Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 26, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: • ASCO GU 2024 conference highlights https://www.youtube.com/watch?v=YweU8hjA0Lw&t=2s
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: The new hot flash drug for women works for one of our guys, too. (bn)
Chat Log
Unknown · 6:23 PM PROMISE link – just clck on this https://www.prostatecancerpromise.org/?utm_campaign=ANCAN&utm_medium=link&utm_source=Webinar
Steve Roux, MI · 6:31 PM Promise sent me a free DNA “Color” test kit and I sent the kit back. They say it will be 30 days to get results.
Jim Marshall, Alexandria, VA · 6:45 PM Did Abiraterone for 5 years with Prednisone & lupron and did aerobic exerices most days and tolerated it prety well as long as i exercised.
Unknown · 6:49 PM thanks for all your input and information, guys
Bob McHugh · 6:53 PM I had Axumin at .5 PSA . Found a quarter sized lesion in the prostate bed.
AnCan – rick · 6:57 PM To Join Solo Arts Heal with Beth Horner tomorrow at 7.30 pm Pacific Join from the link below https://themarsh.org/soloartsheal
Len Sierra · 7:02 PM Got to leave, Gents. See you next week.
Bob McHugh · 7:17 PM Where was the cardiac cath done, if I may ask?
Bob McHugh · 7:18 PM Three stents here.
Richard Tolbert · 7:18 PM Jim Ma
Bob McHugh · 7:22 PM Is an EKG advisable?
Kirt Schaper · 7:31 PM I have to go.
Unknown · 7:32 PM An echocardiogram can test your hearts function and structure.. it can find many issues
Jim Marshall, Alexandria, VA · 7:34 PM Had the echocardiogram and it did not show anything. I went to the Nuc;lear Stress test which showed 2 Stents surely needed. Jim
Jim Marshall, Alexandria, VA · 7:36 PM Liptor did no good for me along with Crestar. But later and been on Pravastatin knocked it down to 142 with HDL up and LDL down below recommended. jim
Wang Gao Shan – PANAMA · 7:36 PM Thanks Everyone… I have to go.
Unknown · 7:40 PM Thanks Jim
Dr. Jeff · 7:42 PM Arterioscler Thromb Vasc Biol. 2020;40:e55–e64. DOI: 10.1161/ATVBAHA.119.313046
Unknown · 7:44 PM Statins make me weak, my cholesterol has always been low but my PCP recommended a statin, took me months to figure out how weak they made me. My oncologist figured out that the statin was the cause.
Steve Roux, MI · 7:54 PM yes. need to ask about firmagon. My insurance denied the orgovyx.
Dr. Jeff · 8:01 PM Russ Hoover: I had frequent hot flashes on Firmagon and Abiraterone. I eat tofu and ground flax seeds daily and the hot flashes are markedly reduced.
David M · 8:05 PM I have to roll guys.
David M · 8:06 PM Great meeting as always
marc valens · 8:07 PM I’m still getting Lupron shot in the butt every 3 months.
Unknown · 8:07 PM Thanks guys
Jim Marshall, Alexandria, VA · 8:14 PM May the Lupron Supply chain is stocked until it runs out. ABBvie stopped production last year. Jim
Larry Fish · 8:15 PM whats the name of the new drug for hot flashes?
Jim Marshall, Alexandria, VA · 8:15 PM Maybe UPS directly to Dr E.
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just
so happens that ASCO (American Society of Clinical Oncology) has come out with new guidelines regarding vaccines for cancer patients.
The guidelines include a recommendation for doctors to take vaccination histories at the start of cancer treatment, followed by provision of recommended vaccines, re-vaccination after cancer treatments that wipe out immunity (for instance stem cell transplant), as well as vaccination of household contacts in order to protect the cancer patient.
We are more vulnerable to infection, because our immune system is injured by chronic inflammation, by the cancers, and by our treatments. Also, we don’t get as good an immune boost from some vaccines as people without cancer do.
If our immune system is “compromised” we can’t take live vaccines at all, and non-live vaccines aren’t as effective. Live vaccines contain weakened but still replicating virus or bacteria. They cause a mild infection in normal people, which triggers an immune
response. But for those of us with a weakened immune system, live vaccines, such as chicken pox/shingles, measles, mumps, oral typhoid, and German measles, can cause a real infection. Non-live vaccines are safe, including the new RNA vaccines. Non-live vaccines for different conditions can be given on the same day.
Here is a summary of recommendations, which I have shortened for prostate cancer:
“Clinicians should determine vaccination status and ensure that adults newly diagnosed with cancer and about to start treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines
Vaccination should ideally precede any planned cancer treatment by 2-4 weeks. However, nonlive vaccines can be administered during or after chemotherapy or immunotherapy, hormonal treatment, radiation, or surgery
Adults with solid and hematologic cancers traveling to an area of risk should follow the CDC standard recommendations for the destination Note. Hepatitis A, intramuscular typhoid vaccine, inactivated polio, hepatitis B, rabies, meningococcal, and nonlive Japanese encephalitis vaccines are safe
It is recommended that all household members and close contacts, where feasible, be up to date on vaccinations “
Here are some specific recommended immunizations for adults with Cancer:
One dose of Tdap, followed by Td or Tdap booster every 10 years
Hepatitis B
19-59 years: eligible 60 years and older: immunize those with other risk factorsc
For adults 20 years and older, use high antigen (40 µg) and administer as a three-dose Recombivax HB series (0, 1, 6 months) or four-dose Engerix-B series (0, 1, 2, 6 months)18
Recombinant zoster vaccine
19 years and older
Two doses at least 4 weeks apart
Pneumococcal vaccine
19 years and older
One dose PCV15 followed by PPSV23 8 weeks later OR One dose PCV20d
HPV
27-45 years: shared decision making
Three doses, 0, 1–2, 6-monthsAbbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Abbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Now, a few further details about some common shots:
COVID
The COVID-19 vaccines protect patients with cancer, reducing the risk of severe COVID-19 illness and hospitalization. The recommendation is to receive at least one dose of the updated 2023-2024 COVID-19 vaccine. For those on therapies which diminish the immune response, ASCO recommends additional vaccine doses after 2 months. It is recommended to postpone immunization for 2-3 months for individuals who have recently had a COVID-19 infection.
FLU
It is safe to vaccinate during chemotherapy or while white cells are low. But the nasal spray flu vaccine should not be given to patients with cancer.
Pneumonia
Patients with cancer are at higher risk for pneumonia. (Blood cancers 50 times the risk!) Pneumonia vaccines reduce the chances of getting pneumonia and the need for hospitalization.
Shingles
There is a new vaccine called RZV. It is non-live so OK for us. (the previous vaccine, a live attenuated type, is not recommended for patients with cancer.) RZV should be made available to all adults with cancer. This vaccine remains immunogenic even after cancer treatment has begun.
RSV
Patients aged 60 years and older with cancer are eligible to receive the respiratory syncytial virus vaccine.
Our immunity to tetanus, diphtheria, and pertussis weakens as we age, and this decline may be accelerated after cancer treatment. It is strongly recommended that individuals diagnosed with cancer receive the Tdap vaccine if they have not been vaccinated as adults.
Why bother?
“Infections are the second most common cause of non–cancer-related mortality within the first year after a cancer diagnosis, with most of these deaths attributed to influenza and pneumonia, deaths that can be prevented throughimmunization. While patients with cancer have lower immune responses to influenza and pneumococcal vaccines, evidence supports the safety and benefits of vaccinations in reducing the severity of infections and associated hospitalizations.”
Often we will see the term “immunocompromised.” Does this apply to us? This term is not, to my knowledge, precisely defined. For those of us with prostate cancer, it usually means neutrophils (a type of white blood cell) are down below 1000 cells per microliter of blood, and is usually due to our treatments. The immune system is complex, and there are many ways to become “immunocompromised.” Anyone on chemotherapy could be considered to be immunocompromised. .Ask your oncologist if you fit this category, and if you know of a clear generally accepted definition, please write to me.
The authors sum up: “A cancer diagnosis can be overwhelming, and vaccination may not be an immediate priority in the treatment plan. However, numerous studies consistently highlight the best protection when vaccines are administered before starting cancer treatment, emphasizing the need for early vaccination.”
What’s in a Clinical Trial? – Dr. John Antonucci’s Primer
On Tuesday, February 27 a squadron of AnCan specialists attempted the impossible: to condense the essence of arguably the best scientific meeting on genitourinary cancer research in the world into 1 hour of intelligible, useful information. A couple of hundred scientific poster and oral research presentations from the American Society of Clinical Oncologists annual GU meeting (GU ASCO24), made available and understandable to us AnCan’rs? You can view their attempt as well as the slides at https://ancan.org/patient-highlights-from-the-2024-asco-gu-conference/ and judge how they managed.
To prepare for the session, a basic understanding of research is very helpful. It starts when scientists comes up with a question. For example, “Does Lupron do any good?” They then design a study to answer the question.
Types of studies:
Not every study is an experiment. In an experiment, the scientist does something to the subjects, such as try a new drug, and compare them to a control group, which doesn’t get manipulated. In observational research, the scientist studies the subjects but doesn’t do anything to them.
Randomized controlled trials (RCT) are a type of experiment that are highly thought of. If you want to find out if Lupron is any good, you can find 2 groups of subjects with prostate cancer, give one group Lupron, and the other group a placebo (ie no medicine, although you still administer the fake dose). You have to be careful that the 2 groups match, because if you accidentally put most of the healthy patients in group A, they will do better but mess up your conclusion. This is the controlled part: you have to make sure both groups match except for the experimental manipulation. This is partly done by randomizing, assigning the subjects at random to the groups. At the end, you find out how long each group lived (or some other pre-established endpoint) and make a conclusion. This type of study is an experiment. It is also prospective: you create data as you go along which makes it a good study.
One of the several types of observational studies is the cohort study. Cohort studies follow groups to see how they do. For example, you could follow 1000 men over time, and see if the smokers get more prostate cancer than the nonsmokers. This could give a clue into what contributes to prostate cancer and how to prevent it. These studies are often prospective (looking into the future) but can also be look-back, or retrospective as well. A well-known cohort study in prostate cancer is the Canary Cohort that looks at low/intermediate Active Surveillance; or the Framingham Heart Cohort.
A cross-sectional study can answer questions like, what percentage of 50-year-old men have had a PSA test? You have 500 fifty year old men answer the question, and get your conclusion. It’s at one point in time. (The opposite is a longitudinal study, following subjects over time.)
Qualitative studies don’t collect numerical data like the others. If you want to find out what life is like on Lupron, you interview lots of men on the drug and get the big picture. The opposite is quantitative, where numerical data is collected.
Naturally, it makes sense to have lots of subjects in any study so you don’t get fooled by chance. For instance, you could flip a coin twice, get heads twice, and wrongly conclude that all coin flips will be heads. So big studies are better than small ones. The number of subjects in a study is known as n. Small ‘n’smake results suspect.
The chosen study type depends on the question, the ethics, and the resources. Only an experiment, like an RCT, can make a cause-and-effect conclusion, because it’s randomized and has a control group. Other studies can discover correlation; that’s when two phenomena occur together but causation is unclear.
There are studies of studies as well: A Meta-analysis will review and combine several similar studies to make the results even more convincing. A Literature review will review many studies, pick the best, and create a summary for us.
Basic science research uses instruments like petri dishes and microscopes to study molecules or cells or tissues; these are in-vitro studies. Lupron started in basic science research. Then it progressed to animal or in-vivo studies. Treatments that look promising at this stage progress to human clinical studies.
Clinical Trial Phases
You will hear human clinical studies presented as Phase I, Phase II, or Phase III studies. According to the FDA, Phase 1 has 20 to 100 healthy volunteers or people with the disease/condition. It lasts several months and is to test for safety and dosage. About70% of drugs move to the Phase 2, where up to several hundred people with the disease/condition are studied for several months to 2 years looking atefficacy and side effects. Approximately 33% of drugs move to phase 3, where 300 to 3,000 volunteers who have the disease or condition are studies for 1 to 4 years to deeply look at efficacy and monitoring of adverse reactions.
A drug like Lupron, when it did well at all these phases, was then submitted to the FDA for approval. After approval it was still followed, in phase IV or post-marketing research, as it was given to thousand of patients. Keep the phases in mind if you volunteer to be a research subject.
Clinical tests One last thing. How do you measure if a test is any good? What if someone asks, “Is PSA any good as a test for prostate cancer?” There are two key measures to consider: sensitivity and specificity. Sensitivity asks, “If prostate cancer is present, how good is the test at detecting it?” This measures the test’s ability to identify those with the disease correctly. Specificity, on the other hand, asks, “If prostate cancer is absent, how good is the test at correctly identifying those without the disease?” This measures the test’s ability to identify those who don’t have the condition correctly. Both measures are crucial in evaluating the effectiveness of a diagnostic test.
Clinical tests can be either predictive–A predictive test is designed to predict the likelihood of a specific outcome or response to a particular treatment or intervention. –or prognostic–a prognostic test is used to estimate the likely course or outcome of a disease, regardless of treatment.
Your AnCan team looked at all those ASCO meeting presentations with an eye toward good study design, importance, whether it’s an experiment or not and if so what phase it is, is it prospective, does it have a large-n, and is it of interest to men in our group. Hopefully reading this will make it easier to understand the ramblings of our AnCan Mods.
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 18, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: • ASCO GU 2024 conference highlights https://www.youtube.com/watch?v=YweU8hjA0Lw&t=2s
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: Calcium, bone strengtheners and 2 Newbies with different approaches – one at the end.(rd)…. & FYI it’s Len’s B-day today (3/19)!!
Topics Discussed
4+5 Newbie does well on first treatment protocol; caffeine issues; Space Oar; 14x Jevtana Tx… and another foamy gland compatriot; does HT kill cancer cells or just make them dormant?; pros and cons with balancing calcium; which 2nd line AA to start with; great discussion on bone strengtheners; avoid 6 month Depot LHRH; started Pluvicto; this latecomer Newbie self medicates
Chat Log
TonyFig
sent: 6:04 PM
Calcium connection with AFib. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782034/
Jim Marshall, Alexandria, VA
sent: 6:07 PM
There goes my Ice Cream.
AnCan – rick
sent: 6:09 PM
She is a GU med onc
AnCan – rick
sent: 6:18 PM
Dr. Jeff – you do NOT want to be on a 6-month shot!
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 12, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: • ASCO GU 2024 conference highlights https://www.youtube.com/watch?v=YweU8hjA0Lw&t=2s
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: Joint pain and muscle pulls on Pluvicto — how long till they fade? (bn)
Topics Discussed
JimmyG losing sleep over his sleep — others weigh in; small PSA changes and oversized worries; Dr. Elisabeth Heath holds her own with a jokester — but seriously, it’s time to go back on treatment; abiraterone caveats; sore joints and muscle pulls on Pluvicto — how long till they fade?; urinary blood clots 2 years after radiation — doc gives him a bladder tour; darolutamide monotherapy holds the fort, and the hot flashes are finally going away; announcing a new AnCan group for caregivers of people with neuromotor conditions — like Parkinson’s, multiple sclerosis, muscular dystrophy — to be led by Alexa; insurance nixes denosumab for his rapid-onset osteoporosis and insists on Zometa — what’s up with that?; back stateside after overseas visit for radioligand therapy and a brief course of PARP inhibitor — signals are good so far; results of a study (LuPARP) that looked at that combination.
AnCan and The Marsh (well renown, long-established theater company with a large following in the Bay Area and venues in San Francisco and Oakland) collaborateevery 4th Wednesday of the month for Solo Arts Heal.
For February we had a real treat of a guest – decades in the making! Yes, decades. It was our pleasure to have one of Rick’s oldest, and best friends (and AnCan Advisory Board Member) Mr. Mark W. Kissin, FRCS (Fellowship of the Royal College of Surgeons) join us. This has been a wish for years, and we are so grateful that Mr. Kissin was up so early (around 2:30 am UK time) to make it happen for us.
Mr. Kissin is a recently retired breast cancer and melanoma surgeon in the United Kingdom. He is recognized as a pioneer in sentinel lymph node biopsies, which help determine the spread of breast cancer. He has presented an amusing history of the breast at many medical conferences.
The National Health Service of the United Kingdom has presented him with an NHS Distinction Award for his work, dedication, and innovation; and he has received a British Citizen Award Medal of Honour. BBC television once broadcast him performing a full mastectomy and reconstructive breast surgery live to demystify the procedure and to help minimize women’s trauma about it.
In retirement. Mr. Kissin finds plenty of time to work on his golf handicap, grow vegetables, and enjoy his grandkids.
(For our US audience: UK and Commonwealth surgeons drop the title of doctor and revert to Mr. on surgical qualification. Your barber, or hairdresser, may be able to explain why!)
Mr. Kissin’s show was filled own songs, and he gave a short excerpt from his lecture, “The Illustrated Art History of the Breast,” which has been delivered at many high-profile medical conferences around the world.
This isn’t an interview, but a front row seat to a warm conversation between two life-long friends. You don’t want to miss this show.
Watch here:
Bonus! Here are the two pictures of Rick and Mr. Kissin featured in the show!
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 4, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: • ASCO GU 2024 conference highlights https://www.youtube.com/watch?v=YweU8hjA0Lw&t=2s
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: Here’s how to investigate if there’s a personalized/precision treatment for you (rd)
Topics Discussed
Exhaustive personalized/precision treatment pursuit; two successive Gents show us opposite sides of how a GU med onc beats a community practitioner; monotherapy enzalutamide; two more Gents manage their prostate cancer but not their heart issues; Dr. E is frank with an advanced patient but doesn’t reveal her cards just yet; our Gent thinks Guardant shows ‘weird’ results… or maybe they’re not so weird?; Pluvicto trumps olaparib in research and in practice; should spot RT metastatic directed therapy yield to systemic hormone treatment?; understanding the FDG scan
Chat Log
Jimmy Greenfield
sent: 6:22 PM
Mitoxantrone plus prednisone was previously accepted as standard chemotherapy for this stage of disease; however, docetaxel-based regimens have been shown to both palliate symptoms and prolong survival in hormone refractory prostate cancer.t.net
sent: 7:20 PM
Thank you, Rick, Dr. Bob, Len, and all, for a helpful discussion
Hi-Risk/Recurrent/Advanced PCa Video Chat, Feb 27, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
In a special session before tonight’s meeting, we presented key papers from ASCO GU 2024, a major conference for doctors treating prostate cancer, and answered questions — details here.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: PSA rising but nothing on the PET scan – the tumor was hiding behind his bladder. (bn)
Topics Discussed
After beating back his cancer many times, he’s now neuroendocrine and wonders about options besides platinum (immuno, DLL3, alpha) — Dr. Rahul Aggarwal is likely to have answers; Tylenol on top of Orgovyx and darolutamide may have been one too drug too much for his liver; struggling to work remotely with Dr. E’s office team — you’ll need “a heavy dose of patience”; after 6 unhelpful chemo rounds, now seeing a good lutetium response, but unresponding tumors may be neuroendocrine; maximum out-of-pocket expense is the important number in choosing a Medicare Part D plan; trusting a broker for Medicare selection, and are Advantage plans a bad deal for cancer patients?; despite rising PSA, PSMA scan looked clear…turned out the tumor was hiding behind the bladder; good feedback on Dr. Elisabeth Heath; 90-day Lupron break to “catch my breath” — is restarting now a lost cause?; Lupron finally over, he’s switching back to a real bike from his e-bike…but when do the hot flashes stop?
Chat Log
Jim Marshall, Alexandria, VA · 5:34 PM
we all need to be our own best advocate at all times
Jim Marshall, Alexandria, VA · 6:05 PM
on a Macbook, I see all the names. without hovering
Len Sierra · 7:05 PM
Chromogranin A (CGA) and neuron-specific enolase (NSE) levels are biomarkers for NEPC. Also, synaptophysin and DLL3 (Delta-like Ligand 3) is positive in 76% of NEPC.
AnCan – rick · 7:06 PM
Contact: Garrett Crook 424-314-0745 Garrett.Crook@cshs.org Principal Investigator: Kanya Sankar, MD
AnCan – rick · 7:07 PM
DLL3 NCT04471727 https://classic.clinicaltrials.gov/ct2/show/NCT04471727?term=HPN328&cond=Prostate+Cancer&draw=2&rank=1
AnCan – rick · 7:14 PM
HPN328 is the DLL3 drug
AnCan – rick · 7:38 PM
Solo Arts Heal TOMORROW NIGHT rd + MARK KISSIN FRCS check https://ancan.org/solo-arts-heal/ for links to The Marsh page and join us on Zoom or YouTube
Thomas Matica · 7:54 PM
Did Rick say that there is video discussion on the insurance issues? I can’t find anything. Thanks.
AnCan – rick · 7:55 PM
Tom – search for Triage Cancer on our site
AnCan – rick · 7:56 PM
Here you go….. https://ancan.org/webinar-lets-talk-medicare-2024/
Patient Highlights from the 2024 ASCO GU conference
In a 75-minute “pre-game” before the 2/27/2024 meeting of the high-risk/recurrent/advanced prostate cancer group, moderators John, Rick, Ben, and Len discussed highlights from the just-concluded ASCO GU conference, a major meeting for genitourinary cancer specialists. They selected from hundreds of papers on prostate cancer presented in sessions and posters. We closed with a 30-minute audience Q&A.
What we covered:
Abi boosts olaparaib for BRCA
After triplet therapy, what next?
Less treatment, same cancer-fighting power
Trial of a neuroendocrine PCa drug
Prostate cancer and suicide
Germline & somatic testing is too infrequent
What treatments work after Pluvicto
Pluvicto flare largely lasts only one treatment
Community providers do poor job treating mCSPC men
Hi-Risk/Recurrent/Advanced PCa Video Chat, Feb 19, 2024
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darolutamide achieves undetectable status after many years; should he radiate L4 – ask his QB!; PSMA scans at low PSA levels; intermittent hormone therapy requires active surveillance… and anxiety for some; Ac225 Tx in Austria followed by Ac225+Lu177 and a PARP with no HRR mutation; another Gent remains undetectable; no evidence of PCa from scans but inferior blood counts; Newbie at the back end – 20 year survivor finally requires 2nd line anti-androgen
Even though I have been on Treatment Holiday for 21 months I still get my PSA and testosterone blood test every month. I feel like I am then proactive. jim Marshall
Jerry Grimes, Brighton, MI
sent: 6:55 PM
Hey all, gotta run. All the best!
Peter Kafka – Maui
sent: 7:08 PM
With all this movement in the nuclear medicine field, are there specialized Nuclear Oncologists now working at Centers of Excellence or is much of this being managed by GU Med Oncs or Radiation Oncs?
Len Sierra
sent: 7:09 PM
Peter, in many instances, nuclear medicine specialists are used.
Len Sierra
sent: 7:19 PM
The European Medicines Agency (EMA) is the European Union’s (EU) equivalent to the FDA. The EMA is a decentralized agency located in Amsterdam, Netherlands, that evaluates, supervises, and monitors the safety of medicines for humans and animals in the EU and the European Economic Area (EEA). The FDA and the EMA work together to streamline efforts, share best practices, and promote human and animal health.
Len Sierra
sent: 7:40 PM
From Johns Hopkins: Blood cells are made in the bone marrow. The bone marrow is the soft, spongy material in the center of the bones. It produces about 95% of the body’s blood cells. Most of the adult body’s bone marrow is in the pelvic bones, breast bone, and the bones of the spine.
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just
