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- Опубликовано: 5 июл 2024
- Medical oncologist Mark Scholz, MD, goes into more depth about the newest scans and treatments available for men with advanced prostate cancer. He describes the various contexts in which any one of these treatments would or would not be included in a patient's treatment plan, and some of the factors involved in fine-tuning each patient's upfront treatment to maximize the odds of achieving a long, durable remission. Phase III clinical trials are demonstrating that these types of patients are benefiting from more precise and aggressive treatment upfront, which reduces the risk of future relapse, the need for further intervention--which may include indefinite hormone therapy--and potentially even prostate cancer-related mortality.
0:07 Can you explain the process by which prostate cancer spreads?
1:43 Which body scans should men be getting if they are high-risk?
2:07 If a man does not have access to PSMA PET scans, which scans should they be doing?
2:43 How does the treatment protocol differ if someone has oligometastatic disease (only a few metastatic lesions) versus someone with extensive metastatic disease?
3:49 Does spot radiation to bone metastases cause any pain for the patient?
5:30 If spot radiation weakens the bone to which it was directed, then how do you think about patients with osteoporosis, for example, who may already have weakened bones, but need spot radiation for prostate cancer control?
8:00 How often, or in which cases, do you consider the addition of chemotherapy in patients with oligometastatic disease?
9:24 Do treatments like Xofigo (injectible radiation) or Provenge (immune therapy) have any effect on metastatic lesions?
10:28 Which metastatic patients are the best candidates for Xofigo considering the possibility of spot radiation. Is there a maximum or minimum number of metastases that you use to determine in whom Xofigo would be most effective?
11:06 Is IMRT (lower doses over a longer period of time) or SBRT (higher doses over shorter time frame) better for treating bone metastases?
11:36 What are the side effects for patients who are going through aggressive combination therapy?
12:26 What is lutetium-177 and how does it work?
13:34 How many 6-week rounds of lutetium-177 would a patient receive?
13:53 Do you expect a PSA decline after lutetium-177 if it is working?
14:12 How effective is lutetium-177 for disease control?
14:29 How does lutetium-177 compare to Xofigo?
15:52 How many patients have you personally known to be treated with lutetium-177 and how successful has it been?
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My prayers are with all who are battling this tough fight I encourage everyone not to give to this fight but to continue to watch and receive information like this let's us know there is HOPE!!! Stay safe and much love❤️
Need a good doctor, every one need a good doctor .
The last point made to advocate for your health is spot on and, not just for men with prostate issues but with all health, dental, and mental health issues. Great advice!
I undertook this healing path in 2014. My regret was failing to get a second opinion. The side effects of the treatment were very difficult. Still alive.
I’m stage 4 with high volume. I do appreciate your efforts with the information.
I am in the same boat as you with stage 4 and many bone mets sites. Finished chemo 6 months ago and PSA dropped to near zero but is slowly rising again. This was a very informative video and provides some options to talk to my doctor about.
Mike I am on apalutamide as well as firmagon injections. Both are now $30 per month in Australia ( pbs )
I m having a psma pet scan soon to check for any residual ca . So far my psa is zero . I finished chemo 10 weeks ago .
Look it up, no one seem interested, yet.
>>Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.
Great content for both doctors and patients. Thank you 🙏
I am so worried now because after my mri showed 2 tumor in my prostate and one in my bone, I'm questioning myself if I have metastases cancer already? My psa was only 3.8 and I'm 62 this yr, My urologist told me those things they saw are only suspisious not yet determind if those are cancerous so he sent me to nuclear medecine here in Sweden they injected me a few doses of radiation to scan my bones and a needle biopsy, now still waiting for the result my appointment will be at the 8th of May. Wish me luck.
How r u???
Good luck with your diagnosis. I’ve had stage 4 prostate cancer going on 4 years now. I’ve had several different treatments not always fun but I am still here and the cancer is being kept at bay. Get a second opinion and you must be your own advocate. Find as much information as you can so you can ask the right questions. Good luck and maybe find a support group it helps. I’m guessing you will come through this okay.
My father has also stage 4 prostate bone mets but I m so worried about my father I think I will die because of panic I don't want to lose my father if prostate cancer spread in bones then its get incurable and I don't understand what is life expectancy on this stage plzzzz help me
I do wish you luck from USA. Sweden is far ahead of other countries regarding the treatment of PC in my opinion. I'm 64 and may visit your country one day after I retire. As you know, the PSA is not a test for cancer. It's arguably misused as a preventative measure because men with cancer often have high PSA. But in reality a man can have a 2 and have Prostate Cancer or a 13 and not have it. In January I was 13.14 and now almost three (3) months later (after I went for a second opinion) I'm @ 7.16. I'm scheduled to go back to discuss the second result later this month (May 2023) and based on that result, probably get another blood test in 6 mos. I'm thinking of cancelling the appointment because I have no symptoms. I urinate and raise the flag adequately, no blood, no pain. and both DRE's normal. You see, before the retest showed the drop to 7.16, I had an MRI which was all clear, RADS2. I think the MRI would have been RADS1 but I had something on my hip the radiologist felt warranted further investigation. But maybe the radiologist also considers the PSA, age, etc...I'm only guessing how the MRI score is determined. Anyway, the follow up XRays of the hip showed no lesion, maybe a "tear" i.e a rip; but likely minor osteoarthritis. Based on the MRI and XRay, I'm not going to biopsy, which was my motivation for the second opinion and second blood test. The first Dr had not felt a second blood test was necessary (Inot that he wouldn't do one) because I let him know I was at 5.83 last year (2022). He thought I should have been "seen" then and the jump to 13 supported his recommendation (which was the reason I went there in the first place). If you don't mind. what I wanted to ask you is why did you get an MRI if you had a 3.8? I had a 3.8 in 2013 and no one even suggested I get checked, I wouldn't have even considered it. I think it turned out to be a lucky thing you did, but what led you to? Did you, or do you have symptoms? Don't worry. As your Dr. said, you don't know what those lesions are. In two days you'll have the result. I know how I felt when I was opening the webpage to see my second PSA so I know how you must feel. But that's why I'm wondering, how do you feel, I mean physically and why did you investigate in the first place with only 3.8? I believe everything will work out well for you.
@@vimzibaiegh thank you for kind letter , iVe been checking up my psa since I was 40 yrs old but stop it because of the pandemy the reason why
Excellent... ! I go in for my PSMA PET tomorrow. This helps me understand. Thank You
Thank you!!
Thanks for sharing
Thank you for the great informative video! Can Lu177 be administrated at the same time as chemotherapy, or should the chemotherapy sessions be over before administrating lu177 (and if so why?)? Best
Another informative episode--thank you! For those of us that are stage 4b and responding well to ADT, where does IMRT fit into a treatment plan. I was initially diagnosed with over 25 mets, in my 50s, overall health is great (except for that cancer thing). PSA went from 1,621 at diagnosis to 0.5 now. PSMA PET scan last August showed dramatic decrease in mets. Does it make sense for someone like me to seek out IMRT for the remaining/larger mets?
For those with oligometastasis 5 or fewer, spot radiation may work. Either a single radiation dose or 5 sessions can work just as well as longer course treatment.
@@mperloe Your response does not address my question.
@@xt8ob 5 Session SBRT may be a good option if only a few lesions are seen on PSMA PET scan. IMRT means simply that the beam is aimed from many directions to shape the treatment field. The term applies to any type of radiation, but is often considered for 28+ treatments. SBRT is higher dose IMRT where the total dose is delivered over 5 sessions. SBRT is equally effective with fewer side effects. So yes it is an option in this situation.
R u there??
What is the likelihood of metastasis when there is a diagnosis of ETE or extraprostatic tumor extensions? It would be great if this subject was addressed as I have not been able to find any discussion on this.
Thank you, always for the informative videos.age. at age 54, Stage 4 ,metastatic prostate cancer, spread to bones only so far. Have been asking Dr to to get on Zofigo for a month now but was told blood platelets are too low at 68. Any ways to raise count . Only offered a couple rounds of Chemo Cabazataxel to maybe raise blood count
If ADT has stopped working, should it be discontinued?
I have bone-only metastatic prostate cancer. I’m currently receiving Pluvicto injections. Is there any data that shows how effective Pluvicto is against bone-only cancer?
Are these treatments used after normal chemo injections stop working? My husband had 45 sessions of radiation 4 years ago, and was on Xtandi, but recently his psa number is raising, so doctor swiched to Xytiga, if it is not bringing down psa, doctor suggested to have chemo injection maybe 4 sessions. He is 81 years old, so I want to know if these injections stop working, from your last episode I learned he can even have another following chemo injections, but after that what can be used?
Does it effect urinary bladder
Is there a reason that L-177 isnt used at the start when diagnosed or before spread to kill or stop PC, since it looks for and kills it
I expect that cost has a lot to do with it. Pluvicto is much more expensive than the other treatment s.
I was diagnosed 2 years ago with Gleason score 4 and 3.
I had a biopsy that determines that. They offered me.
Radiation Or removal of the prostate. It was one legion on the right side. I had no symptoms.
I did not like the options they Advised. me to get treatment. I wanted to get breakingtherapy. Of the whole prostate only. Excuse me for miss pronouncing that word.
They said no.. radiation . I asked them about space zar They said they do not do that at University. Of michigan.
So I decided to do nothing. They told me within a year. Likelihood spread to my bone. I came back. 2 years He said hes Before he talk he want to. order A PSMA scan. And the cancer hasn't moved at all. still on the right side of the Prostate.. First thing he said to me is you pass the look test and you got a lot of rubber on your tires. requested a breakytherapy again. I know i'm sounding. Unreasonable
I'm even interested in combination with Homo therapy. I reminded him of what he Told me.. About spreading too To my bones he remembered and He said your cancer is not acting like cancer. He said that he will offer me breakingtherapy Permanent seeds plus radiation plus homo therapy. And he said, because even though , the PSMA are clear. He's pretty sure there's something still lingering. I'm thinking about just staying on Homo therapy. pushing it down the road. get on different combinations of Homo therapy If the cancer figure out how to get around one type of homo's therapy until something. Is new.
Come through science. I'm not fearful, Because.we can't get. Out of this life alive. I still run 5 miles a day. Enjoy my electric bike and I eat 1 meal a day.. Thank you very kindly for reading these few words.
Forgot to mention tobelow comment ,,taking vitD and k2 do u think this helps
My PSA dropped dramatically without treatment. How often does this happen and what does it mean? Furthermore, my most recent biopsy found nothing.
Milk, cheese, and sugar cause prostate enlargement and cancer.
You need to discuss the cost.
Thanks again for info,,I38 months in ,,still on hormone therapy!!eekk,
Xtandi then aberaterone,then taxatere,then jeftona,,all are failing, now 2nd radiation on pelvic pain it helps ,,I can't get ahold of your help line ,,,do you have a new number???
👍
What is so magic about 5 legions as cutoff for oligo disease? Why not 10?
Psma ct I can get 4 on medicare.
My father is 72 years old he had bph for last 4 years he took tamsulosin but from few months ago he had pain in left leg and unable to walk after x ray mri and blood test diagnosed prostate bone mets and tumour in his left femur treatment is going on but i m worried about it i dont want to lose my father can he live
I received 10 radiation treatments in my left femur.
Had leg pain, and im 70 year's old.
Keep a positive attitude, and if you believe in prayer, do so. Also keep watching these videos, they are full of cutting edge technology. And the more you can learn about the disease the further ahead you are when talking to your oncologist about it
Also the leg pain is gone
@@michaelhelfand8773 thanx dear stay happy with good health....sending prayers
@Michael Helfand when did u diagnosed???
@@michaelhelfand8773 are u there???
ADT drives bone mets, or so the literature claims. Then again, we need to talk about this.
>>Undetectable levels of Prostate Specific Antigen (PSA) have been reported from the first patient with metastatic castrate-resistant prostate cancer (mCRPC) to ever receive two cycles of Clarity’s 67Cu-SAR-bisPSMA at the 8GBq dose level. PSA is a marker of tumour burden, clinical response to treatment and an indicator of the recurrence of disease for prostate cancer.