This next person writes, "Surely you should be looking at removing a person's immune cells and
repurposing them for specifically attacking cancer cells before reintroducing them rather than just
over-stimulating the immune system as a whole. Is that not right?" Well, it's interesting. I
don't know how sophisticated this questioner is, but they seem to be talking about the two common
types of immune therapy that we have available to us in prostate cancer. One is Provenge
where we do take immune cells out of the patient's body and repurpose them to attack prostate cancer
specifically. Whereas, general enhancement of the immune system is something that is accomplished
with medicines like Keytruda, Opdivo, Yervoy, and the simple non-specific enhancement of the immune
system also does have some benefit although there are more problems with toxicity because
the immune system can start to attack the normal areas of our body and cause problems with asthma,
or rashes, or other problems, so in principle, what this person is describing is true,
and of course, most interesting of all will be whether combinations of both at the same time
will give better results. We are willing to take a chance of unexpected toxicity to save people's
lives we're talking about using these medicines in otherwise, you know, in dangerous cancers that can
be life-threatening. So sometimes we're willing to accept the fact that there can be some collateral
damage or side effects if we can get people to live longer with an adequate quality of life.
So, I think in summary, these are two different ways of enhancing the immune
system. I don't think one is better than the other; I think they both have value.
Are there any agents that can protect structures like nerve bundles from radiation damage and
the same way that SpaceOAR is able to protect the rectum from radiation burns?
Unfortunately not; the only way to protect the nerve bundles is to undergo a focal
type of treatment to the prostate rather than the standard therapies that encompass the whole gland.
So, a lot of patients don't realize that when they undergo treatment for prostate cancer with
radiation or surgery the whole prostate is targeted; there's no special attention
to this to the tumor in the prostate; it's all about just getting the whole gland treated or
the whole gland removed. So, invariably, the nerve bundles, which are right on the surface
of the prostate, are placed at high risk and this is why erectile dysfunction is the one
unsolved problem when you when you're treating the whole prostate which is the standard approach
in the United States and throughout the world. This is why focal therapy is so attractive — is
that the nerve bundles can definitely be spared in many cases and that lowers the risk
of erectile dysfunction to a dramatic degree. So, this is sort of the ongoing technological
progress in the management of prostate cancer is now starting to be focused around developing good
focal prostate cancer techniques. Focal therapy, whether it be with radiation,
or laser, or high-intensity focused-ultrasound, electrocution (it's called electroporation)
all these different methods are perfectly fine for destroying sections of the prostate
or even the whole prostate, but the challenge of course is knowing right where the tumor is
putting an adequate margin around it, and then delivering an accurate treatment plan
that that covers that anticipated area on a consistent basis, and this is not easy to do.
There's a number of centers that are developing skills in this area, and it's a very attractive
option if if the cancer sets up for that, and if you find the right doctor to do it.
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