Why Prostate Surgery Wasn’t the Cure | Dr. Dino Prato

Frank removed his prostate with a robot. All clear, they said. Years later his PSA crept up and the cancer was coming back. If the prostate was gone, why wasn't the cancer gone with it? What to consider, what was he dealing with? Why was this prostate cancer not over something that is unfortunately not uncommon? Hi, I'm Dr. Dino Prado and for two decades we've helped patients move from the guesswork of cancer treatment to precision. Today's story is about Frank and how the da Vinci prostectomy seemed to solve everything until it didn't. And how interventional radiology, deep mapping and precision oncology changed the plan and made all the difference. Frank, not his real name, was 59. When his biopsy came back positive, the team recommended robotic assisted prostectomy. He chose surgery. It was fast, it took care of the problem and let's get it out and move on. That's really like the common sense approach. Post op is PSA drop. And it felt like he had green lights across the board. But early on, Frank struggled with urinary incontinence which lasted for some time and even some erectile dysfunction. The incontinence lingered for months and intimacy felt fragile and uncertain. Everyone hoped time would fix it. Frank tried to move on. He thought that removing the prostate would have removed the problem and after this life saving procedure he would have been in the clear. Well, years later this PSA started to rise and Frank's PSA began slowly rising. And then he began to worry. Probably thought in initial it was a lab issue. And then the number kept going up and nudging higher. The PSA was climbing. If the prostate's gone, how is this happening? This is where many men learn the hard truth. Surgery removes tissue, but it doesn't always remove all the cancer and the driving forces of the cancer which can lead to reoccurrence and spread. And what I want to talk about in this episode is exactly what went wrong and what we can do to change this. First of all, what Frank needed early on was a circulating tumor cell data. The circulating CTCs with methylation score would have told us right in the beginning if this cancer had a chance of already spreading prior to surgery, it would have told us that we already have micro metastatic cancer cel and at that point robotic surgery isn't going to be curative. What we could have done up front is taken a look at this information and given Frank a huge advantage. We sat with Frank and we began to do deep mapping and we showed exactly where things went wrong with the right testing, this is important, so let's rewind. How would we have handled this initially? Number one, we would have avoided surgery. We were around the circulating tumor cells, looked at the immune system, looked at all the DNA, rna, thousands of markers and understand what caused the cancer and what was feeding the cancer, what were the drivers of the cancer, what was making the CANC grow and spread. Then we would have used 3D cone beam interventional radiology, oncology, minimally invasive procedure where we'd go in with a catheter the size of the hair, visualize all the vessels so we're not harming anything, kill the tumor, build the immune system and come out with a band aid. About a 45 minute procedure, done, cancer gone. But we would have known if there were circulating tumor cells there that the cancer was not in full remission and we would have needed to treat that. One of the advantages with prostate cancer is it's a great immunotherapy cancer first drugs called Provinch that was developed for Prost cancer was using dendritic cells, immune system to fight the cancer. So immunotherapy is really critical for prostate cancer. And when we do this directed tumor, we get this beautiful release of what's called damps, damage associated molecular patterns. These signals that go into the blood, into the body and tell your natural killer cells and dendritic cells to go after all cancer cells, wherever they might be in the body that look like this cancer, that's a very powerful thing. Your body naturally does that. And when you do surgery, you get none of that. You remove it, you might actually get inflammation. If you don't have all the cel, you didn't do the testing, which most people do not do, the cancer will return. But deep mapping tells us so much. First of all, the next generation sequence, it finds the mutations. And even though some people may do DNA testing, this is just the beginning. We don't want to end here. The key here is RNA Transcriptomics. We're looking at thousands of markers, not like 10 or 20, but thousands. And then deep mapping shows us where the resistance are, where the routes are, what are the drivers to this cancer. Then here's the most important part. Pay attention to this. It's immune spatial biology, which I've talked about many times before, because this is like the SWAT team that tells us why the police. Your immune system can't get to the tumor. And it looks at all the gangs around the tumor that are blocking it from getting the treatment it needs. So it finds the blocks, looks at the doorways and sees where the tumor is cold and makes it actionable and hot. Through understanding its tumor microenvironment and changing it. This is critically important for many cancers, but particularly prostate cancer, which is a very immune centric cancer. So now we know what's going on. Now we were able to treat Frank, bring him into remission, and monitor him with circulating tumor cells and methyl scores, which are leading indicators. Way before you would see a tumor come back with just a PSA rising, or let's say tumor markers, or imaging for that matter. That's already lagging indicators, that's after it's already grown and spread. We're talking about leading indicators. So we don't want to watch and wait with bated breath. We want to stay on top of it. With the latest in science and adaptive monitoring, which we do with precision, oncology allows us, if need be, to pivot quickly. Especially when patients come to us with advanced prostate cancers who've already done these surgeries and now it's in the bone and other areas, they don't know why it occurred. We are able now, with this deep mapping, to build a thorough, comprehensive plan with immunotherapy to help our patients. You get these green lights, everything's good, but it's without checking the detailed information to what caused the cancer in the first place. That's why precision oncology is so important. And in fact, many times intravenous phytotherapeutics become really important alongside the treatments because it allows us to get to the cancer and shut down these pathways that are leading to its spread. It reveals the resistant pathways, allows us to develop better planning for the cancer, and now help that cold tumor turn hot so the immune system can take out the cancer without harming our normal organs, tissues, erectile dysfunction, fatigue, urinary incontinence, Avoiding all of that, that's the key of the immune system. So then we could build a custom immunotherapy just for that patient. Now, let me make this clear. This is beyond PD1 inhibitors. It's literally building a custom immunotherapy, Often either cellular biologics or other agents that we know are immunotherapy agents that are custom based on the precision data sets we get from the patient. So this is the playbook. This changes the game for pro cancer. When you have detailed data and minimally invasive interventional radiology oncology, which is basically image guided surgery, you can come in and out with precision, delivering the exact agents you need to create an immune system response to the entire body and go after that cancer. Even if the cancer is spread beyond the prostate and now is in the bones and in other areas of the body, we can do that systemically with genetically targeted fractionated chemotherapy and use the same precision targeting to create these damps damage associated molecular patterns, these micro signals that go into the natural natural killer cells, dendritic cells, to teach your immune system to fight the cancer. And I say that because the natural killer cells is your God given ability to fight cancer. If it was working properly, you wouldn't have gotten cancer to begin with. So the natural killer cells and dendritic cells are critically important. And technologies like sippy, chemo immunoprecision injection, which I mentioned, is using a catheter the size of your hair and going right into that prostate, but with full visualization of all the circulatory patterns. So you're only going into the prostate, killing the cancer with an immunotherapy treatment and sealing that so the tumor dies. Immune response that goes everywhere in the body, if need be, to go after micro metastatic cells. Then you monitor that with advanced circulating tumor cells and with methylation scores and vesicle scores that we do that tell us the cancer is holding its remission. See, this is the key. And even in some of the most advanced cancers, we can build cellular vaccines like autoglas adoptive immunotherapy where we use natural killer cells and dendritic cells which are grown and expanded based on your damps damage associated molecular patterns. These actual signals that now can tell your immune system where to find the cancer everywh go after it. With adaptive monitoring. This is next level. We're not just tracking the psa, we're looking at the velocity, CT DNA, CTCs, methylation, and putting this all together. Think of it as like an air control panel on an airplane. We can see where everything's at because we take the guesswork out and then we help people get the precision care they need. And that's the key. If the cancer tried a new move, we would be able to pivot very quickly and help that patient. Frank finally said, this feels like I'm heading in the right direction. I'm out of the dark and I can see what's going on. And headed into remission. So over the months we saw The PSA stabilized, CT free DNA, drop, circulating tumor cells, drop methylation scores, everything going down. Frank finally returned with good energy, confidence and felt great. And we focus on preserving long term health. We also looked at cardiovascular disease risks and other things to give the patient longevity, help them with their intimacy with getting full energy and health. This is critical. This is the difference. With precision oncology and we reminded him like we do with all our patients. Precision is not magic, but it's data and targeting. And when combine what patients need, it makes all the difference. With precision, you can get out of the guesswork and you can get into more life and better care. Deep mapping is so important. Immune spatial biology is so critical. Understanding why that prostate cancer developed and treating it makes all the difference in the world. I hope this was helpful and it gave you an insight to understanding prostate cancer and advanced prostate cancer in a far deeper way. May the Lord bless you on your journey to healing Bump.