Dr. Eugene Kwon on Oligometastatic Disease

In the December 2014 issue of Prostate Forum, we feature a conversation with Dr. Eugene Kwon of the Mayo Clinic about oligometastatic prostate cancer.

Dr. Eugene Kwon is Professor of Immunology and Professor of Urology at the Mayo Clinic. Kwon was one of the driving forces behind the initial development of immunotherapy for prostate cancer. As an offshoot of his immunotherapy practice, he has developed expertise in treating ogliometastatic recurrent prostate cancer.

Here’s Dr. Myers’s introduction as well as an excerpt of the interview with Dr. Kwon.

Download the issue to read the entire interview.

Next month we’re featuring conversations with Dr. Piet Ost and Dr. Paul Okulieff. Subscribe now to receive the issue!

from Prostate Forum Volume 16 # 6

In This Issue….

by Dr. Snuffy Myers

This is another in our series on the diagnosis and treatment of oligometastatic prostate cancer. In the past, we have interviewed those who are trying to improve our ability to find prostate cancer metastases, like Drs. Almeida, Barentsz, and Bravo.

Beginning with our interview with Dr. Karnes from Mayo Clinic (see Prostate Forum Volume 16 Number 4), we started to look at treatment options for oligometastatic disease. In this issue, you’ll read a conversation with Dr. Eugene Kwon, who is also a part of the Mayo Clinic prostate cancer team. However, Dr. Kwon has also played a major role in seeing that the Carbon-11 Choline PET/CT scan technology remains available in the United States. His interview is interesting from both a diagnosic and treatment perspective.

Our conversation with Dr. Kwon also has an interesting human dimension, as he discusses the long path that took him from full time surgery to immunology researcher to an expert in prostate imaging and the treatment of oligometastatic prostate cancer. I enjoyed this part of the interview, especially the account of his time at NIH. It is a classic tale of how research leads you in completely unexpected directions. My experience at NIH was very similar and forever changed the course of my life. In any case, I hope you enjoy this interview as much as I have.

Let’s talk about your recent work with oligometastatic disease and Carbon-11 Choline PET/CT imaging. First, can you briefly define ogliometastatic disease?

The purest definition of oligometastatic disease is few metastases. (Oglio means few). In academic circles, we’ve set the number of few metastases to between one and five oligometastases. There are three kinds of oligometastases, but I have simplified it to two different kinds of oligometastases because it can be very complicated.

You can have one to five metastases that show up after you think you cleared your prostate cancer with an initial procedure on the primary tumor-after prostatectomy, after cryotherapy, after radiation, etc. You think you’re cured and then all of a sudden, there are one to five metastases. That is the evolving form of oligometastatic disease.

The other form of ogliometastatic disease, which is rare for newly diagnosed men and usually seen in more treatment-advanced patients, is the kind I call residual oligometastases. Residual ogliometastatic disease is one to five metastases leftover after you’ve treated a bunch of metastases with some kind of systemic therapy.

Those are two kinds of metastases that we talk about when we talk about oligometastatic disease.

Are these metastases seen in specific parts of the body-like pelvic lymph nodes, bones, etc?

We now have a lot of information from our Carbon-11 Choline PET/CT scanners. The Carbon-11 Choline PET/CT scanner obviously sees things differently and earlier than any other scanner.

The information we’ve received from the C-11 Choline PET /CT scanner really surprised me. Prostate cancer doesn’t behave or distribute itself any way near the way I was taught that it does.

I think that the traditional, or classical view of prostate cancer is: after you treat the cancer in the prostate gland, the cancer comes back near the area where you removed the prostate gland, or maybe within a couple lymph nodes near there. The classical perception is that as the disease progresses, it climbs some kind of anatomical ladder and escapes into the bones or lymph nodes. The classical perception is much like picking dandelions in your front yard. You yank the dandelion out, but a couple of weeks later it grows back by the roots.

That is the common perception of prostate cancer. And it’s totally wrong

 


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