In this clip from our 2018 prostate cancer conference, the moderator asks the
speaker, Dr. Evan Yu, to share some stories about some patients who had seemingly miraculous
responses to treatment. His stories are important because they highlight an important point.
Statistics are just that, statistics, and that's important to remember as you're doing
research, your doctor is quoting you statistics. They don't really define what's going to happen
in your individual case because everyone's case is unique. With that said, please enjoy
the video.
Dr. Moyad: What's the most mirac—I mean you're still early in your career—what's
the most miraculous case you've ever seen in your career of a patient that you took
care of. The most miraculous case—or it doesn't have to be a case—or a situation
that you went, "Wait a second, how did this happen?" Can you share that with us?
Dr. Yu: Yeah, I mean I would say there's a lot actually. I mean because miracles do happen,
so I have quite a few cases, but I would say this: I've had patients before that have presented
with very, very widespread disease that were felt to be kind of metastatic or incurable
and wanted to go with really aggressive modalities and we didn't talk about this at all, but
we do have newer imaging modalities that are finding metastatic lesions early and we're
going after them. This is way before we had that. So I had a patient who actually was
a surgeon and he had metastatic prostate cancer. I mean lymph nodes all the way up to here,
and he's like I don't just want the hormones; I want everything taken out and he underwent
multiple surgeries, had everything stripped out, and underwent I think just six months
of hormones because he didn't like the side effect, and it never came back. Never.
Dr. Moyad: Never
Dr. Yu: Never came back
Dr. Moyad: See, so you've had a number of these?
Dr. Yu: Somebody just asked if he's alive. He's no longer with us, but he did not die
of prostate cancer. He died of natural causes, a very long natural life.
Dr. Moyad: People don't understand I have to see these guys afterward at meetings. If
he's told this story and I found out the person wasn't still alive we wouldn't invite him
back. So yeah, that's a good one. You got another one?
Dr. Moyad: This is part of the problem I have with oncologists. That I—I mean even Mark
introduced me to this—I've seen stuff I couldn't even, blows my mind. And you tend
to hear more about the glass as half-empty, but I wish people would sometimes show these
case studies because there are a lot of them out there. These people that were just suddenly
it's all gone.
Dr. Yu: Okay, yeah I have other cool ones. I don't know, this one just popped into my
head. This is probably not the second coolest one, but it's just what popped into my head.
So, I had this patient that was on our stand up to cancer study where we biopsied patient's
metastases and would do whole exome sequencing—whole genome sequencing actually—of the tumor
and he had an interesting mutation in the androgen receptor and if you read about that
mutation it's an imitation that seems to allow just standard steroids to bind to it. so he
was on abiraterone and prednisone because you give prednisone to prevent the side effects
of abiraterone. You get this fluid excess as a side effect and the prednisone helps
serve as negative feedback to the brain to say stop making al these hormones.
Dr. Moyad: Zytiga with prednisone, right?
Dr. Yu: Yes. So his disease was progressing on it when we biopsied him and found that
result, and I found that he has this mutant on the androgen receptor because all these
steroids—I said abiraterone even combined in the androgen receptor; these steroids glucocorticoids
combined too, weakly, but this mutant allows glucocorticoid to bind more tightly. Okay.
And so I said, hmm maybe we should just take the steroids away and keep the abiraterone,
and we did that. It's like five years later and his PSA is still undetectable. It just
dropped like that. Pretty Cool. Biology in action, right?
Dr. Moyad: Yeah, but do you want to know what's cool about it is that you actually had some
kind of genetic testing done. I still think it's crazy that today when men fail any sort
of hormone therapy or it becomes advanced that they don't get genetic testing done.
I know what the con is. The con is well we can't help that many people. Not that many
people respond. But yeah, it's still a couple of people. Maybe it's a couple out of ten.
Maybe it's even one out of ten. Maybe it's one out of twenty. It's another shot.