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AUA Castration-Resistant Prostate Cancer Guidelines - Interview with Michael Cookson

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Posted 3/14/2019 4:25 PM (GMT 0)
Dr. Cookson was my diagnosing urologist back in 2013. It's interesting to see him in this interview! He was at Vanderbilt in Nashville at the time. He left there and went to the University of Oklahoma College of Medicine. Today he's "Professor and Chairman of the Department of Urology at the University of Oklahoma Health Sciences Center, and holds the Donald D. Albers Endowed Chair in Urology. "

AUA Castration-Resistant Prostate Cancer Guidelines - Interview with Michael Cookson

The conversation seemed of interest given some recent discussion here on the forum about new treatments for prostate cancer in later stages.
Posted 3/14/2019 6:55 PM (GMT 0)
Thanks for posting Jerry. I read the report and it had some interesting points. Paraphrasing, hopefully correctly:

Metastatic CRPC is uniformally fatal with median survival -2.5 years. Yikes! Worse measure than I was aware of.

Guideline 1. With nmCRPC it appears the strategy is to stay on Lupron and add either Zytiga or Xtandi to extend the time to developing distant Mets.

Guideline 4 is interesting to withhold systemic chemotherapy and immunotherapy for nmCRPC except in trials. So this appears to reverse some early use of Taxotere in high risk but not mCRPC and doesn’t appear to give a nod to Provenge early on. Interesting.

So you and I and some others have two very good friends with very different experience. On the one hand Todd1963 was ultra high PSA over 3216 and terribly metastatic with both bone and visceral Mets, but not CRCP and he is doing great at more than 12 years out. Our dearly departed friend John16 was also dx with metastatic disease but quickly upon starting treatment displayed CRCP and succumbed in about the median 2.5 years. God awful disease.
Posted 3/15/2019 12:47 PM (GMT 0)
This is scary stuff. As you know, I'm G10 with distant mets in 6 places - 3 in spine, 2 in ribs and one in left shoulder. They have now determined that the spots in my lungs are not PC. Fortunately, at least for now, my PSA tests are all <0.1. This suggests and maybe I'm overreacting, that once my ADT treatments are no longer effective, next treatment steps won't make much difference. Wow.
Posted 3/15/2019 1:31 PM (GMT 0)
Randy,
As someone who just started “lifelong” ADT, I admit I also found the interview unsettling. Despite the troublesome side-effects I may experience from Lupron/Xtandi, I have been feeling positive about the longer time to CR provided by this drug combination - about four years, which is twice as long as taking the same drugs sequentially. A great improvement for sure, but it still seems depressingly brief. Of course those numbers are means, so it could be longer - or it could be shorter. At this point I still feel positive, but I don’t much care to entertain what the post CR treatment path may be.

Let’s keep carrying on.
Posted 3/15/2019 1:37 PM (GMT 0)
Hi Randy,

My take is that the key negative is being castrate resistant, which you don’t appear to be as your PSA is being controlled by the ADT. Further you are following Guideline 1 by adding either Zytiga or Xtandi on top of Lupron/Eligard. The results they showed are good for that combination.

When Zytiga and Xtandi first came out they were being first used after men became castrate resistant to Lupron. Since then docs and studies have been using the drugs concurrently in high risk advanced situations and showing much better results. I hope this will be effective for you. Our friend Todd1963 was on Lupron for more than a decade and added Zytiga for a few years and has stayed undetectable. He is currently on an ADT holiday.
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