Hi, I’m Dr. Scholz. Let’s talk about prostate cancer.
In this video we’re going to cover Azure otherwise known as high-risk prostate cancer.
I’m always concerned about that terminology “high-risk” and that was one of the reasons
for selecting colors to describe these different stages. High risk of what? High risk of dying?
Actually, not. The risk of succumbing to prostate cancer if you’re an Azure is maybe anywhere
between 3-15% over the next fifteen years (using older technologies of course, you can’t
have fifteen year outcomes unless you go back fifteen years) and now we’re in an era of
galloping technology, things are getting better every year. So what might have been a 15%
mortality rate 15 years ago may be much lower for someone today. But we are talking about
a possibility of mortality, even though it might be delayed and even though it might
be uncommon. Therefore, if you’re thinking about Azure, this is a stage where we say
don’t fool around. There’s a lot of slack and room for mistakes when you’re talking
about Sky and Teal and you can come back, but doing Azure right the first time will
pay rich dividends for you in your future.
So as we go through and talk about Azure what we’re really concerned about is the possibility
of metastatic disease. This is what defines the dangers that we see in any kind of cancer
including prostate cancer. So there’s two types of metastatic situations. One is where
you can detect them with a scan or some other methodology and unequivocal metastatic disease
is present. This may be the case if the doctor says there’s some seminal vesicle invasion
or an enlarged lymph node in your pelvis. But there’s something before that called
micro-metastasis where the disease is in those areas but the specks of cancer are too small
to be detected, even with the human eye—a scan is not going to reveal them.
Experience has shown that we can predict whether or not microscopic metastatic disease is present
by looking at the Gleason score, looking at how high the PSA is, and other factors, and
this is the basis of dividing Azure into three subtypes: Low, Basic, and High. I’m not
going to go into the specifics on how you make those subdivisions. (The PCRI will provide
the information and it’s available on our website.) But each of these different subtypes
Low, Basic, and High is like a different stage of prostate cancer. The type of treatment
will vary depending on which of these substages you fall into. This is just an introductory
short video about Azure, and I want to briefly comment on therapies, but when you get down
to the bottom line, the choice of therapy is rather straightforward with Azure. In fact,
this is one stage, in my opinion, you can simply draw a line through surgery. A large
study was done at John Hopkins treating 9300 men with radical prostatectomy. These men
had Azure, the average PSA was about 7.5, and they didn’t appear to have anything
outside the prostate on digital rectal exam. 80% of those men relapsed over the next 15
years. The cure rates for surgery with Azure are very low. Other approaches using radiation,
seed implants, and hormone therapy will provide much better cure rates than surgery can. These
combination approaches using testosterone inactivating pharmaceuticals, seed implants,
and IMRT (usually to the lymph nodes around the prostate) can provide cure rates close
to 75, 80, 85% in Azure—dramatically better than what can be achieved with surgery.
We are going to be doing a series of videos on Azure going through these different types
of treatment covering this in more detail and helping you to figure out which subtype
you belong into. But the take-home message for Azure is first: get the appropriate staging
done, make sure there’s no obvious diseases outside the prostate, find your subtype, and
when you start reflecting on treatment shy away from surgery and start looking towards
combination therapy with seed implants, hormone therapy, and intensity modulated radiation.