Treatment Options for Advanced​ Prostate Cancer (High Royal Stage) | Prostate Cancer Staging Guide

hi I’m dr. Scholl’s let’s talk about prostate cancer we’ve been through a lot of these videos and we’ve been following a format of going through each of the 15 stages of prostate cancer today we’re going to cover high royal which is the fifteenth stage for those of you that aren’t familiar with a PCR eye-color system for staging Hiero would be considered advanced prostate cancer advanced prostate cancer falls into three broad categories we call them low basic and high royal high royal means more than five metastases visible on a scan and at least one of those spots has to be outside of the pelvic region pelvic regions right around where the prostate is so high royal means something spread outside there and more than five spots the treatment approach for high royal is to be aggressive when we’re talking about the most advanced stage of prostate cancer we’re talking about when this condition starts to become life-threatening there’s a couple basic principles this is an overview of high royal we could probably do ten videos on hot oil and not run out of different topics and we will come back at some point and talk about different treatments in more detail this is just an introduction to make sure that you have an overview and you aren’t missing something obvious so one of the principles is that we have multiple life prolonging therapies now treatments that have been approved by the FDA that are proven to make people live longer it’s a terrible shame if people don’t get exposure to each and every one of these treatments to optimize longevity which is the goal of effective treatment we also want to give them as early as possible over and over studies show that the same treatment given at an earlier stage I don’t mean before high royal but just you can imagine there’s earlier stages of high royal and more advanced stages of high royal when you give effective treatments at an earlier stage of high royal it enhances longevity to a very significant degree it makes sense the treatments the same but in an earlier States there’s less cancer to fight and the disease is more vulnerable to the therapy so in a perfect world if all these different treatments had no side effects whatsoever you’d give them all simultaneously at the first stage of entering into high royal that would give you the best overall anti-cancer effect practically speaking that’s not possible these medicines have side effects sometimes they can’t be given simultaneously and so there’s a sort of a pathway of or a sequence that people often fall into when selecting therapy for high royal usually people start with less toxic treatments and then subsequently implement treatments that have more side effects down the line the thinking for that of course is that quality of life needs to be preserved at all costs as well so we’re balancing between preserving quality of life in optimizing longevity close monitoring of therapeutic results is essential to be able to know when a shift in treatment needs to occur everyone sort of knows what these things are PSA response changes on scans new spots on scans high rising PSA Zoar PSAs that fail to continue declining are all signs that the treatments effect are running out of gas and it may be time for a change those principles again could be the subject of a video in and of themselves and the whole idea being is that if the PSA stops dropping or if new spots are appearing on a scan you need to be talking to your doctor about a change in therapy since this is just an introduction I want to briefly go through the different fda-approved medicines for high royal and sort of in the sequence of what one would normally think about using them to start off with not everyone with metastatic disease has developed resistance to Lupron so-called hormone resistance or androgen resistance that doesn’t mean that people who are starting LeBron for the first time shouldn’t do additional therapy at the same time Lutron alone is effective but not as effective as using things in combination so typically people will initiate both Lupron plus the second generation medication that blocks hormones ie testosterone more effectively medicines such as extender Zytiga so it’s very common for people who are either lupron resistant or people who can still respond to Lupron to be treated with a combination of Lupron plus ik standee or Zytiga and i use those two medicines more or less interchangeably there’s pros and cons with each one but they seem to have similar effectiveness if those medicines stop working the next tier of therapy is to think about some sort of immune therapy such as Provenge which is fda-approved to treat men with prostate cancer Provenge is a very convenient easy to administer treatment that is given over a six-week period immune cells from your body are removed in sort of a dialysis type procedure they’re shipped off to Seal Beach California and the cells are activated to fight prostate cancer subsequently they’re then reinforced into the body to fight the disease Provenge has been controversial for a number of reasons one is that we typically don’t see sharp PSA declines after Provenge this doesn’t mean that it’s not working studies clearly show prolonged survival some of the early studies which were done in very advanced disease showed sort of a modest improvement in survival of three to four months subsequent analyses of those studies show that men they get started in a more timely fashion can prolong their lives by well over a year Provenge is given over such a short time period it’s easy then to quickly move on to some other form of therapy the next tier of treatment would be something like either chemotherapy with tax attorney of Tana or an injectable form of radium called Sophie go both of these medicines have been shown to prolong life will tend to lean towards Sophie go as long as people don’t have terribly rapidly advancing disease because the side effects are less so if he goes given as a simple once a month injection sometimes it’ll cause a little nausea sometimes a little diarrhea but generally very well tolerated after that therapy has been administered it’s logical to consider some of the standard chemo therapies that have been around now for 15 years taxi Tara and Jeff Tana typically taxi Tara started first is it a medicine that’s infused intravenously every three weeks it’s given with supportive medications to boost the immune system medicines such as Neulasta neupogen and other types of agents and that treatment is monitored because PSA declines are expected to occur and if they are not occurring then these medicines are stopped early there’s been some studies recently suggesting that Jeff tada a medicine very similar to text here has fewer side effects than taxi terror and some people like to switch over to the Jeff Tana to try and improve quality of life these are the standard things that are used for high royal what if all these medicines have been used up what’s the next step well typically people start thinking about clinical trials and this is a vast and rapidly changing landscape one thing that has come to attention in the last year or so is a new injectable form of radioactive medicine called lutetium 177 clinical trials are running all across the country and responses have been remarkably good with relatively few side effects so if you’re facing a situation where a clinical trial is being proposed look into lutetium 177 injections when a person is in the highroad category he’s in a fight these medicines that we’ve been talking about can cause fatigue and other side effects it’s important to maintain as throughout I’m often asked about diet as well and it does appear that modest diets vegetarian diets do have an inhibitory effect on the cancers growth the simplistic view would be if you don’t feed the cancer well it doesn’t grow as well so staying away from the typical American diet the hamburgers and the and the the high fatty foods the animal products is probably beneficial lastly long-term hormone blockade leeches calcium out of the bones and can cause osteoporosis there’s a number of medicines that are available to counteract that a popular one is called X Jeeva X GeV a an injection that’s traditionally be given once a month it’s very effective the problem is in cumulative doses who can have issues related to the teeth or to the jawbone and many physicians have backed off from the standard format of monthly injections and are using a little less frequently to reduce this risk I hope this has been helpful for you to just introduce you to the broad field of advanced prostate cancer we’re going to revisit a lot of these different medications in more detail and try and expound upon the advantages and disadvantages of each one [Music] [Applause] [Music] you

1 comment

Leave a Reply

(*) Required, Your email will not be published