Hi everyone! A lot of you have been submitting YouTube comments and a lot of
you guys have questions on prostate cancer that you would like us to ask Dr. Scholz
and today we're going to answer those questions.
So, our next question I think I've seen this question come in
at least 200 times and it makes sense to me and I look forward to this day,
but, "When are we going to see prostate cancer diagnosis via imaging and without biopsies?"
Well, it may come within the next 10 years. Dr. Klotz shared a video looking at micro RNAs in the
urine and it looked very accurate. That could be out, who knows, two to four years?
These new PSMA PET scans light up specifically for cancer, so if someone was unable to go through a
biopsy he could have a PSMA PET scan and if there's nothing lighting up in the prostate
it's a very strong indication there's no prostate cancer present.
The biopsies are still attractive of course because it gives you the grade of the cancer
and that's an important distinction for what kind of treatment you need.
With everything you talked about and the developments of imaging,
do you think that we'll see maybe if they are going to do biopsies we'll just see
a complete lack of randomized biopsies and just do targeted biopsies with this imaging?
Well, I think we can do targeted biopsies now in 2020. There's a lot of momentum from the past
because random biopsies have been standard for 30 years; it's the lingua franca of the prostate
cancer world, so I don't know when we'll finally move beyond doing random biopsies in everybody
but I don't see it happening immediately, probably not within the next five years—hopefully, someday.
I look forward to it. I'll never forget opening up the Wall Street Journal and seeing you
talking about randomized biopsies and talking about, like, harpooning the prostate. So...
Yeah, it's, I mean, they are a very large bore needles and
they—about 1 in 100 men are hospitalized afterward with a life-threatening infection when everything
is done properly. When the biopsy is done improperly, the infection rates are even higher.
It's on the same topic but this is a question from me because I get this at helpline a lot
and I'd like to hear your answer: Do you think that biopsy, when they're doing the biopsies
and they're taking the tissue out, that that could cause the cancer to spread in the body?
It doesn't seem very likely. The question comes up all the time and there have been
concerns about it. They can actually show cancer cells in the bloodstream after biopsies and after
radical prostatectomies, but people forget that the cancer just getting out of the gland is not
what translates into metastasis. It has to do with the genetic makeup of the cancer cells themselves
and their capacity to land somewhere, put down roots, and then grow in a foreign environment
in a different part of the body, and those are the important aspects of the cancer—not
whether or not it gets outside the prostate, but whether it has the genetic capacity to grow in a
distant part of the body. And so yeah, it's well documented that with a biopsy or with a radical
prostatectomy that there are numerous cancer cells that get out but they don't reproduce.
I do have a question, "I had an undetectable PSA for one year post-open surgery and then I had a
0.11 (so 0.11) PSA and then 3 months later, a 0.2. I will be getting—I'm going to be beginning
radiation therapy in a week and my question is, they are going to just radiate the prostate bed,
then if the PSA still goes up they're going to hit the lymph nodes. I trust my doctors
but i want your opinion on whether the lymph nodes should be treated at the same time?"
Well, we don't have enough information. We don't know how old they are; we don't know
what their Gleason Score was, but there's always a consideration in this modern era for treating
the lymph nodes at the same time because studies show that there's no additional side effects.
So, there's a temptation to be more thorough and cover the area not only where the prostate
used to be but also the surrounding lymph nodes, but there's so many unanswered questions here,
you know, we don't know very many details about this individual and another question
would be does this person need to get a short course of hormone treatment with his radiation?
Should they go get a PSMA PET scan? There's just a lot of different angles now that are
we really can't address, but there's no right or wrong answer. There are certainly cases where it's
reasonable to just radiate where the prostate used to be, see how things go, and god forbid it comes
back again or the PSA doesn't drop, get a PSMA PET scan, find out where it is in some other part of
the body, and then radiate that spot. So this—even when you have all the information it's not always
entirely clear what the best pathway forward is, but those are some of the considerations.
We have somebody in the comment section who is having a hard time finding a doctor who
does brachytherapy and I know that you've done a lot of research and they can contact PCRI for
helping them find that, but my question is why is brachytherapy not really a popular
radiation treatment in all of the span of, you know, the other radiations?
It seems that the primary reason is that the doctors who do it are
paid so much less than the doctors that do other types of radiation.
I believe Medicare is going to try and rectify this in 2021 and bring
the reimbursement rates for brachytherapy up on par with other types of radiation,
and I think you'll see a huge resurgence because the clinical research that's been done
shows that brachytherapy cure rates are higher or highest of all the different types of treatments.
So, it is economical, convenient, and effective, and certainly no more toxic, so brachytherapy
should be a consideration whenever people are talking about treating prostate cancer, and
once they start paying the brachytherapist a fair rate—the insurance companies, you know, set these
rates—then you're going to see a big resurgence in brachytherapy over the next five, ten years.
Alright, so our next question is, I'm on abiraterone but my PSA
is increased from 37 from 20. Can Nubeqa now be a treatment?
So, when someone is resistant to Zytiga, which sounds like this person is, there's a small chance
that second-line—second-generation—hormone therapies Nubeqa or Erleada and Xtandi will
be effective, but the chances for success are only about 10%-15% of the patients. However,
it's still reasonable to try it because these medicines are well-tolerated and usually within
60 days you'll see if the PSA stabilizes or starts dropping. So, I think it's okay to
start Nubeqa, but also plans need to be made if the Nubeqa is not working; what is the next step?
Thank you so much for watching! If you would like Dr, Scholz and
I to cover one of your questions, you can go ahead and leave them
in the comment section of this YouTube video or on our other videos
and we can go ahead and pick them up from there. Also, please subscribe to our YouTube channel;
the subscribe buttons right here on the right. We come up with new prostate cancer videos every week
and visit our website pcri.org if you would like more information. We hope you have a great week.