So, this question is very interesting to me because we have so many patients on active
surveillance, and this patient has Gleason 6 prostate cancer
and they want to know if there's ever a time that they need to be thinking, "Yes,
inevitably treatment is going to have to happen." I know that in a study with Dr. Laurence Klotz,
he did a study with, I think, about 2000 patients, and proved the Gleason 6 did not metastasize. So
in that case, then, if the person has Gleason 6 if they had to experience treatment at some
point, would that mean they had a completely different Gleason? A new tumor that popped up?
Yes, exactly. So men that are on active surveillance have prostate glands, and
they can contract a new cancer, and there is possibly a chance that the Gleason 6 over time
could change into a higher grade. So, as long as it remains Gleason 6, it will not spread,
but people need to be under surveillance for the possibility of a higher grade cancer appearing
over time. This is not common, and for men that are appropriately screened with MRIs and biopsies
and whatnot, the chances of needing treatment in the next 10 years is probably about 10% to 15%.
Men that don't have MRIs, it seems more likely, as 30% or 40% of men will need
treatment within 10 years, but it's — there are a lot of men —we've got men that have
been watching their prostate cancers for 20 years and they have not needed treatment.
Just because somebody gets a Gleason 6, you know, tumor on their prostate does not
automatically mean that they're going to get other tumor types, you know, Gleason 7 8 or 9.
It seems like you have patients who have just had Gleason 6 permanently and that's just it.
That's correct.
That's incredible. If a patient is pre-diabetic, should he consider
surgery instead of radiation to avoid adjuvant ADT which may increase the risk of diabetes.
If a person is unconcerned about the development of impotence and incontinence,
then I suppose there might be a small advantage to surgery over taking radiation plus hormones.
The trouble is, is there's—there are a few problems with that—and one is that the
patients that require hormones with their radiation
would probably also require hormones with their surgery. It's not a typical policy to give
surgery with hormones, but many men with high-risk disease would be much better off if they did
take hormones as the idea is to eradicate the cancer at its inception rather than waiting for
it to come back. I would not shy away from doing radiation plus hormones; I would—in other words—I
would not pick surgery because I think the other negatives of surgery are far more serious and god
forbid there is a little more problem with blood sugar, that could be managed with medications.
So, the next question is, is letrozole effective for preventing further gynecomastia
if it's already begun to occur?
I think the short answer is yes. Letrozole blocks estrogen. Some men, when they're taking
hormone blockade, the residual testosterone gets converted into estrogen, they start to
develop breast enlargement. Men who are on hormone blockade want to prevent the development of breast
enlargement because the enlarged breasts don't go away after treatment is stopped.
If someone wants to try and fix the situation they're going to have to go
through some sort of plastic surgery. So if the process has begun it can be
stopped either with radiation or with an estrogen blocker like letrozole or arimidex,
and these medicines are very well tolerated; they have few of any side effects,
and we use them liberally in our patients that say they have any nipple tenderness or they think
there's any enlargement. In previous interviews I've seen you talk about that if a patient is
experiencing gynecomastia on any of these hormone therapies to stop, and to, you know, talk to their
doctor about it before any other breast tissue grows. Does that mean that they would need to
switch to a different type of hormone therapy or are they all going to do the same thing?
Well, I don't know — I don't think you can simply stop hormone therapy. Typically people
are in for a certain course and they're sort of obligated for cancer reasons to continue on,
so implementing various measures quickly before the breasts get bigger
is what I would recommend. Starting medications
such as letrozole or talking to a radiation therapist about radiating the breast area.
How effective is shockwave therapy for erectile
dysfunction after somebody's had surgery or radiation?
It's hard for me to get to the bottom of that answer. I know that there are a lot of
places that are offering this service now, and I can only think of one patient that went through
this treatment and said he thought that it really helped his situation, so apparently it can help
some people. I've had a number of other patients that have tried it without really any benefit,
so I'm not recommending it now until I see some more positive benefits.
I see it come up a lot in google comments or things that people send us all about
shockwave therapy, and it's really hard for PCRI, especially, to answer that, just as you stated,
because, you know, we haven't seen any positive results either way, and it just sounds like,
you know, a lot of things get marketed on the internet but that doesn't necessarily mean it's
great for you and effective. Even more, we need to talk about the side effects of them.
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