Advanced Prostate Cancer - Oligometastatic?

Hi Hanandy,

Thank you for the best wishes and hope you are both doing ok.

of course, the name of the trial was STAMPEDE2 but we don’t have any real info on it yet, hopefully this will be discussed at the next meeting in mid Nov. 

https://www.isrctn.com/ISRCTN66357938

just did a quick google search and this link has lots of info on the trial and eligibility etc and will be running out of UCL. 
It seems like the trial is looking at three new treatments alongside existing treatments for people who have PC that has metastasised to the bones and distant lymph nodes. 

if we get any more info at our next appointment then I will let you know! X

Thank you so much x

Good morning Sunnysideup . You have beaten me to it on the trial angle of your good news in getting a more proactive treatment for dad. As you say, there are 3 options which are all aimed at giving earlier treatment to the cancer whilst it is still hormone sensitive rather than waiting for it to recur at a later date. This hit it hard and fast mantra is demonstrating promising results in terms of time to recurrence and thus giving better quality of life. As the consultant mentioned the possibility of radiotherapy to the bone mets then this could mean that they are looking at the SBRT arm of the trial. The Lutetium 177 arm relies on the same technology as the PSMA PET scan but a radioligand is attached to specifically target cells which express the prostate cancer and kill it with nuclear therapy - I think this arm of the trial is more for those with widespread mets although work in other countries is also looking at this in the oligometastatic state. At a possible cost of 100K I think it would be unlikely your dad would be offered this. Also his PSA is now down to 0.4 which is at the lower end of accuracy for the PSMA Lutetium 177 technology. The third option is a PARP inhibitor and to be eligible for this your dad would probably have to have had a genetic test on his initial biopsy sample to check that he has the right genes in the first place.

With advanced prostate cancer the hormone injections are normally for life but again this is being challenged. The initial 3-6 months is to reduce the size of the lesions and make it a smaller target for the radiotherapy and thus less likely to produce collateral damage to surrounding areas. The HT will continue afterwards as the radiotherapy continues to work for around 18 months. Traditional thinking is to remain on HT for life or until it no longer produces the castrate state but what this can do is push any residual cancer cells into finding different ways of getting its food so a different kind of hormone therapy is needed which works in a different way to the injections. There is some evidence that by stopping the injections once the PSA becomes negligible and there is no evidence of cancer on the scans, then waiting for the PSA to start going up before restarting HT,  can reduce the push into hormone resistance and thus increase the time to recurrence. There is also work being carried out that adding in a second generation antiandrogen at the time of primary radiotherapy can shock the cancer cells into becoming more sensitive to the RT.

This is a fast developing area of research at the moment so I hope that your dad is eligible for the treatment but we have to thank men like him for participating as it does mean more monitoring.

Please keep us updated as it is important for others with bone mets to know what is available. Also it shows how useful having a PSMA PET scan at initial diagnosis is as it can ensure the most appropriate treatment from the start.

Good Morning Alwayshope, 

Thanks so much for the information above - it makes much more sense written out like that than trying to read the medical journals online and also brilliant to understand what the three different arms of the trial relate to. It does sound like the first option would be the most suitable for my dad given his current response to the hormone treatment. Our next consultation is back at Kings hospital in a few weeks, under the guidance of the consultant we spoke to yesterday at the RM, so hopefully I will be able to report back more then. If my dad is able to take part in the trial then he’s definitely up for doing so!