Mayo reports dramatic outcomes in prostate cancer study

Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced today.

“We were all pretty shocked,” says Dr. Eugene Kwon, an immunologist and urologist at Mayo and leader of the clinical trial in which the experimental therapy was being used. “These results were far beyond anything we ever envisioned.”

The two patients had a particular subset of prostate cancer that is very aggressive and deadly. Unlike most prostate cancer, which grows slowly and usually remains confined to the prostate gland, aggressive forms tend to advance and spread quickly. By the time the cancer is diagnosed, treatment is usually ineffectual. These aggressive prostate cancers are the second-leading cause of cancer death (after lung cancer) in American men.

A treatment that tricks the immune system The clinical trial that the men was enrolled in was a Phase II study — one designed to see if a particular treatment is effective in a modest-sized group of people (usually 100 to 300) and thus deserving of a much larger, randomized Phase III trial. The agent being tested was an immunotherapeutic drug called MDX-010, or ipilimumab. It was given to the two men in combination with standard hormone therapy.

The men first received the hormone therapy, called androgen ablation, which blocks the body’s production of testosterone, thus shrinking their tumors somewhat. “It ignites a little immune response,” says Kwon. The response isn’t strong enough to fight off all cancer cells, however. That’s where the ipilimumab comes in. “It’s like pouring gasoline on a pilot light,” says Kwon. The ipilimumab tricks the immune response into “burning” long enough to overpower the cancer cells, he says.

A surgical surprise Within weeks of treatment, the two men’s tumors could not be seen on MRIs. But the real surprise came when the first patient underwent surgery. Removing the prostate gland in advanced cases has not been shown to have any therapeutic benefits. But because of the remarkable MRI results — and the tenacious insistence of the wife of one of the patients — Kwon and his Mayo colleague, urologist and surgeon Michael Blute, MD, decided to go “off study” and operate.

When Blute opened the patient on the operating table, he saw a lot of blanched scar tissue — usually a sign of advanced cancer. He sent tissue samples to the pathology lab (standard procedure) and, while waiting for the results, went out to prepare the patient’s family for what he was sure was going to be bad news.

“But the pathologist came back saying he couldn’t find the cancer,” says Kwon. “They ended up removing the prostate. Not only could they not find cancer outside the prostate, they couldn’t find it inside either.”

Surgery on the second patient produced similar results. A year-and-a-half later, both patients are entirely off therapy and have no evidence of cancer, says Kwon.

Caveats Much more research is needed, Kwon points out, to determine the precise mechanisms behind this treatment — and what the most effective dosages and ways of administering it might be. Kwon also points out that so far, only three of the 54 patients in the therapy arm of the clinical trial have demonstrated such dramatic results. “In this trial, we may have been working with sub-optimal doses,” he says.

This fall, Mayo intends to start a clinical trial using higher and repeated doses of ipilimumab in combination with hormone therapy. “If that moves in a promising direction, we’ll go on to Phase III trials,” says Kwon.

Do some reading on the Da Vinci method of prostatectomy.

I did. Incontinence and impotency are still side effects of EVERY form of prostatectomy. If you want a robot to work on your 'junk', feel free. As far as I'm concerned, any disease where "watchful waiting" is a fully approved method of dealing with the situation shows that we're still many years away from being able to treat this disease like we do most curable illnesses.

In any case, your answer does not answer my question--it seems strange that the wife was so damned gung-ho about her husband getting operated on.

“Incontinence and impotency are still side effects of EVERY form of prostatectomy.”

You’re wrong. I had a robot-assisted prostatectomy 5 yeaqrs ago, with no incontinence and temporary impotence (3 months). I was relaased from the hospital 24 hours after the operation and had virtually no pain. “Watchful waiting” is an educated guess that applies to some situations and not at all to others. In my case the robot-assisted prostatectomy revealed more disease than was detectable by any other means, which led to me parcipating in a clinical trial with meds aimed at lowering the odds of recurrence, and so far, so good...although it is usually a slow-growing (and sometimes a very fast-growing) cancer. They jury is still out - and will be for a long time - but I’m convinced that watchful waiting would have been very bad for me...and I say that as a strong advocate for alternative/complementary medicine.

“In any case, your answer does not answer my question—it seems strange that the wife was so damned gung-ho about her husband getting operated on.”

Perhaps his wife thought it was the best thing for his survival, given the specifics (grade, Gleason score, patient age, other health issues, etc., etc.) of his situation. Or maybe she was just panicked and was making her best guess in a time of stress. Anyone who knows they’re certain of the right approach for every patient in every circumstance is delusional. I have yet to have an MD or a naturopathic physician tell me they they were certain their approach was the right one. Anyway, it seems a more plausible theory than yours...that she encouraged him to have the operation so he’d be incontinent or impotent. I’ve spoken with many couples fighting this disease and I’ve never encountered such a motivation. I guess anything’s possible, but frankly it sounds a bit silly and nothing like the real-life scenarios I’m familiar with.

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