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New treatment for some men newly diagnosed with mets

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Jim Marshall (not a doctor) said ...

An enormous ongoing trial (STAMPEDE) has so far enrolled more than 10,000 men investigating prostate cancer treatments.

Some 2000 of these men were newly diagnosed with prostate cancer with metastases.

The researchers tried to see if giving these men radiotherapy would help with survival. (The radiotherapy was high-energy X-rays.)

Radiotherapy did not help those with too many metastases (mets). But those with only a few mets (a "low metastatic burden") did live longer.

Any man had a high metastatic burden if he had:

  • four or more bone metastases with one or more outside the vertebral bodies or pelvis, or visceral metastases, or both.

All other metastatic men had a low metastatic burden.

(vertebral bodies = spine, pelvis = big bone which includes hips, visceral = non-bone)

The authors suggest that radiotherapy should become the new standard treatment for men who are newly diagnosed with a low metastatic load.

Other doctors commenting suggest that men with only limited lymph node involvement with no mets should also get radiotherapy.

Note the trial used older forms of scans that did not detect small mets. If a man has used a newer more sensitive scan like the PSMA Gallium-68 CT/PET scan, your doctor will only count mets larger than about 15mm in deciding if you have high or low burden.


We will discuss this matter at the phone-in meeting next Friday, 26 October 2018.

... end Jim


The Lancet article published last Monday:




The Fin Review article by Jill Margo that member Fergie brought to my attention:




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Just read the Lancet article, and I know I have banged on about this before, but .....  why are so many men being newly diagnosed at their first diagnosis with metastatic prostate cancer, and so many with high metastatic load, eg lots of mets ???  I would love to know what the stats are from Australia for the number of new diagnosis for men with mets compared to those with the PCa still contained.  Surely if we have the same sort of figures as the UK, we really need to lift our game for getting men tested at or by age 50.  They can do it with breast and bowel cancer, surely with the right "persuasion " they could do it for PCa.  Lets discuss Friday !!

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Bruce Kynaston

As a very much retired consultant in radiation oncology, may I say that the biological basis for the findings of the study is that with a lower tumour 'burden' = total cancer cell population in the primary site (prostate) and the identified metastases, and assuming that each cancer cell in these sites has the same chance to contribute to increasing the number of metastases, It follows that the early treatment to curtail this activity, the longer it will take for significant (larger) metastases to challenge the patient's 'comfort zone" meaning well being.

I hope this makes sense to the reader.


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