Hi, I’m Dr. Scholz. Let’s talk about prostate cancer.
This video is going to cover hormone blockade for prostate cancer for men in the Azure stage
of prostate cancer. Azure is the high-risk more consequential type of prostate cancer.
Men in Azure are going to get some form of hormone blockade in most cases. There is a
higher risk of spots spreading outside the gland and this necessitates some sort of intervention
or therapy that can circulate throughout the blood and can attack the cancer in other parts
of the body. Hormone therapy is ideally suited for this approach because the side effects
are reversible and the treatment is very effective. So men in the Azure stage are routinely administered
hormonal therapy in conjunction with other therapies. So hormone therapy is a remarkable
form of systemic therapy. If you compare to chemotherapy, for example, it has higher response
rates and in general fewer side effects. So men with prostate cancer are very fortunate
to have a form of therapy with reversible side effects that have such potent anti-cancer
effects.
Hormone therapy we call testosterone inactivating pharmaceuticals (medicines to block testosterone)
consist of three broad categories. We have a milder type of hormonal blockade called
the Anti-Androgens--Casodex and Nilutamide for example. The sort of standard hormone
therapy is the LHRH Agonists (Lupron, Trelstar, Eligard) that block testosterone coming from
the testicles. And now in the last five years, we’ve had some more enhanced stronger hormonal
therapies that actually block testosterone within the cancer cell--medicines like Erleada,
Xtandi, and Zytiga. There’s a role for all three of these categories in the management
of Azure, and we’re going to go through and discuss the different approaches that
are used because you don't want to use more hormone therapy than is absolutely necessary.
The longer you administer it and the larger number of medicines you use the more you’re
going to run into side effects, and we will be talking about how to correct some of these
side effects in a separate video. There’s a whole art to minimizing the side effects
of hormonal therapy.
So when we’re talking about Azure, we’re looking at the three subtypes of Azure: Low-Azure,
Basic, and High-Azure. And I contend (and many experts contend) that radiation is sort
of the backbone for treating Azure, resulting in higher cure rates than surgery does, but
when you give radiation for Azure you’re going to be administering hormonal therapy
some TIP concomitantly with the radiation. This is why it’s so important to know your
subtype. Men in Low-Azure can get away with just 4-6 months of Casodex plus Lupron type
approach. Men that have Basic-Azure need a longer time period--studies seem to indicate
about 18 to 24 months of Casodex plus Lupron in conjunction with the radiation and seed
implants as we’ve gone into or will go into in other videos. Men that are in High-Azure
(and you can find these different categories at the PCRI website--High-Azure is a PSA over
40, a Gleason 9, and other factors such as seminal vesicle invasion) men that are in
the High-Azure category should strongly consider adding some of these more potent agents such
as Erleada, Xtandi, or Zytiga to the Casodex and Lupron, and then continue that for about
18-24 months. So how much hormonal therapy you get and how long the treatment is continued
is dependent on the subtype--how serious the Azure stage prostate cancer is--and a number
of studies have shown that men in Low-Azure can get away with a short course of TIP, men
with Basic-Azure require 18-24 months, and men in High-Azure should strongly consider
adding some of these newer stronger hormonal agents to enhance and to optimize their cure
rates.