CTC ~ Circulating Tumor Cell test. Approved for PCa: Ask for it!

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 5/14/2008 6:12 PM (GMT -6)   
My cancer center, Nevada Cancer Institute, has told me that from now on they will supplement a PSA test with a CTC test.  Apparently it is now more useful than PSA in detecting metastatic disease.  I will post the results here tomorrow.  This test was more commonly used in breast cancer but is now approved by the FDA, ASCO, and NCI (National Cancer Institute, but also my NCI) just recently for prostate cancer.  Knowing this now, I would request upon diagnosis this test to verify that there are no PCa cells in the blood.
 
ASCO ~ American Society of Clinical Oncology abstract below:
 
Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 5/14/2008 6:35:07 PM (GMT-6)


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/11/2011 12:42 PM (GMT -6)   
Tony what is the latest on this on CTC cells, this seems like a test that could be useful to certain patients. Do we know of anyone whom had this done or the numbers parameters used to measure such??????

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/11/2011 1:16 PM (GMT -6)   
Bob,
Wow you revived this from the abyss. Yes I wrote about this in 2008 when CTC by CellSearch was only experimental. My oncologist, Nick Vogelzang, was one of the researchers. He still is but the test has promising but limited use. We stopped testing me for it in 2009 when 4 consecutive tests came back at a zero. While the test could detect circulating tumor cells, it was limited in how the data could be used. Not all the patients who had detectable CTC's needed additional follow up over standard protocols.

There is a newer version of the CTC involving stem cells. CTSC is also by CellSearch and is believed to be more effective at determining who might need to be more proactive in their therapies. Here is that write by the researchers:

jco.ascopubs.org/content/early/2011/03/16/JCO.2010.30.5151.abstract?sid=5cf518ea-1b36-4027-98cd-0e1271c18638

It looks more useful to the stage 2C and 3 guys at discovering circulating tumor stem cells what are predictable higher risk for disease progression. I have two guys in my group that are being tested with this test and both have progressing disease. I am not certain that even with this data that they would change their protocols as both have been through secondary HT therapies (Nilandron, DES, Keto and in one case Abiraterone) and chemotherapy with docytaxel and prednisone. They can however monitor the CTSC's and see perhaps earlier in treatment if the protocol they are on is reducing the number of CTSC's in the blood ~ a possible predictor if the treatment is working.

I spoke to Vogelzang hypothetically using one of the cases and he said that when and how to use the test can still be an issue. For example some treatments show a quick response and some show slow responses. The PSA may indicate a treatment is working while the CTSC show's no change. And vice versa. So by reacting to these indicators you may add another protocol while not knowing which one is working. Of course that is a mute point if neither are working.

I hope to see more study material and when this test can be effective in prostate cancer. It is my understanding that the test is also usable in breast and testicular cancers, with minor alterations of the test equipment. But still some controversy there as well.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/11/2011 1:20 PM (GMT -6)   
Pay attention to the "Related Articles" in the thread I posted...

It included this link:

jco.ascopubs.org/content/29/12/1508.full

Tony

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/11/2011 3:32 PM (GMT -6)   
Thanks for the info and I printed those off for any reference use. One was 6 pages the other was 2 pages for the complete info.

Impressed with the stuff you are finding and Vogelzang impressed me from an early PCRI video, in there with Strum, Myers and others.

Hindsight, did you ever think PCa is as wild as you are witnessing??????

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 5/11/2011 4:24 PM (GMT -6)   
Hi Tony,
 
Good post. I asked my oncologist about this test last visit and he was not aware of it. I have a one year follow up with my urologist on Friday this week and planned to ask him the same question. I did some research and the test is not widely available but a lab in SLC says they work with the local hospital to take the blood sample. Apparently the handling is critical to getting a good sample and reading. Lab cost is aoround $610 plus the doc fee and hospital fee. Now all I have to do is convince the urologist to order the test.
 
Thanks,
Don

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 5/11/2011 7:11 PM (GMT -6)   
I see absolutly no value in this test.  What are you going to do differently even if you test positive for CTCs. If your PSA is undetecable and the CTC is positive your oncologist is not going to do anything about it.  If you test negative and your PSA is rising they are going to treat you no differently anyway.  If you test negative for CTC it doesn't mean you don't have CTCs.  It just means that particular vile of blood did not have any CTCs at the time it was taken out of your body.  Nobody knows if all your CTCs were say in your foot at the time they took your blood from your arm. 
 
Even if you do test positive who knows how this effects your prognosis many years from now.  Gleason score is still the best long term predictor of prognosis.  It has a proven long term history.  BTW way I said best, not perfect about the Gleason score.  We have years of data to prove what we know about the prognosis using the Gleason score.  We know nothing about what values of CTCs will mean years from now.   I know it is used as a way to measure progression in other advanced cases of cancer.  I don't think they have a clue how these will affect PCa patients.
 
Even if you test positive before treatment will it alter what you do to treat your PCa?  I doubt it.  University of MI has proven that even for high risk cases of PCa surgery prolongs survival.  So you've got to take your shot at a cure.  Most people can't stand by and do nothing when they are told they have cancer.
 
I don't care whay they say I see no value in this test at all.....
 
All that said if they can catch a very small amount of CTC let me see them put a filter in my vien to catch CTCs all the time and kill them.  Then maybe you would have a shot a controlling the spread of PCa or at least prolonging it.....That has some value.

Post Edited (ChrisR) : 5/11/2011 6:16:18 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/11/2011 7:34 PM (GMT -6)   
Chris,
In concept it should be useful but I don't know of any data to disagree with you with. Like you said we need better data to know when to use it and when it isn't necessary. The turn around time for studies on this test are not as long as say for a study on the efficacy of a local therapy. We can get usable data in less time because the end points for advanced therapies are shorter. Obviously because this test is attempting to narrow down the efficacy of advanced therapies as opposed to local therapies. There is a correlation in these studies showing that we can better predict the effectiveness of some therapies. If a person that starts chemo with a CTC of 7 and after say round 4 are seeing a CTC going down with each treatment it may indicate that the therapy is effectively reversing some of the disease. And a person who has effectively kept an undetectable PSA and a zero CTC after therapy has little reason to take on additional morbidity with further treatment. Keep you eye on this on as it may in fact still have a place in prostate cancer as it does in breast cancer.

@zufus,
I knew when I started out that there were a lot on unknowns about this cancer. After all it is cancer. But I never imagined knowing what little I do know about it. It is quite complex.

@Don,
Thanks for the additional information on the costs. I was in a trial on the first go so I never saw the costs.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 5/11/2011 9:58 PM (GMT -6)   
Tony,
Can this test be used to determine if a recurrence is local versus systemic. For example, if PSA starts to rise after surgery and the CTC test is positive, would that eliminate the usefulness of IMRT and that HT is the next step.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/11/2011 10:12 PM (GMT -6)   
Ed,
That was the original intent of this test. But like it was explained to me and Chris said, the measurement is the number of tumor cells that were picked up by the needle. Not very useful if you look at how much missed there was. Instead the focus has shifted to try and determine if variances in the CTC can indicate effectiveness of drugs or predict who might be at higher risk for progression.

I think that recent studies have come a long way in showing that some men can still benefit from local therapies even though prior mets were discovered. We have seen this in the studies that showed that lymph node dissection in higher quantity is better that lower quantity regardless of if the disease was detected in them.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino
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