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The "mothership" and pca spread.

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User
Posted 17 Sep 2023 at 16:42
Every mans cancer experience is different and the people posting in this forum can only speak from their own experience .I for one have found the information from forum nembers invaluable .My father died of prostate cancer it spread to his bones ,he did not have his prostate removed although he could have done he was offered removal or enrollment on the early Stampede trial he opted for the trial and was given a specific hormone combination whether it was the drug being trialed we dont know he died five years after his part of the trial ended .His situation helped my decision when AS was no longer viable I wanted it removed and was very lucky that the consultant I had was on the ball and prescribed Enzalutimide when the RP failed to reduce the PSA .
User
Posted 17 Sep 2023 at 16:42

I agree with you of course.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 17 Sep 2023 at 22:12

At the beginning of this thread I asked if anybody could provide references to Dr Patrick Walsh's research on the concept of the prostate as a "mothership". The question was not about whether there are experts amongst us or even about what our Drs, urologists or oncologists might be advising us. Nor was it about our personal views.

My point was simple ... there's an influential book out there suggesting that there's an invisible link between the prostate and various forms of mets in the body but so far as I can see Prof.Walsh hasn't produced the proof. Taking this concept as a "no brainer" could be dangerous and lead to poor treatment choices.

So far, no proven research from Walsh has been cited. It might be out there somewhere and if it is, it's more important than us just exchanging opinions.

Jules

Edited by member 17 Sep 2023 at 22:34  | Reason: Not specified

User
Posted 17 Sep 2023 at 22:37

I am waiting for the book to arrive. If the book claims this 'mothership' concept the writer has to provide scientific evidence otherwise he is misleading the public. I look forward to reading the book.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 18 Sep 2023 at 00:11

This is relevant to my situation, and I also had read somewhere that single mets, typically rib lesions, may be benign (i.e. false positives).

I've been on hormone therapy (Zoladex and Enzalutamide) for over a year, and also had radiotherapy to the main tumour. My PSA has come down from 20 to 0.02, and the affected lymph node sites didn't even show up on the latest CT scan. I'm still waiting on the results of a bone scan, but hopefully that will be good news as well.

User
Posted 18 Sep 2023 at 00:33
It's a book not a research paper, he can write whatever he likes.

I believe he is just giving his opinion based on his years of experience, I guess it will be up to the subsequent trials to support or dismiss his hypothesis.

User
Posted 18 Sep 2023 at 17:02

Hello .This is not just a theory postulated by DR Walsh but has been proved in respect of breast cancer treatment and other prostate oncologists are postulating the same idea  .Here are two  links for you to look at there are other sources of information on the subject too if you care to investigate .The very fact that there is enough information out there to warrent a trial should indicate that there is reason to believe merit in the idea that removal of the prostate in advanced cases may give better outcomes and surely that is what we all want

https://www.standard.co.uk/news/health/prostate-cancer-patients-to-be-offered-lifesaving-operations-on-nhs-for-the-first-time-a3715866.html

.https://www.broadcastmed.com/cancer/5225/news/a-new-way-to-attack-early-metastatic-disease

 

 

Edited by member 18 Sep 2023 at 17:26  | Reason: Not specified

User
Posted 18 Sep 2023 at 17:55

Hi .No Im fine as far as bladder control is concerned I was dry one day after the catheter was removed  and the other side effects are quite manageable .I get the odd hot flash my wife says I now know how she feels  menopause wise ! As far as I m concerned any side effects are of no importance whilst my PSA remains undetectable and has been for over three years now and my superficial  bladder cancer is completly clear which it has been for 6 years .The removal of my prostate did not clear all the cancer I  was locally advanced but my wonderful  consultant wanted to throw everything at it including Enzalutimide due to prostate cancer being in my immediate  family and my bladder cancer history .He was right to do so and I am in remission hopefully for a very long time .

User
Posted 18 Sep 2023 at 20:24

Hi Librajc,

Thanks for your input.

I notice that the two articles to which you have provided links are dated 2016 and 2017.  Neither article mentions the name of the drug trial(s).  Do you (or anyone else) know what it (they?) are called, and when they are likely to be concluded?

Many thanks.

JedSee.

User
Posted 18 Sep 2023 at 20:57

Hi .The trial is the Atlanta trial and is ongoing .

User
Posted 19 Sep 2023 at 17:35

For those who are questioning the validity of the mothership theory here is the link to Prostate Cancer UK s own explanation of the Atlanta trial and why it is being undertaken .Clarifys the theory and shows that it is not such an outlandish idea after all as some on this particular thread have been suggesting as its not just one doctors idea .
I am someone who was considered to have locally advanced cancer only after my prostectomy and may not have been able to have my prostate removed if the spread had been known beforehand .As it is I have benefitted greatly from having it removed because my salvage RT was commenced when my PSA was undetectable Enzalutimide and the three monthly Decapeptyl injection having proved very successful .By removing the Prostate the cancer load was substantially reduced which made the salvage RT very effective as only small areas of disease remained and these were identified by a PET scan .Today I had my three monthly consultation with my consultant my PSA is still undetectable for over three years now and all blood tests normal .
https://prostatecanceruk.org/about-us/news-and-views/2019/9/new-atlanta-trial-focuses-on-advanced-prostate-cancer

Edited by member 19 Sep 2023 at 17:36  | Reason: Not specified

User
Posted 19 Sep 2023 at 22:08

There are many men who have had their prostate removed, only to find that the cancer has spread and continues to spread, despite the absence of a prostate. Removing the so-called "mothership" has not helped these men, so whatever powers the "mothership" might have, cancer can spread without it.

Expressing a personal opinion, I think there's a risk that men with early stage PCa might think removal of the prostate will achieve more than it can in reality, based on a hopeful interpretation of mothership theory.

Jules

 

User
Posted 19 Sep 2023 at 23:08

The mothership principle is relevant to those initially diagnosed as metastatic, not those who have curative treatments.

We know radiotherapy on the mothership extends life when the metastatic tumour burden is low (small number of distant mets). This was the finding of one branch of the UK STAMPEDE trial and is now the standard of care. It doesn't work when there are lots of mets, probably because some of them have become motherships too.

The ATLANTA trial is extending this in a couple of ways:
• It adds additional non-curative treatments to the prostate; prostatectomy or focal therapies to see if these can extend life too, in addition to the current radiotherapy standard of care (which is also included in the trial probably for comparison).
• It adds the possibility of having small numbers of mets treated with SABR - this is a standard of care today if a small number of mets are discovered only after a curative radical treatment (which consequently failed to cure), but if such mets were found during initial diagnosis, then current standard of care wouldn't treat them (which never made sense to me), but the trial can.

User
Posted 20 Sep 2023 at 10:41

Yes as in everything there are those who do better than others and who benefit from Prostate removal and some who dont.Unfortunately there will always be men who die from Prostate cancer there is no 100 percent cure for this disease .However what is under review here is are there better outcomes if the prostate is removed, is the cancer under better control if the prostate is removed ? etc ,hence the need for the Atlanta trial. Many men have prostate cancer that although treated by RT or prostate removal remains in the body , hidden mets too small to be seen that may at some time start to grow this is where the mothership theory comes into focus do men who have had the prostate removed do better than those who havnt .You cannot dismiss the validity of the trial  by saying ' Well some men still progress without their prostate anyway so the mothership theory cant be correct ' that is not a scientific or valid argument .Where would we be without trials and theories that are tested. You may not have had your prostate removed and opted for RT instead but it may be proved in the future that this is not the optimal treatment for advanced PC and better outcomes and longevity occurs if the prostate is removed .

User
Posted 20 Sep 2023 at 13:07

If I was to guess, I suspect RT in the case of metastatic disease is most likely to win, because it covers the largest treatment area including the prostate bed, and can easily include and cure nearby lymph nodes, and is therefore likely to remove the largest tumour volume.

Prostatectomy has a sharp treatment cutoff, literally being the surgeon's scalpel cut. We already know in the case men not diagnosed as metastatic that this fails to cure in 30% of cases, mostly due to cancer already having escaped into the prostate bed. Also, Prostatectomy has the largest side effect profile impacting quality of life, being continence and if significant pelvic lymph node dissection is included, lymphodema (can mostly ignore ED as these men will be on HT anyway).

Including focal therapy seems a bit strange to me, given these can only treat part of the prostate in any case. I don't know how many metastatic patients only have small tumour burden inside the prostate, although focal therapies don't always aim to clear all the cancer in the prostate.

User
Posted 20 Sep 2023 at 14:21

Best not to guess though hardly scientific ,
We know for certain that RT can give rise to secondary cancers years after the original treatment bowel.cancer and bladder cancer in particular and that some men develop serious bowel problems after RT .So both methods of treatment are not problem free .
Here is a list of scientists who know what they are talking about who espouse the mothership theory
[Doctors name removed by moderator], a professor of oncology at Johns Hopkins University School of Medicine
[Doctors name removed by moderator], a professor of oncology at Cold Spring Harbor Laboratory and the Koch Institute for Integrative Cancer Research at MIT.
[Doctors name removed by moderator], the president and director of the Dana-Farber Cancer Institute
[Doctors name removed by moderator], the director of the Human Oncology and Pathogenesis Program at Memorial Sloan Kettering Cancer Center
[Doctors name removed by moderator], a professor of pathology at the University of Michigan School of Medicine
[Doctors name removed by moderator], the chairman of the Department of Surgery at Memorial Sloan Kettering Cancer Center
[Doctors name removed by moderator], the chairman of the Department of Urology at UCSF Health.
The Atlanta trial will answer many of the questions raised about the best treatment for Advanced PC .

 

Edited by moderator 20 Sep 2023 at 21:35  | Reason: Not specified

User
Posted 20 Sep 2023 at 14:36

The mothership theory was already proven by the UK STAMPEDE trial, and is now the standard of care in the UK.

Metastatic patients don't generally need to worry about treatment induced secondary cancers, as they're typically 20+ years later, and that is based on radiotherapy treatments which were much less precise than those given in the last 10 years.

Edited by member 20 Sep 2023 at 14:43  | Reason: Not specified

User
Posted 20 Sep 2023 at 16:46

You are incorrect the trial which is actually  looking at the Mothership theory is the Atlanta trial and removal  of the prostate in advanced PC cases is not yet standard practice according to the NICE guidelines .As far as secondary cancers from RT are concerned there is no definitive time limit on the appearance of a related cancer  as my consultant told me when I  had salvage RT. .However he said that the average time for developing a cancer after RT in his experience was between 5 and 15 years .As I already have had  superficial bladder cancer they keep a watchful eye on me although i have been clear for 6 years now .Unfortunately a secondary cancer cannot be ruled out completely even though there have been advances in the newer  methods adopted for RT its still radiation and anyone who has had RT treatment needs to be vigilant for developing  symptoms .No cancer  treatment is fully without some side effects some become apparent later rather than sooner .If you  look it up on the Internet you can find out the remits for both the Stampide and Atlanta trials also the exact NICE guidelines for treatment of advanced prostate cancer .

 

 

User
Posted 20 Sep 2023 at 18:33

It is not surprising that there is a great deal of confusion around the 'mothership' hypothesis. From what I have read here and other sources, this concept is no more than a hypothesis. Men suffering from advanced prostate cancer should be careful how you assess your situation on the basis of this unproven concept. Comments from consultants, some of them quite well known, appear to me to be based on their subjective judgement - that is not scientific. 

 

 

 

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 20 Sep 2023 at 21:58

A list of medics who 'espouse' a theory is a subjective judgement unless they can provide scientific  evidence. Of course I haven't done an extensive search for scientific papers; may be there are some which I can't find. If you Google the only item that turn up is this thread on PCUK site!

Edited by member 02 Oct 2023 at 21:43  | Reason: Not specified

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

 
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