, the way they made that graph makes radiation look to be only marginally useful.

They're using a success metric, undetectable PSA with non-castrate testosterone at 20 months, to make an assessment of success earlier than one usually can. That's also one of the points of the study, to verify applicability of that metric vs. longer-term median-survival assessments and so on.

This seems like the beginning of a discussion, not any sort of conclusion.

Hi Jerry, agreed! There needs to be a larger study with a control arm. The article even states that! Well, it kind of states that. I would be more skeptical if not for a long chat with a great doctor early this year. He basically said the same thing except that the kitchen sink also included immunotherapy and Radium! Many will say that we will not see a cure in our lifetime. I suppose it depends on how
Long we live

annie88;

Yes, I will be getting Abiraterone along with Lupron. Yes this will burn my bridge for using it again when the PSA starts to climb. However, the time it takes for the combination to raise your PSA is often longer than using Lupron followed by Abiraterone. Fortunately there are other drugs that they can put me on if/when my PSA goes up.

For the combo of surgery, radiation and hormone therapies, I based my decision on some studies from Italy which showed no advantage in the first five years, but an advantage after 10 years. I have looked for those references I used last year but I can not find them. I will continue to look.

geop,

a doctor can only estimate how long you will live. Very often patients live much longer than estimated since these estimates are based on outdated statistics. I would not ask my doctor when he thinks I will die - he does not know.

Treating the prostate makes sense even if mets are found. There are several studies that seem to indicate that. Apart from surgery I would see that I avoid side effects of further treatments which may not be effective.

The article mentions "cancer-free after four years". Cancer-free probably just means a low PSA value. I would not be surprised if your PSA value stays low for four years when ADT is combined with surgery or prostate radiation. Maybe even much longer.

George

I was diagnosed very metastatic to many bones and many lymph nodes 3 1/2 years ago, with a bone scan that lighted up like a Christmas Tree. PSA was 5,006. Lupron + Zometa took PSA down to nadir of 1.0. I asked my local Onc and a couple of research specialists about debulking or removing/treating the prostate, nodes, or bones, but always was advised not to do so. Stick with systemic stuff.

Removing much of my spine, or massively irradiating almost all of both pelvic bones and sacrum is just not an option. Treating my prostate might make a local tissue difference somewhere down the road, if it may grow to affect urinary/bowel functioning, but, who knows? It was and is about normal size.

Anyway, with resistance after a couple of years, my PSA eventually climbed back up to 95. During that time, I did some more consulting. Tested some family genetics - no common bad genes. Had a Ga68 PSMA PET that showed about 10 widely separated "hot spots" as my PSA was passing up through 60. Did Provenge. Finally started Xtandi 7 months ago, which has taken my PSA from 95 down to 2.6, so far.

The "timing" of things in regards to the CHAARTED, STAMPEDE, and LATITUDE studies had me not doing ADT + Early Chemo, or ADT + Early Zytiga. I am satisfied to be doing Xtandi now, and having those other things somewhere in my treatment future.

Considering where I started, and where I have been, I am grateful to have been as asymptomatic and pain free as I have been for this long. I think I still have too many "hot spots", even if they may be "toned down" by Xtandi, to attempt "curative" type treatments for some, most, or all of them.

But, even though I may feel like those interventional things might be about as useful as "rearranging the deck chairs on the Titanic", I will still try to keep an open mind.

It is a fine balance between quantity and quality of life. I was offered clinical trials by two different research specialists involving the CTLA-4 blocker, Ipilimumab. I had other issues going on at the time, and declined, due to my concerns about potential side effects. (Interestingly, shortly after that, an announcement was made that the results of an earlier clinical trial of Ipilimumab vs. Placebo showed no benefit for Overall Survival, and that, indeed, there were quite a few adverse side effects, and that 9 men had died during the trial due to unrecoverable adverse side effects.)

My longer term survival may well hinge upon evolving research into several lines of immunotherapy. Meanwhile, I will surf the waves of survival using the several FDA approved treatments that lie ahead.
I try not to worry about whether I am crossing any particular bridge (much less burning it) either too early or too late.

Charles

Sheesh...5000+...thats crazy...given where you are know...Im thinken real hard on ya CuriousCharles...real hard.. " Believe Bole...plz...ya gotta believe.." words of a 9 y/o to a black and white tv image of his hero... a washed up boxer...who just entered the Twilight Zone......

speaking of which...Howzit bruddah Zufus...your deer friends on the porch are fine...as are your dear friends at the forum...Me?...Im still...causen trouble...and moven...moven...

Y'all tell me...that didn't just happen... do it...but never never make me believe you...