I’m linking an article below from urotoday.com dated November 2017 that is well worth reading by any of us who are in BCR after initial treatment. It caught my eye because it relates to and mentions a clinical trial in which I am currently enrolled.
This is an overview article “The Five-Take Home Messages of the LATITUDE and STAMPEDE Studies” – not a published study or trial. It offers a brief overview of these two studies and then discusses what the studies’ results may suggest for treatment of patients with either metastatic or seriologic (what we call BCR on this forum) recurrence.
Both the LATITUDE and STAMPEDE studies were done using abiraterone (Zytiga) on patients who had not previously been treated with standard ADT. All patients in the LATITUDE study already had high-volume metastatic PCa. The STAMPEDE included patients with bone mets but also include patients who had only positive lymph nodes and also patients who had no detectible mets or nodes but who had other high risk factors -- stage 3 or 4, PSA over 40, Gleason 8 to 10.
There is a lot to consider in this article, not the least being that the author’s ‘take-home messages” are just that – messages, not conclusions – he parses suggested trends and avenues for further study from these two trials.
Of particular interest to me was his message no 1” Yet more evidence that earlier intervention is better” This is where he mentions the study in which I’m enrolled: “Androgen Annihilation in High-Risk Biochemically Relapsed Prostate Cancer.” The goal of this trial is to shed light on whether early intervention with either or both abiraterone or apalutamide may confer any benefit in addition to standard ADT (Degarelix a.k.a. Firmagon) in terms of overall survival or failure-free survival.
I enrolled in the “Androgen Annihilation” trial after washing out as a candidate for the Prostvac vaccine trial because my doubling time suddenly began accelerating and pushed me out of the Prostvac trial's inclusion criteria.
As it happens, I was randomized into the Degarelix-only group of the Androgen Annihilation trial, so what I am getting amounts to the same standard treatment I’d be getting if I weren’t in the trial other than some additional blood tests and scans. I’m not disappointed to be in this control group. I wasn’t looking forward to the added SE’s of Zytiga plus prednisone, though I was hoping to get into the intermediate arm of the trial which included Apalutamide along with Degeralix but not Zytiga.
Another reason I’m not disappointed in being in the trial’s Degeralix control arm relates to the authors’ discussion further on in the article of the yet-to-be learned unknowns having to do the sequencing of standard ADT and these newer treatments. I wonder if using an everything but the kitchen sink approach at the outset may leave less to work with down the road. Maybe yes. Maybe no. Maybe down the road is significantly postponed.That’s why they do studies. https://www.urotoday.com/center-of-excellence/mcrpc-treatment/from-the-editor/100084-the-five-take-home-messages-of-the-latitude-and-stampede-studies-charles-ryan.html
-2002-PSA 9.4, 5 of 10 cores 30-50%
-RP 2002 PT3B N0 MX Gleason 3+4 75% left lobe small focus rt lobe
-PSA low 0.01 slow rise to 0.4
-SRT 2010 1 lymph node targeted. Casodex during SRT
-PSA 0.00 thu 2014
-0.02 Oct 14; 0.04 Apr 16; 0.2 Oct 16; 0.51 Jan 17; 2.46 Jan 18, 4.19 Apr 18; 6.62
-May 18 start Firmagon; PSA 0.45 Jun; 0.08 Jul '18; 0.02 Sept '18