Is ProstRcision a good method for combination therapy with seeds and EBRT?
And so first of all, can you explain what EBRT is and then how this would combine those?
So Radiotherapy Clinics of Georgia founded by Dr. Kritz more than 20 years ago
has pushed aggressively the use of combination seed implants plus external beam radiation
therapy--that's EBRT. In my opinion they've been right. They have their own proprietary trademark
for this combination of giving external beam radiation plus seed implants called ProstRcision,
but seed implants and external beam radiation therapy are available anywhere.
No one else causes calls it ProstRcision, so it's just a trade name that they've coined.
It is a good approach. My only complaint with the Radiotherapy Clinics of Georgia is it's sort of a
size fits all. Seems like if you're intermediate-risk you get the same treatment;
if you're high risk you get the same treatment, and the combination of external beam radiation
plus seed implants is effective but probably should be reserved for the people with high-risk
and the people with intermediate-risk can just have a seed implant without any
external beam radiation. So, I don't believe that everyone needs to be treated that aggressively,
but if someone has high-risk disease ProstRcision, if you want to call it that but really it's just
a combination of beam radiation plus seed implants, is indeed the best way to go.
So, our next question is, will lutetium-177
be extended as far as the stage goes to castrate-sensitive patients and is
there any interest in using it in any other stages currently?
So Novartis bought lutetium-177 for a couple billion dollars and a couple months ago came
out and said that the large trial that's being performed to prove its capacity to extend life
was positive. In other words, that it established that lutetium is effective and it's going to be
probably on the market in the next year or two. This was for men with advanced stage disease that
had already had chemotherapy and it's wonderful that it works and we know that a lot of times
treatments that are effective in advanced disease will be more effective at earlier stages,
for example, hormone sensitive disease like the questioner is proposing here. There have been
some limited studies done, small trials, showing that to no one's surprise that
there is -- that patients do achieve responses when they're hormone sensitive with lutetium,
patients that have metastatic disease, and so I think it will be popular in that setting.
The next question, of course, in the back of everyone's mind is would it be effective in
people that had rising PSA levels after surgery. We know that a certain percentage of those people
have cancer where the prostate used to be and you can radiate it with beam radiation and
cure a significant proportion, but what about people that have small specks of cancer somewhere
else in the body? Will we be able to inject lutetium and eradicate those microscopic specks?
This is a complete unknown and, of course, we don't know with that degree of radiation exposure
throughout the body with lutetium, would that become dangerous after 5, 10, 15 years? There
are a lot of unanswered questions, but uh it's exciting to have that we have this brand new tool.
So, our next person is asking a question regarding chemotherapy, and they want to know how effective
icing fingernails, mouth, and scalp are during that chemotherapy process because they want to
know if there's certain situations they should do it in certain situations they shouldn't?
It's almost universally effective there's really no situation that we wouldn't do it.
Fingertips is because all the fast growing portions of the body are more susceptible
to chemotherapy side effects--your hair, your fingernails, and so the simple idea is that if you
make these areas of the body cold the blood flow is reduced and so when men
are having the chemotherapy circulated in their bloodstream--which is only for about an hour--that
if you keep ice chips in your mouth, for example, it shunts blood away from your tongue
so that your sensitive taste buds are not impacted by the chemotherapy. People that don't
do that will notice that food kind of tastes bad, that the taste buds are affected by the
by the chemotherapy, and ice is a simple way to minimize those side effects.
Does it work in all types of chemotherapy like taxane or anything else or does it only for
prostate chemotherapy for instance?
It's been so long since we've used anything but Taxanes. So with breast cancer they use ice caps
to prevent blood flow to the scalp so that women who are undergoing therapy don't lose their hair.
So I think it's pretty popular approach for other types of cancer.
This person was recently diagnosed with intermediate prostate cancer and they
say that they understand that surgery would removing the prostate would certainly fix
flow issues--and I think they're talking about urinary flow issues--and they also understand
that radiation treatment there may be some short-term increase of urinary flow issues,
but long-term does radiation treatment for prostate cancer resolve flow issues from BPH?
Sometimes it does. The radiation over a period of one to two years will cause some reduction in the
size of the gland and men can have improvements in urinary function. It can go the other way too the
some men can develop chronic irritation of the urethral passage which can exacerbate urinary
flow problems, so and of course with surgery, yes it can sometimes alleviate flow problems
by removing the gland, but of course, it can also instigate problems with incontinence where you're
leaking constantly. So, these treatments for cancer I typically don't position them
as fixes for urinary problems; I see that as a separate issue, and I would not be attracted
to doing surgery or radiation except under the most rare circumstances because of its impact
on the urinary function I'd be looking at the global picture of cure rates, urinary function,
overall quality of life, not just one narrow aspect as is being proposed in this question.
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