Researchers reported on one patient with prostate cancer that had spread extensively to his spine. He received a combination of three treatments: hormone therapy to block cancer-feeding signals, chemotherapy drugs, and a special enzyme treatment combined with a low-methionine diet (methionine is a protein building block). After six months, imaging showed the cancer tumors had shrunk dramatically, and by nine months, they appeared to be completely gone. While this is just one patient’s story, it suggests this combination approach might be worth studying further in larger groups of patients.

The Quick Take

  • What they studied: Whether combining hormone therapy, chemotherapy, and a special enzyme treatment with a restricted diet could help eliminate prostate cancer that had spread to the spine
  • Who participated: One 62-year-old man with prostate cancer that had previously been surgically removed but later returned and spread to multiple bones in his spine
  • Key finding: After six months of combination treatment, imaging showed the cancer tumors had shrunk significantly. By nine months, follow-up scans showed no remaining cancer in the spine
  • What it means for you: This case suggests a new treatment approach might be promising for advanced prostate cancer, but much more research is needed. This is one patient’s experience, not proof that it works for everyone

The Research Details

This is a case report, which means the researchers documented the medical journey of a single patient in detail. The patient had prostate cancer that returned after surgery and spread to his spine. He received three types of treatment at the same time: androgen-deprivation therapy (drugs that block male hormones that feed prostate cancer), chemotherapy (strong cancer-fighting drugs), and oral recombinant methioninase (an enzyme that breaks down methionine, a building block of proteins). He also followed a special low-methionine diet to reduce his intake of this protein component. The doctors tracked his progress using advanced imaging scans called PSMA-PET and methionine-PET, which can show where cancer cells are active in the body.

Case reports are valuable because they can identify new treatment possibilities that haven’t been tested before. When a single patient responds dramatically to a new treatment approach, it gives researchers a reason to study that approach more carefully in larger groups. This case is important because it combines three different treatment strategies in a way that hasn’t been widely tested, and the results were encouraging enough to warrant further investigation.

This is a single case report, which is the lowest level of scientific evidence. It shows what happened to one person, but we cannot know if this treatment would work the same way for other patients. The patient’s cancer did appear to disappear based on reliable imaging tests, which is a strong observation. However, without comparing this to other patients or treatment approaches, we cannot be certain the combination therapy caused the improvement. More controlled studies with many patients are needed to prove this approach works.

What the Results Show

The patient began treatment with a combination of three approaches. At the six-month mark, imaging scans showed that the extensive cancer tumors in his spine had shrunk dramatically. Most of the cancer appeared to be gone, with only a small amount of remaining activity detected in the neck area of the spine. By nine months into treatment, a different type of imaging scan confirmed that even this remaining cancer had completely disappeared. No new cancer spots were found anywhere else in his body. These results suggest the combination treatment may have successfully eliminated the spinal metastases, which is remarkable because bone metastases from prostate cancer are typically very difficult to treat and often continue to grow despite standard treatments.

The patient tolerated the combination treatment without reported serious complications during the nine-month period described. The fact that he was able to continue all three treatments together (hormone therapy, chemotherapy, and the enzyme treatment with diet) suggests this combination may be feasible for patients to tolerate. The researchers noted that the patient’s case builds on their previous observations that methionine restriction with the enzyme treatment showed promise in other prostate cancer patients, including those with bone involvement.

This case aligns with earlier research by the same team showing that methionine restriction combined with the enzyme treatment appeared helpful for prostate cancer. However, this is the first detailed report of combining this approach with both hormone therapy and chemotherapy in a patient with extensive spinal metastases. Standard treatment for prostate cancer that has spread to bones typically includes hormone therapy and sometimes chemotherapy or radiation, but adding the methionine-restriction approach is relatively new and not yet standard practice.

This is a single patient case, so we cannot know if the results would be the same for other patients. We don’t know if the improvement was due to the new methionine-restriction treatment, the standard treatments, or the combination of all three. The patient was carefully selected and monitored, which may not reflect how the treatment would work in routine medical practice. We don’t have long-term follow-up information beyond nine months, so we don’t know if the cancer stays gone or if it returns later. Without a comparison group receiving standard treatment alone, we cannot determine if this combination approach is actually better than existing treatments.

The Bottom Line

This single case suggests the combination of hormone therapy, chemotherapy, and methionine restriction with enzyme treatment may be worth studying further in clinical trials. However, this is NOT a recommendation to use this treatment yet. Patients with prostate cancer that has spread to bones should continue following their doctor’s standard treatment recommendations. The methionine-restriction approach should only be considered as part of a research study at this time. Confidence level: Very low (based on one patient case)

This research is most relevant to men with advanced prostate cancer that has spread to the bones, particularly those whose cancer is not responding well to standard treatments. Oncologists (cancer doctors) specializing in prostate cancer should be aware of this case as a potential avenue for future research. This is NOT yet appropriate for general use outside of research settings. Men with early-stage prostate cancer or those whose cancer is responding well to standard treatment should not change their approach based on this single case.

In this patient, the most dramatic improvement occurred within six months, with complete response by nine months. However, this timeline may not apply to other patients. It’s unknown how long the benefit lasts or whether cancer might return later. Much longer follow-up would be needed to understand the true durability of this approach.

Want to Apply This Research?

  • If a user is enrolled in a clinical trial testing this approach, they could track weekly energy levels, appetite changes, and any side effects from the methionine-restricted diet using a simple symptom diary within the app
  • Users interested in this research could use the app to monitor their understanding of clinical trials in their area and set reminders to discuss this emerging treatment option with their oncologist at their next appointment
  • For patients enrolled in research studies, the app could help track adherence to the low-methionine diet by logging meals, monitor timing of enzyme doses, and record any side effects or symptoms to share with their medical team

This case report describes the experience of a single patient and should not be considered proof that this treatment works for everyone with prostate cancer. The methionine-restriction approach with oral recombinant methioninase is not yet standard medical treatment and should only be pursued as part of approved clinical research studies. Men with prostate cancer should continue working with their oncologist to determine the best treatment plan for their individual situation. This information is for educational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider before making any changes to cancer treatment.