So, Dr. Scholz, this patient had a radical prostatectomy in 2010
and then they had salvage radiation in 2018. The last five psas have been gradually changing 0.03,
0.04, 0.05, then it went down to 0.02, and then back up to 0.05.
They're wondering at what level does their PSA need to be at in order to get treatment?
Those are very very small numbers. Sometimes men have tiny amounts of PSA after surgery and
radiation just because the surgeon didn't get all of the prostate out, so there does need to
be some patience in a situation like this and unless the PSA starts rising above 0.2
consistently with an elevating pattern, we can't be sure that there's any cancer there. Now that we
have these new PSMA PET scans, once the PSA gets up to about 0.2, or 0.3, or 0.4, it's time to get
a scan and see if there's any cancer detectable on a scan before any considerations are given about
treatment. Treatment can consist of radiation or hormones--combinations of these things--sometimes
even some chemotherapy, but it's all going to be determined by the the findings on a PSMA PET scan.
So, Dr. Scholz, this person has seminal vesicle invasion and they're wondering
if it's considered metastatic and if they would benefit from getting triple therapy?
I don't. Patients who have invasion of the seminal vesicles--little rabbit ears
on top of the prostate--historically, that has been an indicator that there might be
metastatic disease somewhere else in the body; it means there's a higher risk of metastatic disease.
Now that we have these new PSMA PET scans, the
possibility of spread can be checked with a scan rather than have to guess. And so, some men with
seminal vesicle disease do have early metastases in other parts of the body, others don't,
and now that we have these new scans we can make a determination. So, because the seminal vesicles
are right next to the prostate, technically, it's not metastatic disease--it's getting outside the
prostate through direct extension out through the surface of the gland. So, that doesn't have the
same implications as metastasis which either flood flow through the lymph or the blood vessels and
demonstrate a capacity to grow in different parts of the body. So, no, seminal vesicle disease is
not a truly a metastatic situation. It's talked about sometimes in that regard because sometimes
patients that have seminal vesicle invasion, they will have micro mets,
but as I mentioned already, the scans that we have now can
actually make that determination. We don't have to guess like we did in the past.
Is zinc good for prostate health? Is there any evidence,
any studies, showing that it actually benefits prostate health overall?
I am not aware of any studies that show that men with prostate cancer should take zinc. The
studies that I've seen suggest that men with prostate cancer should avoid zinc. However,
there are pretty good studies according to expert eye doctors indicating that as people age they may
be able to prevent macular degeneration and things like this with the addition of zinc,
and I always say that the eye trumps the prostate; our vision is so so valuable, and
the evidence that zinc is deleterious for prostate cancer really comes from very old studies in men
with very very advanced prostate cancer. So, I see a lot of our patients being advised to take
zinc for ocular reasons and I think that that is fine, but I don't know of any reason that zinc
should be used to help men with prostate cancer or bBPH or any other prostate related issues.
So, our next question is, does chemotherapy in any way reduce
bone pain for metastatic prostate cancer patients?
It certainly does. In patients who come with metastatic progressive prostate cancer and are
experiencing discomfort in their bones, typically, when we initiate chemotherapy, we're not 100 sure
it's going to work on everybody, so the things we look for are reduction in PSA and a reduction
in bone pain, and the reduction in bone pain in men who are going to respond is usually the first
thing that appears. So, we would look for relief of pain within a week or two as a sign that the
chemotherapy is engaging and is likely to be an effective therapy in that particular individual.
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