Talking Estradiol (E2) for Recurrent and Advanced Prostate Cancer: Wassersug et al
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics. Sincere apologies to all for failing to record our May 6 Group. It was totally a platform fault and not down to AnCan. As regulars are aware. this is a very rare event. AnCan hopes this session might make up for it.
Estrogen in its various forms has long been used as a primary and secondary means of managing prostate cancer. Primarily it can be used in place of an LHRH ADT drug. In its secondary capacity, it can be employed in addition to an LHRH drug to help men cope with side effects arising from lack of estrogen caused by the LHRH drug. These side effects include hot flashes and weakening bone density. Today Estradiol (E2) is considered to be a safe treatment when used as a skin patch or gel versus its original application in pill form that carried significant cardiovascular risks.
The foremost peer expert on the use of estrogen to manage prostate cancer is Richard Wassersug, Ph.D, author of Androgen Deprivation Therapy: An Essential Guide for Prostate Cancer Patients and Their Loved Ones that is now in its 3rd Edition https://connect.springerpub.com/content/book/978-0-8261-8403-0. Richard is also an AnCan Advisory Board Member.
In this 60 +minute discussion, Dr. Wassersug talks with two patients about using estradiol. One has used for primary control for 17 years, and the other just started using an Estradiol patch to control side effects alone. He is also joined by AnCan advanced PCa peer Moderators, Dr. John Antonucci and Rick Davis.
Rechallenging advanced disease with enzalutamide after Pluvicto is mentioned towards the end. Dr. Wassersug has since clarified that he favors rechallenging advanced disease with previous therapies after some form of radiation based on the abscopal effect. The use of enzalutamide in this context is not based on trial evidence.
AnCan asks that you first read Richard Wassersug’s book before reaching out to him. AND… Dr. Wassersug urges you to spend as much time exercising today as you have taken to watch this video!
Join us for this ‘ripped from the headlines’ webinar featuring a hot topic in the Active Surveillance community.
When world famous physician-scientist, leader of The Human Genome Project and former NIH Chief, Dr. Francis Collins, suddenly needs treatment for his prostate cancer that has accelerated from indolent to aggressive faster than a Formula 1 racer, many patients and medical professionals ask – whats up?
The NIH/NCI is considered one of the best medical institutions in the world. Did their active surveillance (AS) protocol fail or was Dr. Collins an anomaly? Do patients need to worry? … and is ‘cure’ really a possibility for Dr. Collins?
At short notice, AnCan Foundation, ASPI and The Active Surveillor have gathered together two world-renown urologists who curate their own AS cohorts. Drs. Peter Carroll and Laurie Klotz will discuss their views on the safety of pre-treatment AS for prostate cancer. Howard Wolinsky will moderate the discussion. AnCan’s own AS Support Group Moderators will be speaking after the presentation sharing their own thoughts
Watch here: (closed captioning is provided for this webinar, click the CC button at the bottom next to the gear.)
Special thanks to Bayer, Novartis, Johnson & Johnson, Myriad Genetics, Telix, and Blue Earth Diagnostics for sponsoring this webinar.
For information on our peer-led video chat PROSTATE CANCER VIRTUAL SUPPORT GROUPS, click here.
To SIGN UP for any of our Virtual Support groups, visit our Contact Us page.
What’s in a Clinical Trial? – Dr. John Antonucci’s Primer
On Tuesday, February 27 at 16:45 EST sharp, a highly-trained, elite squadron of AnCan specialists (Speak for yourself Dr. John -rd) 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 is 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 results. 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. As you’ll see on Tuesday, small ‘n’smake results suspect.
Which type of study is chosen 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 was given to thousand of patients. Keep the phases in mind if you volunteer to be a research subject.
Screening Test Evaluations
One last thing, which came up in last week’s group: How do you measure if a test is any good? For instance an experimental test for the feared neuroendocrine cancer might be evaluated. Or what if someone asks, “Can PSA test for prostate cancer?” Two ways: you ask, “If prostate cancer is present, how good is the test at detecting it?” This is sensitivity. And, “If the test is positive, how often is prostate cancer really there?” This is specificity.
Your AnCan team looked at all those ASCO meeting presentations from last month. They looked 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 reding this will make it easier to understand the ramblings of our AnCan Mods.
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!
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
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!
We’re back in action this 2024 with a fabulous guest, Ursa Miles!
Ursa is a performer and author from the Ozarks currently based out of Chicago. Her work has appeared on stage at the International Storytelling Center (through Jonesborough Storytellers Guild), The Mountain Makins Festival, Big Muddy New Play Festival, and This Much is True. Her book Passive Aggressive Fables for Adults is available wherever books are sold. Ursa is also a survivor of proxy supraventricular tachycardia who lives with neurocardiogenic syncope, hypoglycemia, and hypermobility disorder. She loves cheesecake.
Ursa tells stories about maintaining relationships with her passions for the outdoors and the arts while navigating her life as a heart and neurological patient.
Wild animals such as deer, bears, and raccoons make appearances. Oh my! You’ll be captivated the entire show.
