From Lucas Heights to Peter Mac

This article appeared in the Fairfax press today. It contains some background about a new prostate cancer treatment. It also gives some insight into which treatments are and are not brought to market by the handful of pharma companies that control the development of new medicines.

I had heard about lutetium through the Prostate Cancer Foundation of Australia (linked in the Resources section of this blog). The following excerpt from a paper given by Professor de Bono at the European Society of Medical Oncologists’ conference in September 2017, is lifted from a message to a PCFA discussion list. The paper concluded

this phase II trial demonstrates that 177Lu-PSMA treatment for patients with MCRPC who have failed standard therapy provides encouraging response rates with acceptable toxicity, in addition to improved QoL and pain reduction. Based on this trial, we eagerly await the results of larger studies with long-term follow-up.

Some glosses:

  • MCRPC = Metastatic Castration Resistant Prostate Cancer
  • QoL = quality of life

Hormone therapy, also known as androgen deprivation therapy, is basically chemical castration. This is one of the “standard therapies” that have failed those in the lutetium trial. In other words, lutetium is, at present, a last resort. (Not that this makes it any less desirable for those participating in the trial!)

The discussion attached to The Age article linked above had an interesting further observation about PSA testing. (One needs to log in to the web site to read this discussion.) One of the posts claimed that the PSA test was a less accurate predictor of prostate cancer than a biopsy. A response observed correctly that, for men in whom cancer had not been diagnosed, a high PSA score is not necessarily an indicator of prostate cancer. In men in whom prostate cancer has been confirmed, however, PSA tests are routinely used to assess how effective a treatment has been.  So in terms of how “good” the PSA test is, it depends if one is talking about it used as

  • an initial screening test, or
  • a test in men with confirmed prostate cancer.

PSA should not solely be relied on as a screening test. It is routinely used in the latter context.

I have had about five PSA tests in the course of my treatment so far, and a biopsy as well. The PSA sends up the red flag for the possible presence of cancer, the biopsy  reveals the location and type of cancer. You wouldn’t do a biopsy without an elevated PSA score. (In my case, this was confirmed by a second PSA test). The PSA can be done in a few minutes at a pathology centre; my biopsy was performed under a general anaesthetic. One can’t replace the other. They do different things.

2 thoughts on “From Lucas Heights to Peter Mac

  1. Dear Joseph

    I reply here because it isn’t PC-related. Otherwise I would comment on your comment! They are always great to see.

    It sounds like the right move at the right time. Getting crap coffees depending on who is the barista is a real bore! At least when it happens down in Maling Road, and it has (shock horror), we have a lot of other places to go. Moving is obviously disruptive as hell. I was, however, just telling our niece about Mum’s gypsy gene, and her (and my) preparedness to up sticks and try living somewhere else. It can be exciting to have a new start! Jill is not like that at all. I was stunned to hear, early on, that she had lived in the same house for the first eighteen years of her life. This was almost unimaginable to me.

    (Incidentally, we had some neighbours over for coffee few weeks ago. I was telling her about how many places we had lived in. The dialogue went something like this (and apologies if I repeat myself): Jo: Was your father an engineer? Me: Yes … Jo: Was he a civil engineer? Me: Yes! Her dad had been one too, working for VicRail, or whatever it was called then. So they were posted all over Victoria. Most country towns still have a Railway Hotel intended for the patronage of train drivers, firemen, and other dudes. By way of compensation, Jo renounced her early mobility, and has been in Burwood for about 30 years, rather like Jane & Rene in Katoomba.)

    I had a look at the Invers library website. Try a search on “Booker prize”. The old Sirsi Dynix is popular over the Tasman as well! Unfortunately the Advanced search doesn’t support browsing. It does, however, have field searching, so one can just search for author, title, or whatever. [Horrid jargon alert!] This helps to disambiguate the odd search. For some reason I was moved to try a search on “sic.” (don’t forget the full stop, although it may work without it). Just bang it in the generic search box. You should get 29 hits.

    True confessions time: I had to look up what this actually stood for, and am indebted to the Guardian Notes & Queries for the following definition.

    “(*sic*) (with square-brackets usually) is an abbreviation of ‘*sic* erat scriptum’ which is Latin for ‘thus it had been written’, meaning that the quote prior was transcribed as it was found in the original source, complete with errors, coloquialisms etc.” [,5753,-23558,00.html ]

    I rather enjoyed the old [sic.], to give it its full library cataloguing dress. This was a cataloguer way of saying “the author might be illiterate, but I’m not”. Alas, it went for good when ‘Anglo-American Cataloguing Rules’, 2nd ed. (affectionately known as AACR2) was superseded by ‘Resource Description and Access’. This got rid of all the Latinisms, and all the abbreviations like “p.”, “ed.”, “vol.”, “verso t.p.”, and the like. However, they live on in all the legacy records done under AACR2. The magic of full-text searching brings out these ancient pedantries: I imagine cataloguers long since retired clicking their tongues and thinking “I’ll fix you!”. I would argue, however, things like [sic.] are really a courtesy to the reader. ‘The young visiters’ shouldn’t be tidied up to ‘The young visitors’. This is done correctly in the Invers catalogue, albeit it is a pretty crappy record; no sign of a [sic.]. (And I wonder how long it has been “awaiting cataloguing by T/S” [AKA technical services]? The damn thing was published in 1919! I think they mean “awaiting someone to get it out of the permanent low priority backlog”.)

    As the young folk say: fully sick!

    Good luck with it all – love Guy

    On Sunday, May 13, 2018, Guy's prostate blog wrote:



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