Half Life – 36 - science
July 2nd, 2021
There are a few moments in life when what you studied at University is actually useful. Having to dissect scientific papers, wade through statistics, and work out what all the language meant, was part of student life over thirty years ago during attempts to untangle the mysteries of the human mind. Admittedly, scientific papers focused on psychology are not quite at the same level of complexity as those researching new and innovative cancer treatments, but any small helping hand is welcome when trying to understand publications such as The Urology Times or The Lancet.
The Vision trial had been closely watched by prostate cancer science geeks like me from its inception, and it finally published the results last month. Since the treatment it’s been looking into is also the one injected into me every six or seven weeks, the conclusions were deeply personal. Add in the expense and it becomes a question of whether the drama of the process, combined with the money, had been the flush of an enormous toilet, taking hope and money down together, or something genuinely therapeutic. Previous studies into the use of radioactive pharmaceuticals, Lutetium-177 to give it its name, targeted to hit cancer cells while avoiding normal ones were on a small scale, but with very positive results. That was enough to get it licenced. Side effects seemed to be minimal and, to date, no patient has grown any extra limbs or been able to fire laser beams out of their eyes. Compared to chemo it’s a walk in the park, or in my case a hobble in the garden. It was with considerable relief that the conclusion of the trial showed the treatment to be beneficial. Just how beneficial is so surrounded by research paper conditionals that it’s impossible to work out how much it will help me. The only way to do that is to see what the results from my own, one person, experiment look like.
PSA are three letters that quickly became central to all discussions with doctors since diagnosis. Standing for ‘Prostate Specific Antigen’ it’s the main measure in the blood of how well the cancer is either under control or spreading. The simple principle is that low PSA is good, high is bad, and rising is a worry. A normal level in men (women don’t get to play this game) is around 4 and if it gets to 15 or 20 doctors start to worry. Part of the meeting ritual between prostate cancer patients is to compare levels of PSA when the disease is first discovered. With a score of 328, I win this competition quite often but there are some poor guys out there with levels into four digits. Good manners dictate that asking about PSA levels at subsequent meetings is also required.
Two weeks after each treatment, and again two weeks after that, there’s a blood test to give a clue as to whether the radioactivity has hit Nobby and killed off bits of him, or if he’s managed to side-step it as he has done with so many other medicines over the last two years. PSA is the main measure here too, both in the huge Vision trial and my own small experiment. When the blood test results come in, it’s the one you look at first. A roller-coaster at the best of times, the PSA two weeks after the last treatment was disappointing; it had gone up. The ruined day required several hours of hiding in a small room with the door closed playing music very loudly, before the pretence of a positive demeanour returned. Last time the PSA only dropped after the second blood test, so optimism and hope are dug out of their boxes while nervous fingers drum the desk waiting for those results to come through.
New treatments break into the medical world all the time and too often The Daily Mail hails them as a miracle cure, the research then showing they aren’t. Admittedly, “New drug slightly helps some cancer patients sometimes!” as a headline is not going to sell as many papers as “Cure for cancer found!”, but it’s not helpful. Lutetium-177 was, sadly, a player in this. However, science has had a couple of glory years in these covid times, and it needed it. Ignoring the anti-vaccine lunatics who think they will be tracked by Bill Gates, although it is hard to imagine what interest he could have in them (probably not part of his hunt for the next generation of geniuses), science had started to lose ground in the popularity parade to uninformed opinions mixed with personal agendas.
Reality is always more complicated than the headlines. The longest part of my initial consultation with the doctor overseeing my Lutetium-177 treatment was to dispel the myths about what it is and its effectiveness. The truth is the dull headline and the research bears that out. One of the other acronyms you pick up quickly when looking at cancer research is ‘OS’ - shorthand for Overall Survival, which means how long you live for after the treatment. The Vision trial showed that for advanced cancers there was improved OS of several months. Simply put, it extends life but doesn’t remove the cancer and it does it slightly better than other treatments with fewer side effects. Good, but not a cure and no one except the odd Daily Mail reader was expecting one.
History is full of stories about snake oil treatments and quack medicines (best used for sick ducks). Hope drives people to use them and sometimes pay extortionate sums for the privilege. Knowing Lutetium-177 is effective beyond the anecdotes of other patients and the sales documents of the companies which provide it gives reassurance that at least the treatment is real. How many months it adds to my reality is impossible to know. If the next blood tests are encouraging and my PSA goes down, then my OS might improve. Fingers crossed, in a scientific, data driven, way.