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Gene-guided therapy - a video by Dr Snuffy Myers

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Gene-guided therapy, Gene Testing & PCa

In his video of 30 Nov 2011, Dr Snuffy Myers talks about gene testing.

Gene testing works by taking a sample of the prostate cancer tissue, and testing for some of the genes expressed by the prostate cancer cells. So the cancer must be biopsy-able.

Up until now, in choosing drugs to treat prostate cancer, medical oncologists have only had the results of large clinical trials for guidance. But these trials have produced drugs that are effective for the common "garden variety" prostate cancer.

However, he believes that there are distinct forms of prostate cancer that need to be treated and managed differently.

Treatment begins when the patient fails first line hormone therapy, which for Dr Myers is Lupron (or Zoladex) together with Casodex (Cosudex in Australia). This combination is sometimes called Complete Androgen Blockade (CAD) or ADT2.

If the gene profile shows that the testosterone receptor is over-expressed, then second-line hormone therapy is indicated. In other words, if the cancer still likes testosterone, keep the testosterone away with more hormone treatment with different drug combinations.

Secondary hormone treatment drugs he mentions are a Ketoconazole, Leukine, and Estrogen combination, Zytiga, and MDV3100.

Different populations where gene-guided therapy might help select drugs are:

  • Wide-spread lymph node involvement but no known bone disease, where hormonal therapy is very successful, but it is not clear what to do when that fails.
  • Bone involvement where the usual thickening does not happen, but instead the cancer eats a hole in the bone.
  • Wide-spread bone involvement with a PSA under 10 – an often rapid form of the disease.

At this leading edge of clinical practice, finding a practitioner would be a task.

But if you have the money and are interested, you can always, as he says to finish his video "Come and see us." Otherwise, await promising developments, like the rest of us.

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