From Prostvac to Fear Then to Faith

Early 12th century Viking Christian chapel near Larvik, Norway; photo: Bjarne Gabrielsen

As many of you readers know, I have earlystage, asymptomatic but advanced prostate cancer. After treatment with Provenge, I was informed (perhaps divinely through a former colleague) of a National Cancer Institute (NCI) clinical trial currently recruiting patients like myself. The protocol involves treatment with the vaccine Prostvac and the antibody therapy, Opdivo. I had written about this in earlier posts. Since that time, Yervoy (ipilimumab) has been removed from the trial and most recently a large Phase 3 trial of Prostvac has been discontinued. Independently, I had been informed about the potential toxicity of Yervoy which reinforced my anticipation of the trial; but then the news of Prostvac’s lack of success seriously dampened my enthusiasm. It was just at that time when a devotional (August 13th) from Our Daily Bread Ministries placated my fears and inflated my faith that I was indeed pursuing the right track in my treatment.

The message was from an Old Testament prophet named Habakkuk who served as an inspiring example of  someone who argued with God yet came to the point of trusting Him regardless of the impending circumstances. Habakkuk states (Hab. 3:16-19), “I heard and my heart pounded, my lips quivered at the sound; decay crept into my bones and my legs trembled.” However in contrast, “though the fig tree does not bud and there are no grapes on the vines, though the olive crop fails and the fields produce no food, though there are no sheep in the pen and no cattle in the stalls, yet I will rejoice in the Lord, I will be joyful in God my Savior.”

What do we do when circumstances are beyond our control or when the outlook seems hopeless? The prophet Habakkuk’s situation was out of his control and the fear that he felt terrified him. The coming judgment could be catastrophic. Yet, in the midst of the impending chaos, Habakkuk made a choice to live by his faith and rejoice in God. He did not place his confidence and his faith in his circumstances, ability or resources but in the goodness and greatness of God. His trust in God compelled him to proclaim: “The Sovereign Lord is my strength; he makes my feet like the feet of a deer, he enables me to treat on the heights.”

When we are faced with difficult or unknown circumstances, we too have only to place our faith and trust in God to be our strength. He is with us in everything we face.

Are you unsure of whether or not you have a personal relationship with God? See the following.

1. Prostate Cancer Is My Assignment.

This blog is Part One. Part Two, entitled “Why Do I Write This Website?’ will be forthcoming.

I am sure most of you have heard about the Rev. Billy Graham. In 2018, his daughter, Anne Graham Lotz, also a noted speaker and teacher, was diagnosed with breast cancer. She writes about enduring surgery, “seven brutal chemotherapy infusions” as well as radiation. When asked what she thought God was teaching her through her ordeal, she wrote as follows in the June, 2019 Decision magazine. “Many people who are diagnosed with something like this wonder, ‘why did this happen to me? Why didn’t God protect me? Does He not love me? What did I do to deserve this?'” She states “this cancer is not any indication that I have been bad or that He doesn’t love me or that He hasn’t blessed me. It’s just my assignment. It’s what He’s given me so I can use it to glorify Him.”

In early 2004, my wife Marie and I attended a small, country church in Maryland. I had been raised to believe in the practice of prayer accompanied by anointing the sick with oil according to James 5:14-16. “Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer offered in faith will restore the one who is sick, and the Lord will raise him up, and if he has committed sins, they will be forgiven him.” Anointing with oil had been a practice in every church I had ever attended. My pastor and the elders had planned to anoint me with oil and pray over me but we hadn’t scheduled a time to do this. I have first-hand knowledge of several individuals who have been healed from cancer as attested to by their physicians after being prayed for and anointed.

God often speaks to us when we least expect it. January 11th, 2004 was to be the 25th anniversary service of our church. In dressing for church that morning, my mood was anything but confident, trusting, worshipful or joyful. I was still asking God why He had allowed this cancer to recur after successful surgery in 1995. I was not in any celebratory mood at all and could have just as well stayed home that morning. But I was part of the music program and choir at church so I put on my best face and with a doubtful attitude, asked God to show me something, anything in answers to my questions. There was a guest speaker that morning whose sermon was about the characteristics of an ideal church. During the sermon, I sat in the choir loft and frankly, paid little attention. However, as the sermon progressed in one ear and out the other, the still small inner voice I know to be that of the Holy Spirit started to tell me to go forward and ask to be anointed with oil. An opposing inner voice urged me to postpone it until a more opportune time. The inner debate raged like a tennis match. Our service ended with a pastoral invitation for anyone who desired prayer to come forward to an altar. I decided it is now or never. At the invitation, I looked for two elders in the congregation and asked them to anoint me with oil and pray over me right there and now. Several other men joined them. I knelt at a simple altar railing and these men prayed for my healing while laying hands on my head and shoulders. I am not an emotional person and do not shed tears readily. But the feeling I experienced can only be described as being in a shower fully clothed. “Water” seemed to be pouring over me. Tears were rolling down my cheeks. I had never sensed the Holy Spirit in such an amazingly strong way. I heard the distinct command to “reach out and touch the hem of my (Jesus’) garment” reminiscent of the words a woman, plagued by years of suffering, had uttered upon seeing Jesus when she proclaimed “if I just touch His garments, I shall get well”, (Mark 5:28). I remember thinking that I cannot do this in reality since Jesus is not physically present but I reached out my hand anyway. Tears flowed from all of us men. I also heard the distinct words, “go and show yourself to the priests,” a term Jesus often cited after healing someone in the New Testament. But He is applying it to me to mean “go and show yourself to physicians especially where I had been treated”. I was confident that I had been touched in some way. As the service ended, I stood to my feet with a dazed look on my face. My wife Marie had been watching and could see something very unusual was taking place. In short, I had never in my 62 years experienced God’s (or Jesus’) presence through the Holy Spirit as I did that Sunday. Was I physically healed? No. What did this all mean? I had been given an assignment. I had many lessons to learn in the process and this was just the beginning. (For more information, see the My Story portion of this website, for the years 2004-5.)

PSMA PET-CT Offers Best Detection Rates in Recurrent Prostate Cancer.

In a recent study, investigators reported the findings of a clinical trial designed to compare the rates for detecting recurrent cancer sites using the prostate-specific membrane antigen (PSMA) PET-CT imaging agent (68Ga-PSMA-11) to those of 18F-fluciclovine in a group of men with recurrent prostate cancer who had already undergone prostatectomy and had very low levels of PSA (less than 2.0 ng/mL).

Whole-body positron emission tomography–computed tomography (PET-CT) scans are necessary to determine the location and extent of disease in men whose prostate cancer has returned, to select the best course of treatment. However, there is no consensus among different health authorities as to which specific PET-CT imaging agent should be used to identify suspected sites of prostate cancer recurrence in these patients.

Guidelines defined by the National Comprehensive Cancer Network (NCNN) have established that 18F-fluciclovine is the most suitable imaging agent for these cases, while the European Association of Urology (EAU) recommends the use of prostate-specific membrane antigen (PSMA) PET-CT imaging agents. 18F-fluciclovine labels prostate cancer cells by exploiting their increased amino acid (the building blocks of proteins) transport, whereas PSMA PET-CT agents label prostate cancer cells containing high amounts of PSMA, a marker of disease. Preliminary reports suggest superior detection rates of PSMA PET-CT compared with 18F-fluciclovine PET-CT. However, these imaging tests have not been compared prospectively and directly.

To ascertain this, a prospective, single-center, open-label, single-arm trial (NCT02940262) was carried out at the University of California Los Angeles. All men enrolled in the study had PET-CT scans with both imaging agents within a period of 15 days. The study’s primary endpoint was to determine the detection rates for both imaging agents on a per-patient and per-region level. Each PET-CT scan was analyzed by three independent experts. The opinion of the majority was considered the correct interpretation of the findings. Between February, 2018 and September, 2018, 143 men suspected of having recurrent prostate cancer were screened for eligibility and 50 were enrolled into the trial for a median follow-up period of eight months.

Study findings revealed the PSMA PET-CT imaging agent had significantly higher overall detection rates per patient, compared to those of 18F-fluciclovine (56% vs. 26%). The difference remained significant regardless of PSA levels at the time of the imaging scans. In addition, on a per-region level, the detection rates of the PSMA PET-CT imaging agent were also higher than those of 18F-fluciclovine on pelvic lymph nodes (30% vs. 8%), lymph nodes in other regions (16% vs. 0%), bone (8% vs. 0%) and other organs (4% vs. 0%).

This study concluded that the imaging agent 68Ga-PSMA-11 has better detection rates than 18F-fluciclovine in men with recurrent prostate cancer who have already had radical surgery to remove the prostate and whose levels of prostate-specific antigen (PSA, a marker of disease) are very low.

“However, because the PET findings could not be validated by a gold reference standard in two-thirds of patients, neither sensitivity nor specificity could be established,” the researchers said. “Nevertheless, the results of this prospective head-to-head comparison indicate that PSMA should be the PET tracer of choice when PET-CT imaging is considered for subsequent treatment management decisions in patients with biochemical recurrence and low PSA concentrations. Further research is needed to investigate whether higher detection rates translate into improved oncological outcomes.”

The findings of the study, “18F-fluciclovine PET-CT and 68Ga-PSMA-11 PET-CT in patients with early biochemical recurrence after prostatectomy: a prospective, single-center, single-arm, comparative imaging trial,” were published in The Lancet Oncology. The information in this post originally was published in the Sept. 16th, 2019 e mail Prostate Cancer News Today by Joana Carvalho. MSc.