Hey everyone, it's Alex from  the PCRI in today's video,  

I asked Dr. Scholz to share some major updates  that we have from the 2021 ASCO meeting.  

ASCO stands for the American  Society of Clinical Oncologists,  

and those are basically meetings where researchers  from all around the world come together—and this  

year it was virtual—and share their updates in  their research. The reason we're going to be  

sharing these studies is because it's going to  be really beneficial for our future to see how  

the standard of care may change in prostate  cancer. It may not be super applicable today,  

but it is good to know what's coming down the  pipeline. We hope you find this video educational.

A couple interesting things are coming out now in  2021. One is related to men that have metastatic  

hormone-sensitive prostate cancer. This  is a situation that arises when men  

don't get their PSA tested and show up at the  doctor's office with some pain in their bones,  

PSA is over a hundred, and they've never had  treatment and the cancer's already spread.  

Studies have shown that these men respond  well to a combination of Lupron plus Zytiga,  

and the addition of Zytiga to the Lupron has  been shown to extend survival compared to  

giving Lupron alone then giving the Zytiga later when the Lupron becomes ineffective. Same thing's  

been shown if men are treated with Lupron plus  Taxotere, a type of chemotherapy, and large  

studies again confirmed that the men that have  this situation of hormone-sensitive metastatic  

disease should be on Lupron and Taxotere from the  get-go. Don't wait for the Lupron to stop working  

and then start the Taxotere because those  people don't live as long. What hasn't  

been understood until now—until this recent  report—is how will men do if they take Lupron  

plus Zytiga plus Taxotere, all three agents. It kind of makes sense to do that because they kill cancer  

through different mechanisms, and the combination  logically, you would think would extend survival  

to a greater degree, and that's what this study  confirmed. A study was finally done where half  

of the men were treated with a combination  of Taxotere and upron and the other half of  

the group got Taxotere, Lupron, and Zytiga,  all three in combination, and there was a two  

and a half year extension in survival in men  that got the combination of all three drugs.  

So, what logically seemed to be the case  has now been proven in a prospective trial,  

and the standard of care, in my opinion, now,  for men that have metastatic hormone-sensitive  

disease, is to go on a combination of all  three medicines: Zytiga, Taxotere, and Lupron  

when they're diagnosed with this sort of  metastatic hormone-sensitive prostate cancer.

Another interesting report coming out of the  2021 ASCO meeting relates to the use of Xofigo  

in combination with second-generation hormonal  agents like Zytiga and Xtandi. A couple years ago,  

it was reported that the combination of Zytiga and  Zofigo caused an acceleration in the incidence of  

bone fractures, a negative outcome that was rather  unexpected, and now we are told as experts not to  

combine Zofigo with Zytiga. This is sort of  counter-intuitive because, usually, combining  

effective agents gives better cancer outcomes,  and it is desirable to use things in combination  

as long as the side effects are not made worse.  So what's interesting about this report from ASCO  

is they're looking at a study where they combine  Xtandi with Zofigo, Xtandi being a competitor to  

Zytiga, a second-generation hormonal therapy, and  in this report they showed that if you gave bone  

protective agents, like Zometa or denosumab  otherwise known as Xgeva, that the incidence  

of bone complications was dramatically reduced  and almost eliminated. I think that this is an  

important report because it is desirable to  give agents in combination in men that have  

dire types of hormone-resistant prostate cancer,  and it's good now to know through this report  

that these agents can be combined if preventative  agents, protective agents, to prevent the bone  

fractures that are known to occur in men that are  getting hormone deprivation plus Xofigo. Briefly,  

why are these men getting bone fractures? Well,  we know already that osteoporosis is accelerated  

with all forms of hormonal therapy. Xofigo is a  type of radiation that attacks the bones and the  

cancer in the bones, so that combination has been  shown to exacerbate the risk of hormone-resistant  

patients getting these agents and bone fractures,  so this is an encouraging report that now we may  

be able to give these things in combination,  Zofigo and Xtandi and possibly Zytiga as long  

as bone protective agents are given at the same  time, bone protective agents like Zometa or Xgeva.

Another interesting report from the ASCO meeting  relates to the use of high-dose testosterone in  

men that are becoming hormone-resistant. This is  a very intriguing concept that has been floated  

over the last few years as being a rational and  possibly effective way to treat prostate cancer.  

Men are administered a single injection of  testosterone once a month and a certain percentage  

of men are having declines in PSA and regression  of their cancer. This particular approach  

was studied in a report that combined testosterone  with an immune medicine called Opdivo. About 40  

of the men had significant declines in PSA of  averaging about six months remission but some  

patients with remissions as long as a year or even  more, and the side effects, as you can imagine,  

were quite tolerable. Men enjoy getting their  testosterone back and the Opdivo medicine has  

a known spectrum of side effects. Opdivo has  been used for lung cancer and melanoma and other  

situations. It's not FDA approved for prostate,  and people that are interested in this protocol  

may run into difficulty getting it covered  by their insurance—it's an expensive drug—but  

it's encouraging that this idea of giving  testosterone to men with hormone-refractory  

disease may indeed be a useful approach and  this is just one more study suggesting that  

this type of treatment is here to stay, and  in combination with other approaches or as  

a stand-alone treatment might indeed be a viable  way to treat men with hormone-refractory disease.