Does Lutetium177 Increase Survival

[Barree]

Does Lutetium177  increase survival

¹⁷⁷Lu-PSMA-617 RLT  seems to prolong survival in patients with advanced mCRPC pretreated with chemotherapy, abiraterone and/or enzalutamide.

This article appeared today in Health Unlocked.

To see the article click on the following link - https://tinyurl.com/y7yolyaf

[pauldhodson]

Thanks Barree.

[Patrick Turner]

Hi Barree,

I read the same article about the German trial so maybe you are subscribed to the same site which sends out summaries of research every other day. 

What I read said

"""" After the first of an average of 3.5 cycles of treatment with Lu-177-PSMA-617, they had the following outcomes:

• 67 percent of patients had some PSA decline
• 33 percent of patients had a PSA decline of at least 50 percent from baseline
• Median overall survival was 56 weeks (13 months)"""

There are a number of possible questions to ask, and overall survival is kind of vague, and reminds us all that lifetime is a bit of a lottery, and anyone getting remission with Lu177 gets the lottery win, with everyone else wondering "was it worth buying a ticket?"

If 100 patients are treated, and 50 pass away within 13 months, it means just as many live 13mths as those who don't make it, and methinks its very easy to be in the group who don't make it. How many would survive 112 weeks ( 26 months ) ?  

It used to be said that when Pca was found in bones, a man has 2-5 years left, and that 95% pass away before 5 years. I very much understand why a man would spend a substantial sum if he has some to spend on extending his time, and the PsMa Gallium68 scan is now detecting Pca in bones when tumors are very much smaller than what they were with older CT scans which then predicted the 2-5 year survival. I'd guess that I'd have 3-8 years based on the last July PsMa scan I had. But the earlier the detection of Pca mets also makes it is much harder to predict anything, and just because Psa figures take a nose dive, it does not mean a man is in remission. Psa figures fill us with fear and gloom when they rise, and with happiness when they fall, and how long will Psa keep falling after Lu177?

 

There is continuing research with Actinium223, and research on types of ligands to bind radioactive molecules to wherever Psa producing cells are located. One may wonder what could extend the rather poor median survival time to a more cheerful 5 years instead of about a year stated now.

 

I suspect good research may be able to invent ligands to bind chemo therapy chemicals such as taxanes to Pca cells to make chemo therapy many times more effective than it is. I recall when Provenge immune therapy was announced ( costing US90,00 ) maybe 6 years ago, they claimed 12 mths life extension, but later revised it down to 4 mths, which did not prevent a lot of men spending $90,000, and 50% of patients passed away before 4 mths, and probably 10% may have lived 4 years.

 

When many men read about a latest treatment, they feel they want it much sooner than doctors will allow it. If a man is diagnosed with a Gleason 8+, why could he not have Lu177 straight away if its likely that Pca has already spread? should a man have an RP if he has a Gleason 8+ ? . "High risk" Gleason 8+ means that its likely to have spread, and an RP is likely to not be fully effective and that once healing at RP site is complete, then some sort of RT must also be used, and it may as well be Lu177. Maybe to only reason for not using Lu177 soon after diagnosis are the side effects. The existing protocol of prolonged Pca treatments are believed to give the best quality of life for longest time while at least the doctors all know there's no cure yet. I think there must be far lesser side effects before Lu177 use could be moved closer to time of diagnosis, when we all might agree that something must be done soon as Pca is found. I would guess that PsMa scans may become more sensitive than they are so far, and that is going to give more men bad news sooner about their cancer status, but it also should propel these men and doctors to be less blasé and less assuming, and have researchers ask just what might work earlier than otherwise.

Patrick Turner.

[Maffy]

Thanks Patrick,

 

Sound like there's just no hope, even with these new research.

[Barree]

 

Hi Maffy, 

Where there is life there is hope.

Life and Prostate Cancer treatments are I feel very akin to the way we view life itself.

It's very much like the glass of water when the water is at mid level -  is it half full or half empty.

The optimist sees it as being half full  - the pessimist as half empty.

 

Getting on for 20 years ago now I was diagnosed with PCa and told to get my affairs in order as I had about 6 mths to live.

A prognosis I refused to accept. No where on my body have I ever found a use by date.

 

Since then I have been on various clinical trials. I have applied for every clinical trial I felt would extend my life, including the first Lutetium 177 trial.

The initial Lutetium177 trial for me concluded back July 2016.

At times it hasn't been easy but I am still alive and kicking goals.

I cant agree there is no hope.I am optimistic and full of hope about the range of new Prostate Cancer treatments and drugs that continue to appear on a regular basis and I keep looking for the next treatment or trial that looks as if it will give me some more time - who knows what will come along in the near future.

 

Cheers,

Barree

 

 

 

[Patrick Turner]

Maffy mourned, "Sound like there's just no hope, even with these new research."

 

There is hope that a cure for Pca and for a vast array of things that cause death will be found. But don't hold your breath waiting, and be prepared for the worst. 

Latest stats say a man should live to 80 and a woman to 85 and I'm at 70, but have Pca which might kill me within 5 years. But Zytiga wasn't around when I was diagnosed so where would I be without it? I'd be on Docetaxel, and death most likely in 4 years, with no prospect of Lu177 extending my time. I saw what happened before the Psa test came along, blokes keeled over real quick and were often diagnosed with Pca so advanced they'd get a short time of respite after getting balls cut out - surgical ADT - and then Pca would go on to kill them with a horrible couple of last years. By the time I got to 55, there were so many ppl afflicted by cancer I just wondered when my turn would come, and I didn't have long to wait.

 

But had the medical system been regulated to advise a man to have a biopsy at Psa 3.0 like many other countries, instead at 5.0, I might have been diagnosed with a Gleason 5 or 6 maybe in 2005 when Psa slowly drifted above 3.0. Getting it cut out then would have been easy and probably would have been before it spread, which probably occurred by diagnosis in 2009 and Gleason 9, local, but outside the capsule and inoperable. So I've always lived with this sense of dread and little hope, and when someone asked me if I had any dreams I wearily told them "No, but I have a lot of plans" and that was when my knees got so bad in 1993 I was forced onto Centerlink sickness allowance for 12 months and right out of the building trade. Without hope, and without being valued by anyone else, and while robbed of vitality, confidence, and mobility, and zero chance of ever finding partner, I taught myself about electronics and began an 18 year career repairing Hi-Fi gear and doing some hand crafted manufacturing work. see www.turneraudio.com.au  I declared myself useless and unavailable in 2012 when I turned 65 and the old age pension seemed like an unbelievably large and very cheerful income, and I could say farewell to the hoard of grumbling customers who badgered me into working for a tiny fraction of what they were being paid. I discovered much happiness in uselessness.

 

But from 2009 to 2012 I had to cope with being possibly dead soon after I retired. But ALL the old tradesmen I'd known barely ever lived beyond 65, and my father, a vet, died quickly of melanoma at 60 in 1973, well before Keytruda  became drug of choice, and one sister died in 2005, 18 months after diagnosis that was at least 6 months too late. Women were being mown down by breast cancer before 1990s, but some are surviving OK, my other sister is 73, after 8 years now, thanks to detection scans and better medical practices. I'm now 10 years older than when a father and sister died, and any more life is a bonus, and apart from Puff The Magic Prostate Grenade slowly exploding under me arse, there's very little else about me that worries doctors and or me; ie, there are no "co-morbidities" and my days of filled with trying to make my website better for those fascinated by analog audio electronics, talking to men such as yourself, and trying to make  many ppl around me crack a smile when I am with them wherever I go, and so life is full, and extremely cheap to afford, I do not need ever increasing wealth, or consumption of "pleasure goods" such as a world trip on one of those dreadful high rise ships, or a Maseratti, or a big house on Sydney Harbour. Money never made me happy, it never bought me love, and I get by on the simple wonderment of each day, and I feel no need to do more or be better or put on yet more agonies and style. Perhaps each of us has a different outlook, and I think myself lucky I never seemed to secumb to substance addictions, or other mental dysfunctions.

 

So when you say "hope", I can only tell you that hope may be different in minds of others and some ppl say they have a lot of hope, while some have little hope, or may be deeply pessimistic, depressed, and I really wish I had the power to lift people from the gloom that engulfs them. After finding it was so difficult to keep a wife no matter how understanding, compassionate, hard working and charming I was I began to share my house with others who didn't want to be fully alone in a flat and who found it difficult to mate with anyone. The last person came here in 2003, and she finally found a flat of her own in 2014, confident that she could be alone OK, and she was depressed on many days, allergic to nearly everything, but we never had an argument for the 11 years, and she was an excellent lodger, but there was no hope of any fix for her mental conditions. I'll never forget one day she said. .".....I really hate love..." I knew just what she meant, and I once rode along a bicycle path where someone had painted "I hate love". The fact is many just can't find any love, or if they do, they hate it, so it vanishes, and the whole media and culture spews this spiel about happy rosy love all based on erroneous opinions about faith, hope, charity, and a pile of other things, so there is mist of anxiety clouding everyone's mind, and nobody seems to completely escape it, and getting older is no ticket to Hopia, the utopia where everyone smiles and giggles until 120 years old. But she like myself and others go on, and we all seem adrift on a raft called Life, and sooner or later there's a big storm.....

 

So my getting old has me demand I put how I thought at 30 to the rubbish bin while retaining my best ideals. Some say 70 is a time to be spiritual so many head back to a church but I find no solace with anything supernatural because I think humanity's flirt with religion is an imagined answer to the desire for inner peace, the damned worry of being alive, the pain of love. But goodness just is, or just is not in yourself or others, so look for your goodness, and if there is some in others, be grateful, and buy them lunch.

 

At about 17, I found all religious organizations were often filled with flawed people, very disagreeable with anyone outside their narrow minded views of how things should be, and I have not regretted losing God, because I feel the real God is an infinitely incomprehensible being which cannot have any human characteristics and I am at peace being a temporary and insignificant part of the eternal progress of the Universe, which I will NEVER understand. I will not be me after I die, so it would be a good idea to go from now to my end without making anyone else feeling sad, bad, afraid, angry etc, and this is my only chance to do it.

 

At this time of year, I get attacked by magpies when I cycle into their territory and they don't know me. Living things have been attacking other living things for about 4 billion years, and this reality is alive and well, and I apologise the maggies rather than stop to shoot them, but to really make a difference to their hormonal rage while breeding, I'd have to feed them, get to know each one, and I don't have the time. I am not so well intentioned to my Pca which just a bunch of complex cells which have lost growth control structures in DNA, too complex for us to understand yet. Life has a constant lot of change and fight levels going on, we have little control but my advice to myself is "bear it old man, just let life be, avoid what you can, make better what you can, choose wisely...." I used to say I had no right to ask life to give me more than it was prepared to give me.  I used to tell difficult women, "Your problem is you want more than can be had", and it didn't calm them down.

Today I got more hedge clipped, and did a small ride of 24km, not a bad day. Time to eat, 

Patrick Turner.

 

[Patrick Turner]

Barree said "Where there is life there is hope."

I agree entirely. I was born too early to be in an era of the best future life extending treatments. But there has been some progress since my diagnosis in 2009. Whenever someone says a cure is just around the corner, they usually find after they went around the corner they became lost in a maze of complexity, with more questions than answers to be found.  

Patrick Turner.  

[DaveK1200]

21 hours ago, Maffy said:

Sound like there's just no hope, even with these new research.

 

Hi Maffy,

I agree with Barree when he said Where there is life there is hope.

 

Perhaps you might consider looking into some complementary therapies that you can take alongside your current treatments.

My urologist and oncologist both told me what I wanted to take wouldn't help me, but they also told me they wouldn't do any harm either.

 

They certainly gave me lots of hope, and that's priceless.

 

Best wishes

 

Dave

[Maffy]

Hi Barree,

 

Your story is very interesting to hear too. How did you manage to survive? Some are saying we need to combine treatments with dieting and exercise, what did you do apart from volunteering to all the new drugs? 

 

Blessings,

 

Maffy

[Barree]

Hi  Maffey,

 

I wont pretend that survival  has been easy or a breeze for me or my wife - but necessity is a great motivator. We have made every attempt to live life as normally as  can be done when one has advanced metastatic prostate cancer.I kept working until I was 70 and I am always active and busy there is never enough hours in the day.

I am involved in a local Prostate Cancer support group, this group, and  I usually finish up having one or two visits to hospital each week as I have other medical problems aside from PCa.

In addition to my scholarly interest in prostate cancer research and treatment, I am heavily involved in a range community projects.

 

Whilst I  participated in Deakin University Impact exercise trials for a year, and keep reasonably active, I have never gone overboard in terms of any long term continuous or arduous exercise program and my wife keeps me on the straight and narrow with a very normal but healthy diet.

Although of recent times mobility is becoming more of a problem.

 

However, I  have for many years taken charge of my own health and accepted the fact that I am responsible for making the decisions relating to my cancer treatment. I spend a lot more time than most - researching the treatment I am currently receiving  and other possible main stream treatments and trials that might be beneficial for me both now and in the future.

 

Cheers Maffey,

Barree

 

 

[Patrick Turner]

Maffy said "Some are saying we need to combine treatments with dieting and exercise...."

There has been a deafening roar from many doctors and health / wellness promoters, but despite their urgings, so many ppl are deaf to any advice about diet or exercise, so by 60, very many ppl are unfit, overweight, and supposedly more prone to all sorts of ailments compared to those who are fit, and not overweight are not so likely to get. But cancer isn't choosy about who it takes down, and the times I sat amoung other patients waiting their turn for RT shows that a large variety of personal conditions are to be found. I am sure my GP and my oncologist are happy when I turn up dressed in lycra with a bicycle leaning on a wall near the entry desk. I have zero idea whether my mainly vegetarian diet and addiction to cycling 250km+ a week has any slowing effect on my Pca. The benefit may be mythical, but hey, I like to feel alive, and I cannot say where my zest for puritanic frugality evolved, but it just did, and it was about how I felt and it goes back to before Pca diagnosis. This morning I cycled with 10 men 55-75, and 4 women 30-55, and on a 65km which most sane ppl would think was a form of 100% masochism,  and I had heart rate way up max for 25% of the 2:45 time on some gut busting hills, and some wild chase alongs on flat parts of the course. I am on Zytiga, and it has a side effect of "heart attack" but maybe because I do exercise so much, I may be insulating myself from having heart failure soon. If I sat around doing almost nothing and gazing at screens of devices I might suffer sooner. I DO spend much time sitting because I'm re-editing a website. I kind of know what would happen if I was sedentary. 

One fellow in the group is 75, and doesn't look a day over 50. Maybe he's cycled 500,000km, more than twice my total so far. 

 

However, if I say diet and exercise is good, and someone then tries it, don't expect miracles. Both these lifestyle choices must begin slowly and you gradually work upwards. Just how anyone's body responds to the complete lifestyle change to become capable of big things with exercise depends on genes, and on ability to commit, and before you run a marathon, you need to build up slowly to avoid injury, or avoid a heart attack. There are some folks who begin too late, but some say its never too late.....

 

I have zero special genes and I was a natural born plodder, and I rarely won any of maybe 200 cycle races I did in 1980s and 90s. I never ran anywhere, yet the deep commitment remained in me to keep myself in shape. Most people around me "went to fat" as they aged, and my attitude to what's right was seen by many to be grossly un-social because I could not share their pub & club culture. The more active and constructive I became, the less chance I had of marrying; one finds oneself in the outcast minority of health "nutters".

I felt quite comfortable about this though, because really good health makes you less needy, you share OK, but depend less on others.

 

So its probably how you feel that determines any sustained follow-through; many make the new-year's resolution to get fit, lose weight, but what % ever achieve anything? 

 

It appears Barree is so well occupied he must have been amoung the lucky who find sustained rewards of being so occupied, and maybe he doesn't spend much time sitting around moaning about his Pca. So Barree's way of being seems pretty good to me,  and he must have asked thousands of questions to sustain his journey so far.

 

Trials are not always easy to find, and when you find something you think you are suitable for, and your doctor refers you to take part, its not always going to turn out well. My oncologist found a trial of Ipertasib, some chemical that is added to existing ADT, and so it took 3 weeks before I had a date to start. Docs said I'd definitely be included. But when I got to talk to the docs doing the trial after travelling 300km they listen to my story then tell me I would have been an ideal patient for inclusion, but then tell me the wanted numbers for trial had just been reached and they could not include me. So I copped the old run-around. I though maybe the docs doing the trial could have thought I really would not have benefitted, and thus made their trial more likely to fail, so it seems to me docs like to cherry pick patients to some extent, and they don't tell you the real truth. But that does not matter because if the trial does succeed, I might be able to access it as a paying patient. I looked up the chemical online, and it seems to be a minor benefit chemical, with results elsewhere being unclear, so not being in that trial was not a bit slap down to me. 

 

I thought I might be in next trial for Lu177 in Melbourne within maybe 4 months but it seems I just ain't crook enough yet because I am not yet using Docetaxel, ie, I am not on chemo, because I am still on ADT which is said to be working. If I am never in trials for Lu177, or Radium or Actinium targeted RT,  it does not matter  much because I might get Lu177 as a paying patient if the doctors decide it should become routine practice and it may filter down to being local and to nearest public hospital within a couple of years, and by then there may be some splendid improvements to such treatment and new measures to reduce side effects.  We have no idea what research is about to give us for targeted chemo therapy, or immune therapy; it is impossible to know because these are done secretly, and the publicity to progress is given to attract maximum funding so new cancer fixes are subject to the "politics of money and egos".

Keep well, and sane, and I know its difficult,

Patrick Turner.

 

 

[whatmeworry1941]

With my Dad being recently diagnosed with Advanced Metastasised Prostate Cancer in August, after having a minor heart Attack in June.

 

His PSA's were around 800 but after treatment with Bicalutamide and then two weeks later with the Goserelin implant it got down to 100 on October.

 

They discontinued the Bicalutamide, with the next Goserelin implant in November.

 

As many father has never had Docetaxel and is probably too frail for it and PSA's falling it looks like he isn't eligible for the trial.

 

I hope somebody sets it up privately in Melbourne.

[Patrick Turner]

14 hours ago, whatmeworry1941 said:

His PSA's were around 800

It appears the doctors have started your dad on the standard form of Adrogen Deprivation Therapy, aka AHT, aka Hormone therapy, HT, and so far the activity of the cancer has been much reduced and It appears the doctors plan to give him continuing monthly injections of Goserilin to suppress his internal production of testosterone. I have had the same treatment since 2010. I presently alive and very well even with a large number of small mets in bones. But it seems maybe you dad was diagnosed when Psa very high, and he may not have had yearly Psa tests. His Psa may have been only 5.0 at 4 years ago if the doubling time was 6 months.

 

Before my diagnosis my Psa had a doubling time longer than 2 years, but after Psa hit 5, and diagnosis, doubling time reduced to 6months, and I had an inoperable Gleason 9 grade tumor which had probably already spread so that the initial treatment with ADT and then radiation didn't work on the main Pca site of prostate gland, and even if it had worked, the many metastasis sites were not radiated and I was not free of the disease even though Psa went from 8.0 at initial attempted operation to 0.08 at 18 mths later. When I paused the ADT in 2012 for 6 mths, Psa went from 0.08 to 8.0, and I re-started ADT and got Psa below 0.25. But Psa slowly crept higher, and I knew the Pca would be a threat as long as I lived, and all I could do is slow its progress down. I knew I could never get permanent remission, ie, a cure, such a thing is presently so extremely rare it is thought to be virtually impossible, and I have ZERO hope of ever getting a cure.

 

I don't know of anyone who has begun Docetaxel chemo therapy before having spent years on ADT. You may like to hit the cancer hard and soon, get your dad well, but you may find that there's no evidence to indicate early chemo therapy would work. You say your dad is frail and may not withstand the side effects of chemo. Perhaps this is true. But we don't know how old your dad is, and if you were born in 1941, you are 76, and dad might be 96, and I'd agree he may not like side effects of chemo. The ADT can only slow down the Pca; it puts the Pca cells into a sort of coma, they don't die, but remain dormant. But your dad's adrenal gland makes a very small amount of testosterone and its not suppressed by normal ADT so the Pca does get s tiny amount of testo so it grows very slowly until it changes its chemical structure to enable its self to grow without testo. So normal ADT does not work for longer than about 10years, but some get only 2 years before the ADT becomes ineffective. I've had 6.5 years on normal ADT, but am now on much stronger ADT drug Zytiga, and I might get two more years of Pca suppression. Then the Pca will mutate to grow and everything the doctors do will not work. Chemo and systemic radiation like Lu177 may only hold it down for 2 years. I could easily be dead in 5 years.

 

But I'm only 70, and apart from Pca, I am lucky to be fabulously healthy; I cycle 250km+ a week, and some blokes 50 struggle to keep up. 

But by 80 or 90 I will take my turn to become frail and unable to respond to treatment. I'd like to delay the inevitable, but it is of course impossible, so I hope there's good palliative care when I need it, or some other means of quitting if I just don't want to live any more. 

I never got around to having my own family so I am alone, and I go to a place of care away from home I know I'll be amoung the 50% who never get a visit during a full year, but that's how it is now, and I am used to being alone and not grumbling about it.

 

Care for aged ppl in Australia isn't something we can be very proud of. I'm involved with enough ppl to be happy. Having Pca is no worse than having some other long term chronic disease, and if a bus runs over me tomorrow, so be it, but my care of myself has been so good that I may well spend a few years away from home, which is just a damn house, and I'll agree with the move out and end game when doctors can see what is going to happen.

 

I have seen a number of people transition from home to care, and they passed without too much prolonged agony. There's few ppl here who can talk about their future. I can, and I know I have a short future; it is being real, and I've never needed any help dealing with reality.

 

But if you need help, then seek it, and talk to those who may ease your disquiet. We all wish we could provide a better solution to the pains of being alive, but we can only share stories of how we extended life to the maximum, and all of us suffer when a loved relative is in trouble. I watched my dad fade at 60, from melanoma, and saw my mum live happily to 98, and she was comfortable as possible but much of how my sisters and I remember her vanished well before 98, and she wasn't fully aware when nature took its course. One sister is already gone, and she died bravely at 60 from ovarian ca and day before she was chirpy and happy at the care place, but knew she had 2 weeks max, and she overdosed on the morphine drip to avoid the 2 weeks, unable to eat again. It may be the same for me, those around me will know when its time and give me a little help. Its going on all the time and may become officially OK in Victoria soon. 

 

But between now and my end, I want to live, and maybe I'll cycle another 50,000km, and not be completely alone. If Pca pushes me off the bike and off Planet Earth, then so be it.

 

It may be very good luck for your father to be included in next Lu177 trials. Word has spread about Lu177, and other special new RT, so demand would be huge from hundreds if not thousands of men and their families wanting to keep life going. It seems the qualifier to be included in trial is to have progressed to having chemo, and the LU177 is not going to be used before other things like ADT has begun to fail.

 

I've heard there's a clinic in Perth and with Sydney branch giving Lu177 infusions at $10,000 each, and maybe a man needs 4 infusions.

Your dad needs referrel to them by a doctor and there would be a conference by skype to Perth clinic which isn't cheap but you need to remember that whatever treatment you want for your dad may not be deemed to be worth trying.  The doctors have already seen hundreds of similar cases. And the doctors all hope that some better treatment will become available soon but "soon" may be 10 years away. There is some hope for immune therapy which is presently being heavily researched at Sloan Kettering hospital in US and there may be good improvements for the targeted Lu177 and other similar things but I am not holding my breath.

Patrick Turner.

[whatmeworry1941]

My Dad's last psa test was 20 in 2012. His regular Doctor retired and ignored/forgot about the test. He is 83 now. He said he wanted his prostate removed but I think they did the watch and wait method. I am in my 30's.

 

He did get some radiation for his pelvis as he was immobile.

 

I did look at treatments in Sydney privately. He would probably need 2-4 cycles if he has the right PSMA expression, only problem is cost as it would drain their life savings. Just reading about that bloke at the Peter Mac (AFR Article) whose mets were cleared and his PSA dropped significantly after Lu177 gives all us hope that of getting some more time. I just hope the doc requirement isn't a problem for inclusion.

 

On the family issue, have you looked at countries like Russia, Ukraine, Thailand or the Philippines for a lady friend?

[Patrick Turner]

2 hours ago, whatmeworry1941 said:

My Dad's last psa test was 20 in 2012.

Hi WMW1941,

Pardon me making conclusions about your group name where I wrongly assumed you were born in 1941, which would make you 76.

Your dad isn't young, but we'd all like to see him live longer. I can only say how tragic it is that there was no follow-up after a diagnosis of Psa 20 in 2012. Psa was probably 5 maybe 2 years before and that was when the public health system is supposed to follow up with recommendation for specialist for biopsy, and I do not know how persistent the specialists are to make sure there is a follow up. But in my case, I was right onto the docs and I chased them rather than let them chase me, and even then my urologist was slow to refer me to an oncologist to restart my ADT because both the urologist and radiation specialist has failed dismally to do anything other than tickle my Pca pink. Once I was diagnosed with a Gleason 9+9 I think they thought I wasn't worth worry about.

The oncologist works as private specialist like urologist-surgeon but must do time in public hospitals to administer public patients who are fully covered by Medicare. I don't believe I could have got better treatment privately, but the system for allowing Psa to go to 5.0 before action is taken lets some men like me get a real bad grade of tumor before anything is done.

I should have been given biopsy at Psa = 3.0, a recommended level in other advanced nations, and normal Psa for most men is 0.7 at 40 and 1.0 at 60, and risk of Pca is extremely low. My Psa would have been 3.0 some 4 years before diagnosis, but I bet I had Pca with Gleason 6, and maybe before spread occurred.

As a result of diagnosing me late, Unkle Taxpayer has forked out a huge sum so far, most of which could have been avoided. But Polly Tishans say there'd be too many false positives with Psa 3.0. So they are stupid because they appear to be seen to prevent excessive health spending but then cause too much spending catching the horse after its bolted. 

 

If I didn't have enough savings to cover the costs of some of the private hospital costs to get treatment unavailable in ACT, I would have had to arrange a reverse mortgage on my house. Buying private medical insurance at 70 is probably impossible and the refunds for private hospital costs maybe no more than just getting about 45% refund from Medicare. While I do have funds in the bank, I have in fact got MY OWN insurance company, and I don't mind if its owner makes no profit. So if you save say $200,000, you can pay the bills not covered by Medicare, and be thankful we don't live in USA where my $15,000 out of pocket expense last year would have been USD $60,000. That was for "salvation IMRT to PG to boost total level to 101Grey after initial 70Gy in 2010, which allowed most Pca cells to survive. 

I would doubt that any treatment directed at your dad's PG would help much so maybe Lu177 is the only way. And because Lu177 is not yet available at public hospitals, you are forced to buy it from private operators who like to be very private about just how much profit they make. I can't advise on what Medicare might fund for Lu177; Barree might know though. The last .pdf about last year's trial of Lu177 for 30 patients at Peter Mac says that the next intake for next trial of Lu177 for many more men will be for men on Docetaxel, and you have not begun that you can't be in the trial. Basically, the trial is for men who don't have many options left. But you dad may see his Psa go down to less than 5 with ADT, and maybe any symptoms he has will reduce, allowing him a few years of good life quality and without the side effects of Lu177. And when the ADT he's on now begins to fail, docs may try Zytiga, abiraterone, and that may give more years.

I've heard of men whose Psa was up to 3,000, back to less than 1.0, maybe 3 times during a 10 year period. There are HUNDREDS of stories typed into online support groups in USA and after reading a hundred or more I began to get a better idea of where I am and where many others are. So its not yet time to give up hope yet.

 

You mentioned "have you looked at countries like Russia, Ukraine, Thailand or the Philippines for a lady friend?".

I once did look around when I was about 38 and after I'd had a lady from Toowoomba fall in hate with her life here and do a moonlight flit. You see, there's love, and then there's respect, and trust, and shared reasons to stay married, and I found love rarely conquers all. MANY things have to be right, even when you are the most beautiful and marriageable man to be found because you don't have any kids, bad habits and you have paid off the house loan, and have a good job.

 

Anyway, one cannot draw up a wish list but you can really only gather a lady from those available, and give things a try. Oh how willing the ladies were for love I found, but NONE shared my other serious concerns, and nearly all the local born ladies had children from a previous marriage and were poverty stricken and although I was well off, I had the small net income of a sole trader building contractor, and I could not accept I would be financially challenged to pay for her and her offspring. The women in this position just wanted me for sex, and wanted nothing deeper, and they proposed not one single solution towards anything constructive. Time went by, as it does, I wrote to Phillippine girl, but she turned out to be a male scammer. This was in days before the Internet, and I found later that the Internet dating sites just don't work. The trouble is now that I am sexually quite dead, and the women tend to want "financial security" and there are far too many stories similar to what happened with Lang Hancock, ( Gina's late dad ). Some imported women may indeed be fine housekeepers; after the divorce, they keep the house.

I am extremely independent. At age 40, while I was always looking, there was one item which finally released from ever needing a woman;  it was a sewing machine, and I could patch up my cycling gear and clothes to make them last longer. I never expected the ladies to do much around the house, that's futile, they do only what they like, and it ain't housework. Sex, sure, but housework? having kids? no way. 

 

The idea of needing anyone is not ideal for me, but admiration and sharing togetherness is the ideal. And I found if I discussed such issues with a female, it led absolutely nowhere. Not one lady ever needed me. The better I tried to keep them happy, the more confident they became so when, nit if, they departed, they'd go real well with Mr Next. Some told me later how suicidal they felt when they tried, a side effect that wasn't expected. So I could be an angel, they said it was boring, but my life was well spent working for couples who really did make it work, and they held hands while I described the work for their house extension. These were the salt of the earth types of folk, and pleasing them was extremely important, and very rewarding.   

 

The ladies I met in 1980s were to never do what their mothers or mine had done, and had I insisted otherwise, the relationships would not have lasted as long as they did. But at least nobody was killed in this silly process of mating attempts.

I did have a procession of male and female boarders who helped me with expenses and all got on fine with me so I was left wondering why do daily relationship go belly up where there's sex involved? The trouble is that nobody can have sex without the idea that there must be care and love. So ppl have sex without love, and then the neurotic behavior sets in. But I stayed, in my house, they went to the next in a long list of blokes......  and I really do not feel I want to play that silly game ever again, and I have come to terms that no woman will ever touch me again. The last one who did was a beautiful Indian Goddess intern at Canberra hospital in about 2010 and she poked a Good Finger up my rear to feel the size of my PG before EBRT. The previous one was also 40 yr old Goddess GP, and she also did a GFUR before my biopsy.

 

But that taught me something. Digital examinations by men have always been in-out under 1 second. But that GP spent 20 seconds, and if I'd had any hard lumps, I would have felt her feeling them, but no, my PG was just a big swollen puffy soft thing. But at that time it felt pleasant, and I now understand why some fellows might enjoy a prostatic massage at some parlour somewhere, or by a partner. So that lady GP may have been trying to satisfy her medical curiosity, as she'd always done, or she could not have become such a fine GP. I have never felt awkward about an intimate doctorial investigations and have in fact made enough jokes about it to keep the doctor and myself smiling. The idea of marrying someone like that GP crossed my mind, but usually all have another professional partner. The world is full of ppl practising severe discrimination when it comes to who they marry.   

I have a lady dentist, she's Vietnamese, and she's a much better technician than any other male dentists I have ever had, so I love women, but for my private life, unless I get an offer I can't refuse, then I will be single when I die, and just handle it all alone, like so many others.

 

I did once date a Chinese lady 33 from Beijing, for a month in 1988, visiting OZ on 3 month visa, but her English was atrocious, like my Chinese, so we pointed at words in her tiny travellers dictionary, and I drove here around to show her Oz, and get togetherness going. Her mental age was about 16, because she'd never had any kind of our freedom under the time of Cultural Revolution, and maybe she was daughter of stern Communist family, and she wasn't willing to write to me, and so the international culture differences were not bridgeable. The other Chinese where she stayed were extremely critical of us Australians. I just cannot love a woman I can't talk to, so at my age any foreign woman has zero attraction for me. It just does not matter how good they are in bed. I'm only good for one thing now, money, and a ticket to the West, and I've seen so many cases where the day after 2 years of marriage is done, they leave, and they have Australian citizenship, and they don't want to be with some old bugger they can't love. Maybe I have said enough.

Having a bicycle is about enough for me, at least I can go for damn ride any old time I like :-).

Patrick Turner.

[Barree]

The upcoming Lutetium Trial

A  number of members have expressed renewed interest in the forthcoming Lutetium177  trial.

The following outlines some of the basic pre requisites for patients hoping to enroll for this study.

We understand the trial will be open for enrolment late 2017.

NOTE:   You must have received treatment with docetaxel chemotherapy to be eligible for this study.

This trial will compare how Lutetium¹⁷⁷- PSMA compares to the best current treatment  (cabazitaxel) in terms of shrinking the cancer, reducing pain, delaying the time until the cancer grows again, effects on quality of life, safety, and how long men will survive after treatment.

Where will the trial be?
The trial will open at Peter MacCallum Cancer Centre in Victoria and St Vincent’s Hospital in Sydney.

In the near future, it is anticipated the trial will also open at the Royal Brisbane Hospital in Queensland; The Austin Hospital and Monash Medical Centre in Victoria; Royal North Shore Hospital and Liverpool Hospital in Sydney; and Fiona Stanley Hospital in Western Australia.

This study will compare Lu-PSMA with cabazitaxel a chemotherapy treatment for men with prostate cancer that has spread to other parts of the body and has continued to grow despite standard treatment, including hormonal treatment and previous treatment with docetaxel chemotherapy.

What is Lutetium and how does it work?
Many prostate cancers have a substance on their cell surface called prostate specific membrane antigen (PSMA). Lu-PSMA is a radioactive molecule that, after injection into a vein, specifically attaches to cells with high amounts of PSMA on the surface of the cells.

This allows the radioactivity to be delivered mainly to the prostate cancer cells wherever they have spread and to kill those cancer cells.

If you don't have sufficient PSMA on the surface of your cancer cells this treatment will not work.The amount of PSMA exuded by your cancer cells will determined in the preliminary tests that are carried out before you are accepted for the study.

Will everyone in this study receive Lutetium?   -  NO !

Half of the participants will receive Lutetium¹⁷⁷- PSMA and half will receive cabazitaxel. You and your treating team will know which treatment you receive, but you do not get to choose which treatment you will get.

There is no point waiting or applying for a trial if you do not fulfill the requirements/prerequisites specified by the study coordinators.

Barree