What advances to expect in prostate cancer treatment in coming years?

@climateguy

Sounds very promising. I will check it out.

Thank you for sharing.

Given that my PSA remains “undetectable” at the one-year mark, but I also have significant pathological and biological risk factors for recurrence, I am continuing to be on BCR watch.

While I am on BCR watch, I plan to keep an eye on relevant clinical trials and emerging breakthroughs that could improve the detection and treatment of recurrence. In particular, I will be watching four areas closely:

① Better PSMA imaging at very low PSA levels

So that we have a better chance of actually seeing and locating a recurrence while the disease burden is still very small. That is why I am particularly interested in learning more about the Quadra PET/CT scanner mentioned by @jeffmarc—not only its capabilities, but also where it is currently available, since it appears that only a limited number of institutions have access to this technology.

② MRI-guided adaptive radiation

The goal is to make radiation treatment conform more closely to the patient's actual anatomy at each treatment session, potentially allowing better protection of surrounding healthy tissue. I will continue following the clinical trials and research being conducted under Dr. Amar Kishan at UCLA in this area.

③ Smaller margins and more focal salvage treatment

The smaller and more precisely localized the recurrence, the less normal tissue we may need to irradiate. I will also continue following UCLA's research and clinical trials under Dr. Kishan involving SBRT, smaller treatment margins, and more precise salvage approaches, and will share what I learn with the group.

④ Better systemic therapies with less toxicity

I am particularly interested in treatments that could eliminate microscopic disease or delay its progression without requiring prolonged ADT and its associated systemic side effects.

For me, the hope is that if BCR does eventually occur, advances in detection, imaging, radiation technology, and systemic therapy will give us more precise and less toxic treatment options than are available today. In the meantime, I plan to keep learning and sharing what I find.

I believe the only real cure for prostate cancer will be when one of the numerous immunotherapy clinical trials successfully demonstrates a drug mixture that supercharges our immune system to find and kill the cancer cells in our body without damaging healthy cells. That is the stumbling block. Too often when our T cells and NK cells are energized to kill the cancer cells, they eventually destroy so many healthy cells that the body's organs fail. That is called Cytokine Release Syndrome (CRS). Once CRS is overcome, it will be a major breakthrough in treating prostate cancer.

I agree with you 100% about a real, total cure for prostate cancer, which I think is probably many, many years away given how transformative such a breakthrough would be.

However, I believe we may be talking about two somewhat different things. I certainly hope the ultimate cure for prostate cancer will eventually be found, but that wasn't really the point of my post.

Given that I am currently on BCR watch, I am more focused on the incremental advances that may become available in the next few years—better PSMA imaging at very low PSA levels, more precise MRI-guided/adaptive radiation, smaller treatment margins and more focal salvage treatment, and systemic therapies that can control microscopic disease with fewer side effects than prolonged ADT.

In other words, I am not counting on an ultimate cure. I'm hoping that if BCR does happen, it happens far enough in the future that the tools we have to detect and treat it will be substantially better, more precise, and less toxic than they are today.

And if the ultimate cure arrives along the way, of course, I'll happily take that too! 😊

@hector13 I am in a First in Human clinical trial undertaking this exact approach.
It’s what’s called a double bispecific T cell engager treatment.

Quick history, I had my prostate removed in 2011 at 55 years old. Went six years undetectable then got lazy and didn’t go to a doctor because I live in South Texas and Well never mind, anyway, I went four years not going to the doctor, thinking, I had made it into the CLEAR and then October 2024, I went for routine checkup and ultimately found out it had metastasized throughout my skeletal structure. Fortunately, other than a few lymph nodes, no organs.
Hormone therapy, ADT, worked up until January when PSA went from .07 to 14 in less than three months.

My doctor is a renowned oncologist and managed to get me into this trial.

I’m doing 50% for me, and 50% for those who come after me.
I pray every night for the best possible outcome.

@herbertlancaster

Thanks for sharing. Hope the trial works for you and for the rest of us who - someday - may have to deal someday with an advanced prostate cacner metastatic disease.

@herbertlancaster
I live in South Texas as well, and it is hot as hell today! You are fortunate to be in that clinical trial, and I am very interested in some specifics. Can you provide the name of the trial, and if possible, the clinical trial's numeric designation? I try to keep track of T-cell Engager trials to see if they are progressing favorably. Also, do you know if your trial is in phase 1, or phase 2? I really hope your treatment will get you cured. Best of luck!

What are your options if you become castrate resistant with an aggressive form of cancer

@hector13 good morning! Yeah, I live near Rockport Texas and I’ve been buying in servicing a lot of heavy equipment because I’m getting into the logging Lumber Mill work business. And it is hot!
Anyway, here’s what I’m in. I believe MD Anderson is currently taking applications.
NCT06095089.

That’s the PASRITAMIG trial involving the KLK2×CD3 bispecific pasritamig (JNJ-78278343), including the cohort combining it with the PSMA×CD28 costimulatory bispecific.

the PASRITAMIG is in phase 2 trials I think and there’s a lot of published good results. The other drug is First in humans and phase one. So that makes the whole dual bispecific trial a phase one.

@asolidrock standard of care has changed a bit. It used to be pretty much chemotherapy and continue hormone therapy.
There are a few more options out there, but a lot depends on the nature of your particular Cancer.
In my case, I was PSMA heterogeneous. (that just means that my particular Cancer does not express much PSMA) Most newer approved treatments require PSMA expression by your cancer cells to be targeted. Some folks, about 20% of the people like me, don’t have much of that.
So I had to go a different route. That’s why I went to clinical trial route