Hi, I’m Dr. Scholz. Let’s talk about prostate cancer.
In this video, we’re going to cover unorthodox treatments for High-Azure. That’s the high-grade
type of prostate cancer—men that have been recently diagnosed, but have higher Gleason
scores, have possibly lymph node spread in the pelvic region. These are situations that
are more difficult to cure, and so it’s logical that you'd want to consider pushing
the envelope and adding additional therapy.
The standard approach is to give 18 months of hormonal therapy, radiation therapy to
the pelvic nodes and to the prostate, and a seed implant boost.
So what more can you do?
Well, how about some chemotherapy. There are studies showing that 4-6 cycles of Taxotere
can improve cure rates and long-term survival when added to the protocol I just mentioned.
There’s also studies showing that adding Zytiga, a more potent type of hormone therapy,
can enhance cure rates as well. Now as of yet there aren’t any studies looking at
adding both Zytiga and Taxotere to the protocol previously mentioned, which would be a logical
thing to consider since you’re really going all out in these circumstances. The possibility
of doing them both together, therefore, is unorthodox.
How big a deal is that? Well, no one really knows if you’re going to get enough additional
benefit or cure rate by adding say Taxotere—which would be the last thing on your list since
it has the most side effects—and simply adding Zytiga alone.
So how do we make these decisions? Well, you can base it on a patient’s age for example.
A younger man is going to tolerate Taxotere better and also has more life years at risk.
So the younger the patient is, the more likely you might want to consider some sort of unorthodox
therapy. In addition, for example, the patient that has more extensive lymph node disease
or let’s say a PSA that’s very high—50, 60, 70 something in that range—which suggests
a really entrenched type of prostate cancer. So those would be the two circumstances to
consider. A younger patient and a patient who has even more advanced or more worrisome
type of prostate cancer.
I’d also like to also talk about another scenario that often comes up because surgery
is still popular amongst the urologists even in men that have high-grade disease. I see
men undergoing surgery all the time even though they have proven lymph node disease. The chance
for these people to stay cured with surgery alone is extremely low—probably only 20%
or less—but because it has been the tradition to do surgery many men are given an operation,
and if their PSA goes to zero they’re just watched. This makes no sense at all because
almost certainly there is residual cancer somewhere lurking in the body and we know
that medicines like hormone therapy can enhance disease control and cure. There are a variety
of studies that show there are benefits. So it’s considered unorthodox to do something
like Lupron or Zytiga or both after surgery, but I think it’s a strong consideration
for someone in the High-Azure category.
A third thing to consider in the way of unorthodox treatments for men with High-Azure is the
addition of some non-cancer related medicines that seem for some reason to improve cure
rates and disease control. The reason these medicines are unorthodox is we don’t have
prospective clinical trials showing their benefit. These are mostly retrospective trials
that have looked at men and it seems like there’s a trend towards better survival.
What are these medicines? Well, there’s three. One is Aspirin. Two is a medicine used
for diabetes called metformin and it’s often used for weight control as well. And the third
one is your common statins. These are medicines such as Lipitor, Crestor, Pravachol. All three
of these medicines individually have been shown to have better long-term cure rates
compared to men that aren’t taking them, and these medicines typically have relatively
few side effects and doctors are very familiar with them. So adding one or more of these
medicines to the treatment protocol makes sense even though the studies to evaluate
their use are not ironclad.
So in summary when people have a worrisome more advanced type of prostate cancer—high
Gleason scores, high PSAs—what we call High-Azure it’s logical to really push the envelope
and try and find a protocol that’s going to have the best cure rate. Combinations of
medicines are the logical way to go.