So, Dr. Scholz, we have a patient who's in the process of staging their Gleason 8 prostate
cancer. Their bone scans are clear, but the CT and the Axumin pet scan discovered suspicious
lymph nodes and they're waiting for the biopsy results to confirm. The radiation oncologist
asked — like, they want to do a PSMA PET scan, but he [the radiation oncologist] doesn't
think it'd be very valuable because there's already been a situation where the Axumin
PET scan picked up the lymph nodes, and they want to know what you think.
That's a good point. Once you have established disease spread outside the prostate, you're
kind of obligated to go full-court press with treatment. So, that would be like 18
months of Lupron and Zytiga, might even talk about a short-course of Taxotere based on some
recent publication at the ASCO meeting showing that the Taxotere seems to add something more
to the Lupron and Zytiga. What could we discover on a PSMA PET scan that
you wouldn't see at an Axumin? Well, you might find an additional lymph node some other place
outside the pelvic region or even an early bone met that would benefit from radiating that spot.
I suppose it depends on how easy access is to the PSMA PET scan. Sure, definitely get it if they had
easy access. If it's going to be a long involved process and difficult to obtain the scan, then
maybe it is reasonable just to go ahead and give all the treatment that you would normally give.
So, PSMA PET scans are about $3,000 out of pocket currently, correct?
Right, it's sort of a dynamic situation. We're hoping that the medicare billing codes will get
worked out quickly and that these things will start being covered by normal insurance and
become more widely available. Right now it's mostly just at a few limited academic centers.
And as far as early use of Taxotere, you know, if they're getting radiation plus systemic therapies
like Lupron and Zytiga, so hormone therapy, and then early use of Taxotere, is there any concern
for having so many treatments at once and any quality of life issues that need to be looked at?
Definitely, I mean Taxotere has its own side effects, you can't give it at the same time as the
radiation. So, typically what happens is people go on the hormone therapy—the Lupron, Zytiga—have
the radiation, make sure they get through that well, and then consider maybe four to six cycles
of Taxotere thereafter, but there is a, you know, depending on a patient's age and fitness,
all these treatments can cause fatigue, and it can become cumulative or even excessive in some
patients, so you have to kind of take it on an individual case basis. Sometimes when there's
doubts we'll tell patients to consider taking one Taxotere treatment, see how they tolerate it,
and then decide on the basis of how they tolerate it whether they want to do any further treatment.
And using Taxotere earlier in the treatment sequence, would that
eliminate them from being able to use it later like Xofigo does,
and only has the one-time use? Or can they use Taxotere later as well?
They certainly can use it later, and this whole idea of giving Taxotere,
which is a mild type of chemotherapy, at the time of diagnosis is a policy
called adjuvant therapy which is used routinely in lung cancer, breast cancer, colon cancer,
and it doesn't preclude the later use of chemotherapy if there's a future relapse.
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