So, Dr. Scholz, you know, obviously bone metastases—that's very scary to many people including their
families, but you've treated so many people. Are there stories where people have had these
bone metastasis treated and been able to live long lives?
Yeah, I'd like to share a couple of stories with you, but before mentioning those brief
little vignettes, I think it's good for people to know—the people that don't have bone
metastases—that without bone metastases it's really practically impossible for men
to get sick from prostate cancer. So, people are many times running in fear of the possibility
of metastatic disease, but there is a pathway where the disease has to spread to the bones
and then, over a period of time, it can get worse and even be fatal.
But the stories that came to mind when you told me we were going to cover this topic—three
gentlemen that I've been treating for a long time I think help people understand that there's
not a black and white, you know, this is the end of my life type of thing.
I had one patient, Robert, diagnosed back in 1995. He was only 50 years old. PSA of
100. His Gleason score was 9 and he had a positive bone scan in the ribs and two spots
in the pelvis—three spots—and also one in the, I'm sorry, in the right leg. So, bone
scans can sometimes show spots that aren't cancer, so you—when people do really well
you wonder, "well maybe the bone scan wasn't really," but he had a bone biopsy and it proved
that those spots were cancer. And so he was treated with Lupron and Casodex starting in
1995 and he also gave himself some experimental medicine called PC-SPEZ; he later went on
abiraterone in 2012 when that got approved, but he lived to be 74. Unfortunately, passing
away in 2019 from colon cancer and his PSA was undetectable. So, that was accomplished,
really, with just standard Lupron. He never had any radiation to his bones.
Another case we had, his name was Frank. He was diagnosed back in 1996—24 years ago.
He was 56 years old. Gleason 8, PSA of 230. His bone scans showed three mets. He also
had a biopsy to confirm that they were actually spots of prostate cancer and went on Lupron
and Casodex and his PSA went to undetectable levels. He has another bone scan in 2013 and
one in 2019, they were both clear, and as of March of this year, 2020, Frank is 80 years
old and his PSA is 0.01.
A third patient, Will, was diagnosed in 2010, about 10 years ago at age 61. His PSA was
less than 10; Gleason 8, and he had CT and bone scans showing uptake in his pelvis. Bone
biopsy, again, confirmed that it really was prostate cancer in the bone. He was treated
with a little more modern approach where we gave him Lupron and Casodex, but we also gave
him a short course of chemotherapy and he had radiation to the spots in his bones and
to his prostate. When Zytiga came out in 2012 that was added to his protocol and his PSA
is less than 0.02 today in June of 2020.
So, the two things here. One is that men who are treated early—excuse me—treated aggressively
and get into remissions can remain in remissions indefinitely. So, the old aphorism that sooner
or later everyone becomes hormone resistant is simply not true, and the other thing is
that what we call prostate cancer is not one thing. There are certainly types that are
very sensitive to the therapies that we have available and men can do extremely well. So
people have to be careful when they conclude that it's the end of the game if there's a
metastasis that they're doomed to a bad outcome somedays and that's not necessarily the case.
You're looking at Robert and Frank, 20, almost 25 years later. You know, if I hadn't got
into this so long ago, we wouldn't know that these men could go for such long periods of
time and they aren't even fighting a downhill battle. Their PSAs were undetectable after
20 years.
Wow, thank you for sharing those stories. It brings me—it warms my heart to be able
to hear those stories because it gives me hope and also helps encourage other patients
who are dealing with similar situations, and I know it means a lot coming from a prostate
oncologist who has been doing it so long.
Yeah, it's—there's now, of course, we've got all these new medicines that can help
some of the men that may have not responded so well. We can do much better now than we
used to be able to.
Thank you so much for watching. If you would like more information about bone mets or any
of the topics that we discussed today, you can go ahead and visit our website PCRI.ORG.
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