Hi-Risk/Recurrent/Advanced PCa Video Support – Men & Caregivers Recording, July13, 2021
Editor’s Pick: How bad is dairy? Leading to a great discussion around diet and nutrition this week. And a new nutrient that may prove effective … or may just be snake oil? But let’s understand it first. (rd)
At the end of this meeting we discuss glucocorticoids (steroids) taken with abiraterone acetate – here’s Len’s blog post on the topic: https://ancan.org/safety-of-glucocorticoid-regimens-in-combination-with-zytiga-for-mcrpc-patients/
Topics Discussed
Redirecting treatment for recurrence; introducing Provenge; Keytruda suitabiltiy; next step after PARP-I fails for BRCA+ man; drug holiday comin to an end; so what is Free Testosterone; bicalutamide still controls advanced disease: is dairy really off limits?; avoid 3D-conformal RT – old technology; steroids and abiraterone (see above)
Chat Log
Pat Martin (to Everyone): 3:18 PM: I missed what his PSA is currently.
Bill Franklin (to Everyone): 3:20 PM: .06 last time it was measured.
John Ivory (to Everyone): 3:21 PM: https://www.scripps.org/physicians/4526-michael-kosty?tab=overview John Ivory (to Everyone): 3:23 PM: “genitourinary” medical oncologist
John Ivory (to Everyone): 3:25 PM: https://providers.ucsd.edu/details/32684/medical-oncology-cancer
rick stanton (to Everyone): 3:28 PM: radiation oncologists at UCLA indicate 0.6 PSA should be able to be detected via the newly approved PSMA PET scan
Jake Hannam (to Everyone): 3:29 PM: Axumin or PSMA Pet/CT
rick stanton (to Everyone): 3:30 PM: the scheduling wait time for a PSMA PET scan at UCLA is running about 6 weeks – it’s packed!
Ancan – rick (to Everyone): 3:31 PM: Dr. Rana McKay https://profiles.ucsd.edu/rana.mckay
rick stanton (to Everyone): 3:32 PM: I recommend Dr. Rana McKay as well.
Ancan – rick (to Everyone): 3:33 PM: Right now, Rick, we probably don’t need the PSMA R11 at UCLA or UCSF. Pylarify is now becoming readily available, and the price is way lower.
Joe Gallo (to Everyone): 3:35 PM: PSMA PET is free at VA in LA for Veterans
rick stanton (to Everyone): 3:35 PM: I recommend getting germline and tumor genetic testing done from tumor tissue of your removed prostate. This can change the treatments you recieve for the better!!
John Ivory (to Everyone): 3:37 PM: Hot flash device: https://embrlabs.com/pages/hot-flashes
Ancan – rick (to Everyone): 3:40 PM: rd@ancan.org peterk@ancan.org herb@ancan.org
Herb Geller (to Everyone): 3:41 PM: Munveer Bhanjoo, MD at Scripps. He says he is specializing in GU. His office is at the main Scripps on Torrey Pines Rd.
Bill Franklin (to Everyone): 3:42 PM: bfranklin@ancan.org
Pat Martin (to Everyone): 3:43 PM: trazadone works well for me.
Pat Martin (to Everyone): 3:44 PM: For sleep
Carlos Huerta (to Everyone): 3:45 PM: Lorazepam 1 mg at bed time for sleep.
John Ivory (to Everyone): 3:47 PM: I’ve used trazadone for decades, 50 mg
Bruce Bocian (Private): 3:45 PM: I have singled out the two docs you mentioned to me. Where would Dr. Brian Moran fit in the picture. You recommended him to me many years ago and I did see him back in the day.
Ancan – rick (to Bruce Bocian): 3:50 PM: He is a radiation oncologist
Jeff Marchi (to Everyone): 3:51 PM: depo provera is one hormone treatment lasts 3 months. there is someone else in the group that has had success with a different hormone treatment, not here apparently. really helps hot flashes.
John Ivory (to Everyone): 3:52 PM: My comment was regarding sleep, not hot flashes
rick stanton (to Everyone): 3:52 PM: what was your TMB?
Jeff Marchi (to Everyone): 3:52 PM: the hot flashes are what wakes most of us. they call them night sweats also
Herb Geller (to Everyone): 3:55 PM: What is microsatellite instability-high cancer? Describes cancer cells that have a high number of mutations (changes) within microsatellites. For example, microsatellite testing that shows mutations in 30% or more microsatellites is called microsatellite instability-high. Microsatellites are short, repeated sequences of DNA.
rick stanton (to Everyone): 3:56 PM: Microsatellite instability (MSI) is the condition of genetic hypermutability (predisposition to mutation) that results from impaired DNA mismatch repair (MMR). The presence of MSI represents phenotypic evidence that MMR is not functioning normally. Why MSI and TMB (Tumor Mutational Burden) can help predict responsiveness to Keytruda is the concept of “many shots on goal” for T Cell recognition of mutations presented by the tumor. CD8 T cells perform the tumor killing – so if CD8 T cells have more opportunities to recognize many mutations – keytruda has a better chance of working – very crude – but wildly…. it’s predictive to a degree
Carlos Huerta (to Everyone): 4:03 PM: What genetic test is suggested? It must be blood to see what the currrent cancer make-up is, correct?
Herb Geller (to Everyone): 4:03 PM: Circulating tumor cells (CTCs) from blood can be analyzed
rick stanton (to Everyone): 4:03 PM: depends what you are looking for
John Ivory (to Everyone): 4:06 PM: Sorry to hear that, Jake. Very stressful.
Jake Hannam (to Everyone): 4:09 PM: Thanks, John. I’m trying to stay cool about all this.
Len Sierra (to Everyone): 4:09 PM: Somatic Reversion of Germline BRCA2 Mutation Confers Resistance to Poly(ADP-ribose) Polymerase Inhibitor Therapy Two types of somatic reversion mutations have been described: a direct reversion of the wild-type sequence or a secondary mutation that restores the open reading framea ascopubs.org/doi/full/10.1200/PO.17.00044
Herb Geller (to Everyone): 4:11 PM: What is microsatellite instability-high cancer? Describes cancer cells that have a high number of mutations (changes) within microsatellites. For example, microsatellite testing that shows mutations in 30% or more microsatellites is called microsatellite instability-high. Microsatellites are short, repeated sequences of DNA.
Herb Geller (to Everyone): 4:11 PM: Yes, certainly a somatic reversion of the tumor is possible, but the germline stays mutated
Len Sierra (to Everyone): 4:12 PM: Agreed, Herb.
Ken (to Everyone): 4:15 PM: Not at the time he decided to start. The comment was that most immuno type treatments seems to work best early in the disease cycle. I think I would start the work to get it scheduled as soon as you can work it in.
rick stanton (to Everyone): 4:17 PM: thank you all – look forward to next time – need to hop off now – best, rick stanton
Jake Hannam (to Everyone): 4:20 PM: A FMI blood test might be in order for Dennis
Dennis Correia (to Everyone): 4:27 PM: What is a FMI blood test?
Jake Hannam (to Everyone): 4:28 PM: Foundation Medicine liquid biopsy or equivalent
Peter Kafka (to Everyone): 4:28 PM: Foundation Medicine (FMI)
Jake Hannam (to Everyone): 4:29 PM: https://www.startwithstepone.com/ Your doc will have to request it, Dennis
Jim Ward (to Everyone): 4:38 PM: Can you spell Tiltify?
Pat Martin (to Everyone): 4:39 PM: could you give us the web site?
Herb Geller (to Everyone): 4:43 PM: https://www.filtricine.com Here is a link to their patent for this diet: https://patents.google.com/patent/US20200297679A1/en Here is a reference to a recent paper that says there is a suggestion that dairy may increase risk but they also say the evidence is weak: Review World J Mens Health . 2021 Jul;39(3):419-428. doi: 10.5534/wjmh.200051. Epub 2020 Jul 27. Milk Consumption and Prostate Cancer: A Systematic Review Alex Sargsyan 1 , Hima Bindu Dubasi 2 Affiliations expand PMID: 32777868 PMCID: PMC8255404 DOI: 10.5534/wjmh.200051
Jake Hannam (to Everyone): 4:52 PM: And yet calcium + vitamin D is recommended by many docs for men on ADT. Confusing!
Len Sierra (to Everyone): 4:54 PM: Free PCF Health and Wellness in Prostate Cancer, https://www.pcf.org/wp-content/uploads/2016/10/PCF_HW_Guide.pdf
Ancan – rick (to Everyone): 4:54 PM: Nutrition Pamphlet http://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/attachments/nutrition_and_prostate_cancer.pdf Nutrition refernces (UCSF) http://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/attachments/nutrition_and_prostate_cancer_references.pdf
Ancan – rick (to Peter Kafka): 4:56 PM: Peter – Buzz would argue with you about Colin Campbell . He worked with him at Cornell – that’s where Buzz got his PhD
Bruce Bocian (to Everyone): 4:59 PM: Have to run
Jim Ward (to Everyone): 5:00 PM: Gotta hop off the call, gents; good to see everyone. Have a good night.
Herb Geller (to Everyone): 5:00 PM: I gotta go now.
Pat Martin (to Everyone): 5:02 PM: See you next Monday
John Birch (to Everyone): 5:06 PM: Need to go, thanks everyone!
John Ivory (to Everyone): 5:15 PM: ¡Ciao till next time!
George (to Everyone): 5:16 PM: Thank you Peter. Fine job. Thank you all.