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Case Study

A physician’s journey with prostate cancer

Published March 29th, 2022

As a physician, Dr. Ned O’Brian* was used to helping his patients navigate health-related challenges. He found himself on the other side of the table when he was diagnosed with prostate cancer in 1998. Now a patient himself, Dr. O’Brian started on a health journey that would span more than 20 years.

After routine bloodwork detected an elevation in prostate-specific antigen (PSA), a blood-based biomarker for prostate cancer, Dr. O’Brian had a biopsy that confirmed he had prostate cancer. His prostate was surgically removed, and he began hormonal therapy with the hope of preventing the disease from coming back.

Unfortunately, Dr. O’Brian’s cancer did come back multiple times over the next two decades, but each time new treatments were able to keep his disease under control. Then, in 2019, Dr. O’Brian experienced a significant increase in PSA levels, and imaging showed his cancer had spread to his lymph nodes and bones. This development meant that he now had metastatic castration-resistant prostate cancer (mCRPC), which comes with a dismal prognosis.

Under the care of his oncologist, Dr. O’Brian received chemotherapy and radiation to target the disease in his bones. Unfortunately, he still experienced a significant rise in PSA and the treatment had to be stopped. With few options left, and in response to his worsening condition, Dr. O’Brian’s oncologist recommended an early-stage clinical trial as the next phase of treatment.

Dr. O’Brian knew that if he wanted to make any progress with his disease, he would need more focused and dedicated care. In August of 2021, he engaged Private Health Management (PHM). After reviewing his medical history and molecular profiling data, his PHM Personal Care Team advised that there were better treatment options available for his specific cancer. They also advised that the proposed clinical trial drug was still in the early stages and lacked sufficient safety and efficacy data in patients. After meeting to discuss his case in detail, Dr. O’Brian agreed, and his PHM team immediately began putting together an alternative treatment plan.

Based on prior imaging results, PHM determined Dr. O’Brian might be an excellent candidate for a cutting-edge prostate cancer treatment called prostate-specific membrane antigen (PSMA) targeted radioligand therapy (PRLT). PRLT delivers toxic radioactive molecules directly to prostate cancer cells by targeting the PSMA protein on their surface (frequently likened to a “smart bomb” for cancer cells). To confirm that he was a candidate for this treatment, PHM arranged for a PSMA imaging scan at Cornell New York Presbyterian Hospital and coordinated a local biopsy of a periaortic lymph node for additional molecular profiling. The results showed Dr. O’Brian was an ideal candidate for PRLT, but at the time it was only available through enrollment in a clinical trial in the U.S.**

As Dr. O’Brian’s prostate cancer and overall clinical status were in an advanced state, he did not qualify for any of the trials in the U.S. PHM knew we needed to go further to get him the treatment he needed. Since PRLT is approved in Europe, PHM engaged an oncologist in Germany who has deep experience in PRLT. Dr. O’Brian traveled to Germany where he received two cycles of PRLT in October and November of 2021. His progress has been nothing short of remarkable. After his second treatment, Dr. O’Brian’s PSA biomarker dropped substantially, and his imaging results showed a significant reduction in his overall disease burden.

While PRLT is an innovative approach, the specific treatment recommended for Dr. O’Brian was even more forward-thinking due to his advanced disease state. Specifically, for his second treatment, Dr. O’Brian received something called “tandem-PRLT”, which included two types of toxic radioactive molecules rather than just one. This dual therapy has only been given to a small number of patients in the world to date. In the U.S., tandem-PRLT is currently unapproved and not accessible through clinical trials.  

When Dr. O’Brian came to PHM in the summer of 2021, he had been suffering with prostate cancer for more than 20 years, and his prognosis and outlook on life were poor. Today, at 70 years old, his health is returning.

“I’m grateful to the entire team at PHM,” says Dr. O’Brian. “After my progression in August 2021 and seeing my rising PSA numbers, I did not think I would make it through the New Year. Now, I am feeling great and much more optimistic about dealing with this disease.”

While Dr. O’Brian’s journey is not yet done, PHM is helping him understand his options and plan his next steps using the latest science-backed data and research. With PHM at his side, Dr. O’Brian can look to a future he believed was gone – and he can do so with confidence and, best of all, hope.

*Name changed to protect privacy

**Since his treatment, one form of PRLT was approved by the FDA on March 23, 2022.

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition

About the Authors

Nicholas Young, PhD

Director, Research

Dr. Young is focused on designing treatment strategies for clients through a precision medicine approach that leverages the latest advances in science and therapeutic development. At PHM, Dr. Young is a member of the research team providing his expertise across many core areas including oncology. To help provide the best treatment solutions for cancer patients, the research team at PHM arrays the data supporting various treatment options, analyzes molecular profiling data, and proposes novel therapeutic strategies and clinical trials with careful consideration of individual clinical status and molecular profiling results.

Nicole Nibert, MS, PA-C

Clinical Director | Physician Assistant

Nicole provides comprehensive clinical care and case management and is a board-certified Physician Assistant. At PHM, Nicole serves as a Clinical Director on the clinical team. She works exclusively with clients who have a complex diagnosis, providing guidance and health care navigation while working along side PHM’s research specialists to ensure clients receive the best of what is possible in medicine.