PROSTATE PROS Series Finale



On the last episode of the PROSTATE PROS podcast, Dr. Scholz and Liz recap important themes and talk about what’s new in prostate cancer, including Lutetium-177 and Orgovyx.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I'm your host, Dr. Mark Scholz.&nbsp;



Liz:&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz:&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; [00:15] We have a bit of a sad announcement to make, as this will be the last episode of the PROSTATE PROS podcast.&nbsp; Dr. Scholz and I have really enjoyed working on this project and we've covered so many important topics surrounding prostate cancer and men's health.&nbsp; So for this last episode, we're going to recap some important themes and talk about some promising new therapies.&nbsp; So Dr. Scholz, on our very first episode, we talked about how important it is to find the right treatment team.&nbsp; This is something that's come up again and again and again.&nbsp; What are some tips you have for newly diagnosed men trying to find their doctors?&nbsp;



Dr. Scholz:&nbsp; [00:53] I think what's confusing is how much of the responsibility falls on the shoulders of patients.&nbsp; The prostate industry is a very powerful multi-billion dollar industry, and there is a lot happening really fast.&nbsp; When patients are diagnosed, they're not in a thoughtful perspective, they're in an action mode, they're frightened.&nbsp; It is hard to sort out who to listen to and who to stay away from. This process can be aided by family members, primary care doctors, oncologists, and of course, online resources and books.&nbsp; I try to provide some of that information in the book, The Key to Prostate Cancer, but the process, if it was easy, we could give you one simple answer. &nbsp;It is not a simple process.&nbsp;



Liz:&nbsp; [01:46] One thing that we've talked about is to get a quarterback. &nbsp;So this is a doctor that isn't the treating doctor necessarily, but it’s someone that will oversee the treatment and work with the other teams of doctors. &nbsp;This is something I hear you doing Dr. Scholz, you're always talking to other doctors about patients and kind of networking with them to make sure that the patient is getting the best care, even when they're not in our office.&nbsp;



Dr. Scholz:&nbsp; [02:12] I think the issue that you're relating to is that many of these physicians have a conflict of interest. &nbsp;You're asking them, what should I do? &nbsp;But they're a surgeon or they're a radiation doctor.&nbsp; And as a medical oncologist, I'm neither of the above. &nbsp;This is somewhat uncommon, but you can recruit your urologist or your radiation doctor to help you by explaining at the outset that, “you, sir, will not be my treating doctor, but I definitely need your aid and your assistance in picking the right doctor.”&nbsp;



Liz:&nbsp; [02:43] Now you may be thinking that you have cancer and you don't have time to see all these people, but as we've mentioned, prostate cancer is slow growing. &nbsp;So really taking that time to find the right doctor for you is crucial.&nbsp;



Dr. Scholz:&nbsp; [02:56] Just yesterday, I saw a very sophisticated new patient who was feeling the rush job, the sense that the clock is ticking, and he did have a Gleason 9. &nbsp;We consider that the High-Risk category of prostate cancer. &nbsp;But, the idea that you have to make a decision within days or weeks is never substantiated by the literature and the science.&nbsp; Patients can take several months to sort out what they want to do. &nbsp;This sort of careful thoughtful process pays off in the long-term with better results.&nbsp;



Liz:&nbsp; [03:29] So patients really need to take it under their control. &nbsp;One of the things is to educate themselves.&nbsp; In the past couple of years, there's been a huge shift towards imaging. &nbsp;So we've had the approval of the PSMA PET scan and using 3T MP MRIs and color Doppler to help men diagnose their prostate cancer and watch it.&nbsp;



Dr. Scholz:&nbsp; [03:51] What Elizabeth is referring to is that if you don't have a clear picture of where the cancer is and whether it's spread outside the gland, what part of the gland it's located in, it's not feasible to tailor treatment to the specific needs of the individual. &nbsp;Some men are fortunate enough to have prostate cancers residing on one side of their gland. &nbsp;This opens the door to something called focal therapy, enabling men to undergo treatment with less risk of erectile dysfunction. &nbsp;There were a lot of things we could have covered in this last podcast and the reminder that quality imaging and not only MRI and PSMA PET scans, but scans done at centers of excellence that are read by experts are going to help men be light years ahead in their selection of treatment, because they'll have a clear picture of what they're really treating.&nbsp;



Liz:&nbsp; [04:43] So we've actually gotten emails from people all across the country saying, you know, my doctor's never heard of the PSMA PET scan or my doctor doesn't do 3T imaging. &nbsp;So it is really important that you take the time to educate yourself and bring these questions to your doctors.&nbsp; Finding the right treatment team and doing your due diligence to make sure you're choosing the right treatment is all important because of where the prostate is located. &nbsp;Treatment related side effects can have damaging effects on quality of life. &nbsp;Because prostate cancer is so slow growing, hopefully you'll have a very long life, so it's important that that can be lived to the best of your ability.&nbsp;



Dr. Scholz:&nbsp; [05:25] That's so, so important. &nbsp;And these functions, sexual, urinary functions are something that people face every day of their life.&nbsp; In the hustle bustle to get treatment quickly, the fact that if the treatment is not done in an ideal way, that men can be left with permanent issues unnecessarily, certainly if there was no other option, we would live with these negative consequences. But, in most cases now with skillful care, these things can be avoided.



Liz:&nbsp; [05:58] Over the past two years, Dr. Scholz and I have covered all the treatment options from active surveillance to surgery, radiation chemotherapy.&nbsp; These episodes will still be available even after the podcast ends, you can go back and re-listen and keep sharing with friends and educating yourself.&nbsp;



Dr. Scholz:&nbsp; [06:16] One thing about this information provided in the podcast is not only the idea of which treatment is best and what kind of things to look out for, but the step by step process, the thinking process, the procedures, and how you can come to get the right doctors and the right treatment is implicit in the whole podcast system that we have provided. &nbsp;So you can also just learn from the thought process that leads to successful outcomes.&nbsp;



Liz:&nbsp; [06:49] While there are a lot of challenges that newly diagnosed patients face, patients with advanced prostate cancer also are missing out on some tools like Xgeva and Prolia.&nbsp;



Dr. Scholz:&nbsp; [07:01] These medicines are to help compensate for men who have disease that’s spread to their bones or men who've been on hormone treatment and the calcium is leaching out, a process called osteoporosis. &nbsp;The number of times this is overlooked and people coming to us for second opinions is really quite surprising, as they are FDA approved to help compensate for these problems. &nbsp;So simple second opinions can be so valuable for men, even if they have advanced disease.&nbsp;



Liz:&nbsp; [07:35] As we segue into what's coming up and what's new in prostate cancer, we wanted to quickly mention that there are a lot of new drugs and things being tested for FDA approval through clinical trials.&nbsp; Clinical trials are a great way to get access to these new medications, if you have a specialist on your team who is constantly looking out for these and keeping tabs on what's coming up.



Dr. Scholz:&nbsp; [08:03] Every new medicine or treatment goes through a process of being researched. Once it's validated as a treatment, it gets FDA approved. &nbsp;And then after that, it becomes commercialized and broadly available across the country. &nbsp;The things that succeed through that process are very valuable. &nbsp;And we'll be talking about a Lutetium-177 and a new pill called Orgovyx. &nbsp;These medicines have been available, but now are commercially available. &nbsp;If your physician is not staying abreast of all the new developments, men who could benefit from these treatments will be denied access simply through unawareness.&nbsp;



Liz:&nbsp; [08:43] Lutetium-177 is something that we've talked about on past podcasts.&nbsp; And it's not even FDA approved yet, but you've actually had some patients who have had it, is that correct?&nbsp;



Dr. Scholz:&nbsp; [08:57] Lutetium-177 a was purchased by a Novartis pharmaceuticals for $2 billion prior to all the testing being completed because all the preliminary data looks so favorable recently, they released the code for the large clinical trial that was performed confirming that it does prolong survival. This is a medicine that was evaluated in men with very advanced prostate cancer who had already had chemotherapy who had been on other powerful hormone treatments and they'd stopped working. &nbsp;The man who got treated with Lutetium-177 lived longer, statistically significantly longer, than the men who got an alternative, placebo-type approach. &nbsp;This medicine is well tolerated. &nbsp;It can cause some dryness of people's mouths. &nbsp;It can lower blood counts a little bit, but it's a simple injection every six weeks. &nbsp;And it is a potent treatment for men with advanced disease. &nbsp;It may even be a useful treatment for men with earlier stage disease. &nbsp;This will probably be commercially available within a year.&nbsp;



Liz:  [10:05] To learn more about this medicine, we covered it in <a href="http://podcast.prostateoncology.com/podcast/dont-reject-radiation/" data-type="podcast" data-id="266" target="_blank" rel="noreferrer noopener">Episode 10, Don't Reject Radiation</a>.  So you can go back and listen to that.  At the end of 2020, there was a new FDA approval Orgovyx.  This is an oral anti-androgen, so it works kind of like a Lupron, but instead of it being an injection, it's just a daily pill. 



Dr. Scholz:&nbsp; [10:28] So how much do we really need a new pill? &nbsp;When if you could take an injection that lasts three to six months, and you don't have to remember taking pills every day, but Orgovyx may have some other advantages when compared to head to head with Lupron and the other medicines like Lupron, such as Firmagon and Trelstar, Eligard, and Zoladex. &nbsp;These medicines all work by shutting down the production of testosterone in a man's testicles.&nbsp; Orgovyx is interesting for two reasons. &nbsp;One is that the recovery of testosterone when treatment is stopped, seems to be much more predictable and consistent medicines like Lupron, and the others that I mentioned, can have a very protracted and prolonged effect even after they're stopped, and it's hard to predict when testosterone is going to return. &nbsp;Another thing that came out in Orgovyx trials was a lower incidence of cardiovascular complications. &nbsp;For years, I've made a strong argument that Lupron and other drugs do not cause cardiovascular problems directly, but indirectly in men who have a lot of weight gain, blood pressure goes up, blood sugars start to go out of control. &nbsp;Of course these things can lead to cardiovascular problems, but for some reason, in that randomized trial Orgovyx had a lower incidence of cardiovascular related issues. &nbsp;This is certainly an interesting and potential advantage for this medication.



Liz:  [11:56] Technology and medicine around prostate cancer is improving almost daily.  And one of the things that's really promising is immunotherapy.  We talked about this on <a href="http://podcast.prostateoncology.com/podcast/the-intelligence-of-immunotherapy/" data-type="podcast" data-id="262" target="_blank" rel="noreferrer noopener">Episode 9, The Intelligence of Immunotherapy</a>, and we cover all sorts of different things that will benefit men with prostate cancer, like KEYTRUDA and OPDIVO YERVOY.  So if you're interested in learning more about immunotherapy <a href="http://podcast.prostateoncology.com/podcast/the-intelligence-of-immunotherapy/" data-type="podcast" data-id="262" target="_blank" rel="noreferrer noopener">Episode 9</a> is a great place to start.  Making this podcast has been such a rewarding experience for Dr. Scholz and I, and we really hope that it's helped you on your prostate cancer journey.  And we've left you with a little more education and knowledge and empowered you to take control of your prostate cancer diagnosis and spend time really learning about it and understanding, so you can have your medicine personalized to you.  You can find the right doctors, seek second opinions, and then take everything you've learned to spread awareness about prostate cancer.  Remember prostate cancer is a silent disease and it affects so many men and families and loved ones.  This really needs to be something that people are comfortable talking about.  So we hope our podcast has helped give you some points to talk about with your friends and family members and help them make those treatment decisions.  



Dr. Scholz:&nbsp; [13:26] So Kaili, my business manager and myself are very grateful to Liz for all the hard work she's done in compiling these episodes and helping us reach the things that really count. &nbsp;It's been quite a bit of work along the way, which has been a delight to participate in for me. &nbsp;Liz, can you just share a couple of sentences of where you think you're going to be going with your own professional career as you're moving on?&nbsp;



Liz: [13:51] Yes.  I am actually pursuing higher education to become a professional writer.  I am looking forward to it, but I'm definitely sad that I won't be working with you and bringing this podcast to everyone.  I know I've had so much fun learning about prostate cancer and hopefully being able to help all of our listeners navigate this subject.  Again, these episodes have been archived, so you can go back and listen to all twenty-four of them on <a href="http://podcast.prostateoncology.com" target="_blank" rel="noreferrer noopener">podcast.prostateoncology.com</a>, or <a href="https://podcasts.apple.com/us/podcast/prostate-pros/id1460174904" target="_blank" rel="noreferrer noopener">Apple Podcasts</a>, <a href="https://soundcloud.com/prostate-oncology" target="_blank" rel="noreferrer noopener">SoundCloud</a>, wherever you like to listen.  Another good tip is that the PCRI’s YouTube videos come out every week.  These are awesome videos that talk all about prostate cancer.  Dr. Scholz is a very frequent guest on there, so I would highly recommend you check that out.  You can find them at <a href="https://www.youtube.com/channel/UCPYrfTJMCTfhBNZxb31Z1tg" target="_blank" rel="noreferrer noopener">youtube.com/thePCRI</a>.  Thank you for listening and supporting us.

<description>&lt;p&gt;&lt;em&gt;PROSTATE PROS Series Finale&lt;/em&gt;&lt;/p&gt;



&lt;p&gt;&lt;em&gt;On the last episode of the PROSTATE PROS podcast, Dr. Scholz and Liz recap important themes and talk about what’s new in prostate cancer, including Lutetium-177 and Orgovyx.&lt;/em&gt;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&amp;nbsp; I'm your host, Dr. Mark Scholz.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:09] And I'm your cohost, Liz Graves.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:15] We have a bit of a sad announcement to make, as this will be the last episode of the PROSTATE PROS podcast.&amp;nbsp; Dr. Scholz and I have really enjoyed working on this project and we've covered so many important topics surrounding prostate cancer and men's health.&amp;nbsp; So for this last episode, we're going to recap some important themes and talk about some promising new therapies.&amp;nbsp; So Dr. Scholz, on our very first episode, we talked about how important it is to find the right treatment team.&amp;nbsp; This is something that's come up again and again and again.&amp;nbsp; What are some tips you have for newly diagnosed men trying to find their doctors?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:53] I think what's confusing is how much of the responsibility falls on the shoulders of patients.&amp;nbsp; The prostate industry is a very powerful multi-billion dollar industry, and there is a lot happening really fast.&amp;nbsp; When patients are diagnosed, they're not in a thoughtful perspective, they're in an action mode, they're frightened.&amp;nbsp; It is hard to sort out who to listen to and who to stay away from. This process can be aided by family members, primary care doctors, oncologists, and of course, online resources and books.&amp;nbsp; I try to provide some of that information in the book, &lt;em&gt;The Key to Prostate Cancer&lt;/em&gt;, but the process, if it was easy, we could give you one simple answer. &amp;nbsp;It is not a simple process.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [01:46] One thing that we've talked about is to get a quarterback. &amp;nbsp;So this is a doctor that isn't the treating doctor necessarily, but it’s someone that will oversee the treatment and work with the other teams of doctors. &amp;nbsp;This is something I hear you doing Dr. Scholz, you're always talking to other doctors about patients and kind of networking with them to make sure that the patient is getting the best care, even when they're not in our office.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [02:12] I think the issue that you're relating to is that many of these physicians have a conflict of interest. &amp;nbsp;You're asking them, what should I do? &amp;nbsp;But they're a surgeon or they're a radiation doctor.&amp;nbsp; And as a medical oncologist, I'm neither of the above. &amp;nbsp;This is somewhat uncommon, but you can recruit your urologist or your radiation doctor to help you by explaining at the outset that, “you, sir, will not be my treating doctor, but I definitely need your aid and your assistance in picking the right doctor.”&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [02:43] Now you may be thinking that you have cancer and you don't have time to see all these people, but as we've mentioned, prostate cancer is slow growing. &amp;nbsp;So really taking that time to find the right doctor for you is crucial.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [02:56] Just yesterday, I saw a very sophisticated new patient who was feeling the rush job, the sense that the clock is ticking, and he did have a Gleason 9. &amp;nbsp;We consider that the High-Risk category of prostate cancer. &amp;nbsp;But, the idea that you have to make a decision within days or weeks is never substantiated by the literature and the science.&amp;nbsp; Patients can take several months to sort out what they want to do. &amp;nbsp;This sort of careful thoughtful process pays off in the long-term with better results.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [03:29] So patients really need to take it under their control. &amp;nbsp;One of the things is to educate themselves.&amp;nbsp; In the past couple of years, there's been a huge shift towards imaging. &amp;nbsp;So we've had the approval of the PSMA PET scan and using 3T MP MRIs and color Doppler to help men diagnose their prostate cancer and watch it.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [03:51] What Elizabeth is referring to is that if you don't have a clear picture of where the cancer is and whether it's spread outside the gland, what part of the gland it's located in, it's not feasible to tailor treatment to the specific needs of the individual. &amp;nbsp;Some men are fortunate enough to have prostate cancers residing on one side of their gland. &amp;nbsp;This opens the door to something called focal therapy, enabling men to undergo treatment with less risk of erectile dysfunction. &amp;nbsp;There were a lot of things we could have covered in this last podcast and the reminder that quality imaging and not only MRI and PSMA PET scans, but scans done at centers of excellence that are read by experts are going to help men be light years ahead in their selection of treatment, because they'll have a clear picture of what they're really treating.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [04:43] So we've actually gotten emails from people all across the country saying, you know, my doctor's never heard of the PSMA PET scan or my doctor doesn't do 3T imaging. &amp;nbsp;So it is really important that you take the time to educate yourself and bring these questions to your doctors.&amp;nbsp; Finding the right treatment team and doing your due diligence to make sure you're choosing the right treatment is all important because of where the prostate is located. &amp;nbsp;Treatment related side effects can have damaging effects on quality of life. &amp;nbsp;Because prostate cancer is so slow growing, hopefully you'll have a very long life, so it's important that that can be lived to the best of your ability.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [05:25] That's so, so important. &amp;nbsp;And these functions, sexual, urinary functions are something that people face every day of their life.&amp;nbsp; In the hustle bustle to get treatment quickly, the fact that if the treatment is not done in an ideal way, that men can be left with permanent issues unnecessarily, certainly if there was no other option, we would live with these negative consequences. But, in most cases now with skillful care, these things can be avoided.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [05:58] Over the past two years, Dr. Scholz and I have covered all the treatment options from active surveillance to surgery, radiation chemotherapy.&amp;nbsp; These episodes will still be available even after the podcast ends, you can go back and re-listen and keep sharing with friends and educating yourself.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [06:16] One thing about this information provided in the podcast is not only the idea of which treatment is best and what kind of things to look out for, but the step by step process, the thinking process, the procedures, and how you can come to get the right doctors and the right treatment is implicit in the whole podcast system that we have provided. &amp;nbsp;So you can also just learn from the thought process that leads to successful outcomes.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [06:49] While there are a lot of challenges that newly diagnosed patients face, patients with advanced prostate cancer also are missing out on some tools like Xgeva and Prolia.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [07:01] These medicines are to help compensate for men who have disease that’s spread to their bones or men who've been on hormone treatment and the calcium is leaching out, a process called osteoporosis. &amp;nbsp;The number of times this is overlooked and people coming to us for second opinions is really quite surprising, as they are FDA approved to help compensate for these problems. &amp;nbsp;So simple second opinions can be so valuable for men, even if they have advanced disease.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [07:35] As we segue into what's coming up and what's new in prostate cancer, we wanted to quickly mention that there are a lot of new drugs and things being tested for FDA approval through clinical trials.&amp;nbsp; Clinical trials are a great way to get access to these new medications, if you have a specialist on your team who is constantly looking out for these and keeping tabs on what's coming up.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:03] Every new medicine or treatment goes through a process of being researched. Once it's validated as a treatment, it gets FDA approved. &amp;nbsp;And then after that, it becomes commercialized and broadly available across the country. &amp;nbsp;The things that succeed through that process are very valuable. &amp;nbsp;And we'll be talking about a Lutetium-177 and a new pill called Orgovyx. &amp;nbsp;These medicines have been available, but now are commercially available. &amp;nbsp;If your physician is not staying abreast of all the new developments, men who could benefit from these treatments will be denied access simply through unawareness.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [08:43] Lutetium-177 is something that we've talked about on past podcasts.&amp;nbsp; And it's not even FDA approved yet, but you've actually had some patients who have had it, is that correct?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:57] Lutetium-177 a was purchased by a Novartis pharmaceuticals for $2 billion prior to all the testing being completed because all the preliminary data looks so favorable recently, they released the code for the large clinical trial that was performed confirming that it does prolong survival. This is a medicine that was evaluated in men with very advanced prostate cancer who had already had chemotherapy who had been on other powerful hormone treatments and they'd stopped working. &amp;nbsp;The man who got treated with Lutetium-177 lived longer, statistically significantly longer, than the men who got an alternative, placebo-type approach. &amp;nbsp;This medicine is well tolerated. &amp;nbsp;It can cause some dryness of people's mouths. &amp;nbsp;It can lower blood counts a little bit, but it's a simple injection every six weeks. &amp;nbsp;And it is a potent treatment for men with advanced disease. &amp;nbsp;It may even be a useful treatment for men with earlier stage disease. &amp;nbsp;This will probably be commercially available within a year.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;  [10:05] To learn more about this medicine, we covered it in &lt;a href="http://podcast.prostateoncology.com/podcast/dont-reject-radiation/" data-type="podcast" data-id="266" target="_blank" rel="noreferrer noopener"&gt;Episode 10, &lt;em&gt;Don't Reject Radiation&lt;/em&gt;&lt;/a&gt;.  So you can go back and listen to that.  At the end of 2020, there was a new FDA approval Orgovyx.  This is an oral anti-androgen, so it works kind of like a Lupron, but instead of it being an injection, it's just a daily pill. &lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [10:28] So how much do we really need a new pill? &amp;nbsp;When if you could take an injection that lasts three to six months, and you don't have to remember taking pills every day, but Orgovyx may have some other advantages when compared to head to head with Lupron and the other medicines like Lupron, such as Firmagon and Trelstar, Eligard, and Zoladex. &amp;nbsp;These medicines all work by shutting down the production of testosterone in a man's testicles.&amp;nbsp; Orgovyx is interesting for two reasons. &amp;nbsp;One is that the recovery of testosterone when treatment is stopped, seems to be much more predictable and consistent medicines like Lupron, and the others that I mentioned, can have a very protracted and prolonged effect even after they're stopped, and it's hard to predict when testosterone is going to return. &amp;nbsp;Another thing that came out in Orgovyx trials was a lower incidence of cardiovascular complications. &amp;nbsp;For years, I've made a strong argument that Lupron and other drugs do not cause cardiovascular problems directly, but indirectly in men who have a lot of weight gain, blood pressure goes up, blood sugars start to go out of control. &amp;nbsp;Of course these things can lead to cardiovascular problems, but for some reason, in that randomized trial Orgovyx had a lower incidence of cardiovascular related issues. &amp;nbsp;This is certainly an interesting and potential advantage for this medication.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;  [11:56] Technology and medicine around prostate cancer is improving almost daily.  And one of the things that's really promising is immunotherapy.  We talked about this on &lt;a href="http://podcast.prostateoncology.com/podcast/the-intelligence-of-immunotherapy/" data-type="podcast" data-id="262" target="_blank" rel="noreferrer noopener"&gt;Episode 9, &lt;em&gt;The Intelligence of Immunotherapy&lt;/em&gt;&lt;/a&gt;, and we cover all sorts of different things that will benefit men with prostate cancer, like KEYTRUDA and OPDIVO YERVOY.  So if you're interested in learning more about immunotherapy &lt;a href="http://podcast.prostateoncology.com/podcast/the-intelligence-of-immunotherapy/" data-type="podcast" data-id="262" target="_blank" rel="noreferrer noopener"&gt;Episode 9&lt;/a&gt; is a great place to start.  Making this podcast has been such a rewarding experience for Dr. Scholz and I, and we really hope that it's helped you on your prostate cancer journey.  And we've left you with a little more education and knowledge and empowered you to take control of your prostate cancer diagnosis and spend time really learning about it and understanding, so you can have your medicine personalized to you.  You can find the right doctors, seek second opinions, and then take everything you've learned to spread awareness about prostate cancer.  Remember prostate cancer is a silent disease and it affects so many men and families and loved ones.  This really needs to be something that people are comfortable talking about.  So we hope our podcast has helped give you some points to talk about with your friends and family members and help them make those treatment decisions.  &lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [13:26] So Kaili, my business manager and myself are very grateful to Liz for all the hard work she's done in compiling these episodes and helping us reach the things that really count. &amp;nbsp;It's been quite a bit of work along the way, which has been a delight to participate in for me. &amp;nbsp;Liz, can you just share a couple of sentences of where you think you're going to be going with your own professional career as you're moving on?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt; [13:51] Yes.  I am actually pursuing higher education to become a professional writer.  I am looking forward to it, but I'm definitely sad that I won't be working with you and bringing this podcast to everyone.  I know I've had so much fun learning about prostate cancer and hopefully being able to help all of our listeners navigate this subject.  Again, these episodes have been archived, so you can go back and listen to all twenty-four of them on &lt;a href="http://podcast.prostateoncology.com" target="_blank" rel="noreferrer noopener"&gt;podcast.prostateoncology.com&lt;/a&gt;, or &lt;a href="https://podcasts.apple.com/us/podcast/prostate-pros/id1460174904" target="_blank" rel="noreferrer noopener"&gt;Apple Podcasts&lt;/a&gt;, &lt;a href="https://soundcloud.com/prostate-oncology" target="_blank" rel="noreferrer noopener"&gt;SoundCloud&lt;/a&gt;, wherever you like to listen.  Another good tip is that the PCRI’s YouTube videos come out every week.  These are awesome videos that talk all about prostate cancer.  Dr. Scholz is a very frequent guest on there, so I would highly recommend you check that out.  You can find them at &lt;a href="https://www.youtube.com/channel/UCPYrfTJMCTfhBNZxb31Z1tg" target="_blank" rel="noreferrer noopener"&gt;youtube.com/thePCRI&lt;/a&gt;.  Thank you for listening and supporting us.&lt;/p&gt;</description>

PROSTATE PROS Series Finale



On the last episode of the PROSTATE PROS podcast, Dr. Scholz and Liz recap important themes and talk about what’s new in prostate cancer, including Lutetium-177 and Orgovyx.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to

PROSTATE PROS Series Finale



On the last episode of the PROSTATE PROS podcast, Dr. Scholz and Liz recap important themes and talk about what’s new in prostate cancer, including Lutetium-177 and Orgovyx.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I'm your host, Dr. Mark Scholz.&nbsp;



Liz:&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz:&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; [00:15] We have a bit of a sad announcement to make, as this will be the last episode of the PROSTATE PROS podcast.&nbsp; Dr. Scholz and I have really enjoyed working on this project and we've covered so many important topics surrounding prostate cancer and men's health.&nbsp; So for this last episode, we're going to recap some important themes and talk about some promising new therapies.&nbsp; So Dr. Scholz, on our very first episode, we talked about how important it is to find the right treatment team.&nbsp; This is something that's come up again and again and again.&nbsp; What are some tips you have for newly diagnosed men trying to find their doctors?&nbsp;



Dr. Scholz:&nbsp; [00:53] I think what's confusing is how much of the responsibility falls on the shoulders of patients.&nbsp; The prostate industry is a very powerful multi-billion dollar industry, and there is a lot happening really fast.&nbsp; When patients are diagnosed, they're not in a thoughtful perspective, they're in an action mode, they're frightened.&nbsp; It is hard to sort out who to listen to and who to stay away from. This process can be aided by family members, primary care doctors, oncologists, and of course, online resources and books.&nbsp; I try to provide some of that information in the book, The Key to Prostate Cancer, but the process, if it was easy, we could give you one simple answer. &nbsp;It is not a simple process.&nbsp;



Liz:&nbsp; [01:46] One thing that we've talked about is to get a quarterback. &nbsp;So this is a doctor that isn't the treating doctor necessarily, but it’s someone that will oversee the treatment and work with the other teams of doctors. &nbsp;This is something I hear you doing Dr. Scholz, you're always talking to other doctors about patients and kind of networking with them to make sure that the patient is getting the best care, even when they're not in our office.&nbsp;



Dr. Scholz:&nbsp; [02:12] I think the issue that you're relating to is that many of these physicians have a conflict of interest. &nbsp;You're asking them, what should I do? &nbsp;But they're a surgeon or they're a radiation doctor.&nbsp; And as a medical oncologist, I'm neither of the above. &nbsp;This is somewhat uncommon, but you can recruit your urologist or your radiation doctor to help you by explaining at the outset that, “you, sir, will not be my treating doctor, but I definitely need your aid and your assistance in picking the right doctor.”&nbsp;



Liz:&nbsp; [02:43] Now you may be thinking that you have cancer and you don't have time to see all these people, but as we've mentioned, prostate cancer is slow growing. &nbsp;So really taking that time to find the right doctor for you is crucial.&nbsp;



Dr. Scholz:&nbsp; [02:56] Just yesterday, I saw a very sophisticated new patient who was feeling the rush job, the sense that the clock is ticking, and he did have a Gleason 9. &nbsp;We consider that the High-Risk category of prostate cancer. &nbsp;But, the idea that you have to make a decision within days or weeks is never substantiated by the literature and the science.&nbsp; Patients can take several months to sort out what they want to do. &nbsp;This sort of careful thoughtful process pays off in the long-term with better results.&nbsp;



Liz:&nbsp; [03:29] So patients really need to take it under their control. &nbsp;One of the things is to educate themselves.&nbsp; In the past couple of years, there's been a huge shift towards imaging. &nb

That’s a Wrap

PSA (prostate-specific antigen) is essential for prostate cancer screening and monitoring. This episode explores the PSA controversy, explains why annual PSA screening is crucial, and talks about the importance of PSA testing for monitoring prostate cancer treatment. Understand the benefits and drawbacks of PSA, and use this incredible tool to your advantage.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I'm your host, Dr. Mark Scholz.&nbsp;



Liz:&nbsp; [00:10] And I’m your cohost, Liz Graves.



Dr. Scholz:&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.



Al Roker: &nbsp;[00:16] I've been feeling great, but my doctor discovered I had an elevated PSA level in my blood work, PSA standing for prostate-specific antigen. &nbsp;It's the first line of defense when detecting possible prostate cancer.



Dr. John Torres:&nbsp; [00:32] Today, an influential medical task force is changing those screening guidelines. &nbsp;Now, urging all men ages fifty-five to sixty-nine to talk to their doctor about getting a PSA test. &nbsp;Men ages seventy and older should not get screened.



Dr. Kirsten Bibbins-Domingo: &nbsp;[00:46] This should really be a personal choice that a man makes together with his doctor, and the goal of these conversations is really to understand benefits and harms.



Dr. John Torres:&nbsp; [00:57] Previously experts…&nbsp;



Liz:&nbsp; [00:58] There's a lot of confusion and hesitation surrounding PSA screening. &nbsp;What are the proper steps? &nbsp;What do you do if the PSA test does come back abnormal?&nbsp; This episode, Dr. Scholz and I are going to talk about the importance of PSA testing, what a high PSA actually means, and what the best steps to take are to further investigate.



Dr. Scholz:&nbsp; [01:21] The PSA blood test has been around since 1987, about the time my career started it up.&nbsp; I can't tell you how revolutionary this blood test has been.&nbsp; Really, we don't have another blood test like this for other cancers.&nbsp; In some ways, PSA makes prostate cancer a much easier cancer to treat.&nbsp; In other ways, like any powerful tool, if it's misused, it can create confusion and problems.&nbsp; I hope we'll be able to bring some clarity to why this blood test can be controversial.&nbsp;



Liz:&nbsp; [01:57] Everyone knows that PSA tests for prostate cancer. &nbsp;PSA stands for prostate-specific antigen. &nbsp;And when this is screened annually in men, it is to look for prostate cancer, but that is not all that PSA does.



Dr. Scholz:&nbsp; [02:15] The problem with PSA as a screening tool and PSA is used for other things besides screening.&nbsp; But, as a screening tool, men still have a prostate gland.&nbsp; Typically if they have a small tumor in their prostate, the lion's share of the PSA is actually coming from the gland, the benign prostate, not the cancer.&nbsp; This is where the confusion comes.&nbsp; Men will have inflammation of their prostates, and the PSA will be high.&nbsp; Men will have enlarged prostates, and their PSA will be high.&nbsp; Or, of course, they could have a low-grade, or a more consequential cancer, and their PSA could be high.&nbsp; One savvy patient once told me, tell your patients to think of the PSA as a check engine light on the dashboard of your car.&nbsp; Something's going on in the prostate, it could be cancer, and it could be one of these other causes.&nbsp;



Liz:&nbsp; [03:12] When a PSA comes back elevated, taking time to understand what that means is crucial.&nbsp; PSA can be a great tool to tell people they have prostate cancer, but it also has all of these other possible complications.&nbsp; In 2011, the US Task Force advised against PSA testing.&nbsp; Why was this Dr. Scholz?



Dr. Scholz:&nbsp; [03:35] Small cancers that don't spread are the root difficulty we have. &nbsp;There have been active discussions about renaming certain types of prostate cancer as something non-cancerous.&nbsp; That would be appropriate.&nbsp; Of the 200,000 men diagnosed every year, about 100,000 have a condition that was named cancer back in the 1960s, that we now know never spreads.&nbsp; But, that word cancer is so motivating that many people, to this day, are rushing into unnecessary surgery and radiation. &nbsp;So the Task Force, realizing this problem of overtreatment, thought that quite possibly PSA screening was causing more harm than good.&nbsp; Men were having treatments, making them impotent and incontinent for a condition that would never hurt them. &nbsp;They later realized in 2016 that the men who have high-grade cancers were getting a short end of the stick.&nbsp; People were coming in with more advanced cancers.&nbsp; So they rescinded their recommendation to forgo PSA screening.&nbsp; But you can imagine what confusion has ensued when you have a large task force arguing for, or against this powerful and useful test.



Liz:&nbsp; [04:54] Low-grade cancers, which are also called Gleason 6, never spread.&nbsp; So this PSA testing can lead to unnecessary treatment.&nbsp; So there's been a lot of controversy about the PSA testing. &nbsp;What's your policy, Dr. Scholz?&nbsp;



Dr. Scholz:&nbsp; [05:10] Well, I'm a big believer in doing PSA testing, at least in patients who are informed.&nbsp; I get concerned about PSA testing just as the Task Force got concerned. &nbsp;If you have uninformed patients that are like sheep, just doing what the industry tells them to do, those men are at risk of getting unnecessary surgery and radiation, which has all the consequences we mentioned.&nbsp;



Liz:&nbsp; [05:34] This is something we come back to again and again, it's how important it is to advocate for yourself.&nbsp; This means educating yourself, this means having conversations with doctors.&nbsp; PSA screening should begin at forty for people who have family history and at forty-five for people who do not.&nbsp;&nbsp;



Dr. Scholz:&nbsp; [05:54] Be aware that when you go in for an annual physical, many of you are assuming that your doctor's simply going to add a PSA to the blood test section that isn't always happening.&nbsp; Some doctors still are following the 2011 Task Force recommendations, and it doesn't come up in conversation. &nbsp;I have seen patients come in with high PSA, say from an insurance exam, and when they look back at their annual physicals, their doctor wasn't doing PSA.&nbsp; So you need to make sure that PSA is part of the blood screening during the annual physical.&nbsp;



Liz:&nbsp; [06:31] What happens if someone isn't getting annual PSA tests?&nbsp;



Dr. Scholz:&nbsp; [06:35] Well, hopefully they don't have a bad prostate cancer, in which case they'll be fine.&nbsp; But the incidence of prostate cancer is somewhere around one in seven men.&nbsp; This means that a significant number of men could end up with advanced cancers that could have been prevented.&nbsp;



Liz:&nbsp; [06:52] When most people think about PSA, they attribute it with screening.&nbsp; Men with prostate cancer know that PSA is used for more than just screening.&nbsp;



Dr. Scholz:&nbsp; [07:03] So when we were naming our clinic, Prostate Oncology Specialists, we actually considered calling ourselves the PSA clinic.&nbsp; PSA for men who have already been diagnosed with prostate cancers is a very accurate test.&nbsp; Why is this?&nbsp; Well, as I stated before, one of the problems we have with screening is that men's prostate glands are intact.&nbsp; The prostate gland makes a lot of PSA, which is unrelated to cancer.&nbsp; Most men that have been treated for prostate cancer have had their prostates, either surgically removed or they've undergone radiation, which dramatically reduces the amount of PSA production from the gland.&nbsp; So, if we are monitoring someone going forward who's been previously treated, if the PSA starts going up, we know that it's almost certainly coming directly from the cancer.&nbsp; It gives us a speedometer to tell us how much cancer is present and how fast it's growing, which we can tell by how quickly it rises.&nbsp;



Liz:&nbsp; [08:03] So, men with prostate cancer will get very familiar with their PSA numbers because they're being monitored, they're being discussed in terms of treatment options and staging.&nbsp;



Dr. Scholz:&nbsp; [08:14] Many of my medical oncology colleagues are very jealous when I tell them that I specialize just in prostate cancer because of the accuracy of the PSA test.&nbsp; We don't have as much ambiguity about the status of the cancer.&nbsp; We can tell so much about how the cancer is behaving just by checking a PSA.&nbsp;



Liz:&nbsp; [08:35] How often are men with prostate cancer having their PSA's checked during monitoring?&nbsp;



Dr. Scholz:&nbsp; [08:41] Well, they’re certainly different situations.&nbsp; The men who've had surgery or radiation typically will get their PSA checked every three months for a couple of years after the treatment, then maybe every six months out to about five years after treatment, then annually thereafter.&nbsp; Men with advanced cancers, who are undergoing hormone treatments or chemo treatments, will often have their PSA checked every month to determine how effective the treatment is.&nbsp; Is it working and whatnot, because we want to know if we need to switch treatment or strengthen or reduce the intensity of the treatment.&nbsp;



Liz:  [09:18] PSA is a great tool for men with prostate cancer, whether it be for screening or for gauging treatment success.  There is so much to learn about PSA screening, DREs, OPKO 4K.  We've discussed this in past podcasts, but we'll always keep you updated on what the latest is on these topics.  For those of you who love to learn about prostate cancer, the Mid-Year Moyad and Scholz Update with the PCRI is on Saturday, March 27th.  It's free registration and it's virtual this year.  So we're really looking forward to joining in on that.  You can register at <a href="https://pcri.org/" target="_blank" rel="noreferrer noopener">pcri.org</a> and submit any questions to the experts.  This year Dr. Tia Higano will be joining, she is a brilliant oncologist from the University of Washington.  She will be talking about hormone therapy and its side effects.  The new PSMA scan will also be talked about by Thomas Hope.   Dr. Scholz, what are you looking forward to with the PCRI Mid-Year Conference? 



Dr. Scholz:&nbsp; [10:28] Both the topics are so relevant, but the new PSMA PET scans, which we've talked about extensively really can't be talked about enough.&nbsp; They're going to have relevance for men with advanced disease and men who are dealing with early stage disease. &nbsp;This information is going to be very helpful, but it is so new, I don't even know all the things that are going to be coming.&nbsp;



Liz:&nbsp; [10:52] My personal favorite part is always when you and Dr. Moyad talk.&nbsp; So I'm looking forward to hearing some great questions and seeing what you have to say.&nbsp; Thank you for listening.&nbsp; You can email any questions or topics to podcast@prostateoncology.com.

<description>&lt;p&gt;&lt;em&gt;PSA (prostate-specific antigen) is essential for prostate cancer screening and monitoring. This episode explores the PSA controversy, explains why annual PSA screening is crucial, and talks about the importance of PSA testing for monitoring prostate cancer treatment. Understand the benefits and drawbacks of PSA, and use this incredible tool to your advantage.&lt;/em&gt;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&amp;nbsp; I'm your host, Dr. Mark Scholz.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:10] And I’m your cohost, Liz Graves.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Al Roker: &lt;/strong&gt;&amp;nbsp;[00:16] I've been feeling great, but my doctor discovered I had an elevated PSA level in my blood work, PSA standing for prostate-specific antigen. &amp;nbsp;It's the first line of defense when detecting possible prostate cancer.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. John Torres:&lt;/strong&gt;&amp;nbsp; [00:32] Today, an influential medical task force is changing those screening guidelines. &amp;nbsp;Now, urging all men ages fifty-five to sixty-nine to talk to their doctor about getting a PSA test. &amp;nbsp;Men ages seventy and older should not get screened.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Kirsten Bibbins-Domingo: &lt;/strong&gt;&amp;nbsp;[00:46] This should really be a personal choice that a man makes together with his doctor, and the goal of these conversations is really to understand benefits and harms.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. John Torres:&lt;/strong&gt;&amp;nbsp; [00:57] Previously experts…&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:58] There's a lot of confusion and hesitation surrounding PSA screening. &amp;nbsp;What are the proper steps? &amp;nbsp;What do you do if the PSA test does come back abnormal?&amp;nbsp; This episode, Dr. Scholz and I are going to talk about the importance of PSA testing, what a high PSA actually means, and what the best steps to take are to further investigate.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [01:21] The PSA blood test has been around since 1987, about the time my career started it up.&amp;nbsp; I can't tell you how revolutionary this blood test has been.&amp;nbsp; Really, we don't have another blood test like this for other cancers.&amp;nbsp; In some ways, PSA makes prostate cancer a much easier cancer to treat.&amp;nbsp; In other ways, like any powerful tool, if it's misused, it can create confusion and problems.&amp;nbsp; I hope we'll be able to bring some clarity to why this blood test can be controversial.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [01:57] Everyone knows that PSA tests for prostate cancer. &amp;nbsp;PSA stands for prostate-specific antigen. &amp;nbsp;And when this is screened annually in men, it is to look for prostate cancer, but that is not all that PSA does.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [02:15] The problem with PSA as a screening tool and PSA is used for other things besides screening.&amp;nbsp; But, as a screening tool, men still have a prostate gland.&amp;nbsp; Typically if they have a small tumor in their prostate, the lion's share of the PSA is actually coming from the gland, the benign prostate, not the cancer.&amp;nbsp; This is where the confusion comes.&amp;nbsp; Men will have inflammation of their prostates, and the PSA will be high.&amp;nbsp; Men will have enlarged prostates, and their PSA will be high.&amp;nbsp; Or, of course, they could have a low-grade, or a more consequential cancer, and their PSA could be high.&amp;nbsp; One savvy patient once told me, tell your patients to think of the PSA as a check engine light on the dashboard of your car.&amp;nbsp; Something's going on in the prostate, it could be cancer, and it could be one of these other causes.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [03:12] When a PSA comes back elevated, taking time to understand what that means is crucial.&amp;nbsp; PSA can be a great tool to tell people they have prostate cancer, but it also has all of these other possible complications.&amp;nbsp; In 2011, the US Task Force advised against PSA testing.&amp;nbsp; Why was this Dr. Scholz?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [03:35] Small cancers that don't spread are the root difficulty we have. &amp;nbsp;There have been active discussions about renaming certain types of prostate cancer as something non-cancerous.&amp;nbsp; That would be appropriate.&amp;nbsp; Of the 200,000 men diagnosed every year, about 100,000 have a condition that was named cancer back in the 1960s, that we now know never spreads.&amp;nbsp; But, that word cancer is so motivating that many people, to this day, are rushing into unnecessary surgery and radiation. &amp;nbsp;So the Task Force, realizing this problem of overtreatment, thought that quite possibly PSA screening was causing more harm than good.&amp;nbsp; Men were having treatments, making them impotent and incontinent for a condition that would never hurt them. &amp;nbsp;They later realized in 2016 that the men who have high-grade cancers were getting a short end of the stick.&amp;nbsp; People were coming in with more advanced cancers.&amp;nbsp; So they rescinded their recommendation to forgo PSA screening.&amp;nbsp; But you can imagine what confusion has ensued when you have a large task force arguing for, or against this powerful and useful test.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [04:54] Low-grade cancers, which are also called Gleason 6, never spread.&amp;nbsp; So this PSA testing can lead to unnecessary treatment.&amp;nbsp; So there's been a lot of controversy about the PSA testing. &amp;nbsp;What's your policy, Dr. Scholz?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [05:10] Well, I'm a big believer in doing PSA testing, at least in patients who are informed.&amp;nbsp; I get concerned about PSA testing just as the Task Force got concerned. &amp;nbsp;If you have uninformed patients that are like sheep, just doing what the industry tells them to do, those men are at risk of getting unnecessary surgery and radiation, which has all the consequences we mentioned.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [05:34] This is something we come back to again and again, it's how important it is to advocate for yourself.&amp;nbsp; This means educating yourself, this means having conversations with doctors.&amp;nbsp; PSA screening should begin at forty for people who have family history and at forty-five for people who do not.&amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [05:54] Be aware that when you go in for an annual physical, many of you are assuming that your doctor's simply going to add a PSA to the blood test section that isn't always happening.&amp;nbsp; Some doctors still are following the 2011 Task Force recommendations, and it doesn't come up in conversation. &amp;nbsp;I have seen patients come in with high PSA, say from an insurance exam, and when they look back at their annual physicals, their doctor wasn't doing PSA.&amp;nbsp; So you need to make sure that PSA is part of the blood screening during the annual physical.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [06:31] What happens if someone isn't getting annual PSA tests?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [06:35] Well, hopefully they don't have a bad prostate cancer, in which case they'll be fine.&amp;nbsp; But the incidence of prostate cancer is somewhere around one in seven men.&amp;nbsp; This means that a significant number of men could end up with advanced cancers that could have been prevented.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [06:52] When most people think about PSA, they attribute it with screening.&amp;nbsp; Men with prostate cancer know that PSA is used for more than just screening.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [07:03] So when we were naming our clinic, Prostate Oncology Specialists, we actually considered calling ourselves the PSA clinic.&amp;nbsp; PSA for men who have already been diagnosed with prostate cancers is a very accurate test.&amp;nbsp; Why is this?&amp;nbsp; Well, as I stated before, one of the problems we have with screening is that men's prostate glands are intact.&amp;nbsp; The prostate gland makes a lot of PSA, which is unrelated to cancer.&amp;nbsp; Most men that have been treated for prostate cancer have had their prostates, either surgically removed or they've undergone radiation, which dramatically reduces the amount of PSA production from the gland.&amp;nbsp; So, if we are monitoring someone going forward who's been previously treated, if the PSA starts going up, we know that it's almost certainly coming directly from the cancer.&amp;nbsp; It gives us a speedometer to tell us how much cancer is present and how fast it's growing, which we can tell by how quickly it rises.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [08:03] So, men with prostate cancer will get very familiar with their PSA numbers because they're being monitored, they're being discussed in terms of treatment options and staging.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:14] Many of my medical oncology colleagues are very jealous when I tell them that I specialize just in prostate cancer because of the accuracy of the PSA test.&amp;nbsp; We don't have as much ambiguity about the status of the cancer.&amp;nbsp; We can tell so much about how the cancer is behaving just by checking a PSA.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [08:35] How often are men with prostate cancer having their PSA's checked during monitoring?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:41] Well, they’re certainly different situations.&amp;nbsp; The men who've had surgery or radiation typically will get their PSA checked every three months for a couple of years after the treatment, then maybe every six months out to about five years after treatment, then annually thereafter.&amp;nbsp; Men with advanced cancers, who are undergoing hormone treatments or chemo treatments, will often have their PSA checked every month to determine how effective the treatment is.&amp;nbsp; Is it working and whatnot, because we want to know if we need to switch treatment or strengthen or reduce the intensity of the treatment.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;  [09:18] PSA is a great tool for men with prostate cancer, whether it be for screening or for gauging treatment success.  There is so much to learn about PSA screening, DREs, OPKO 4K.  We've discussed this in past podcasts, but we'll always keep you updated on what the latest is on these topics.  For those of you who love to learn about prostate cancer, the Mid-Year Moyad and Scholz Update with the PCRI is on Saturday, March 27th.  It's free registration and it's virtual this year.  So we're really looking forward to joining in on that.  You can register at &lt;a href="https://pcri.org/" target="_blank" rel="noreferrer noopener"&gt;pcri.org&lt;/a&gt; and submit any questions to the experts.  This year Dr. Tia Higano will be joining, she is a brilliant oncologist from the University of Washington.  She will be talking about hormone therapy and its side effects.  The new PSMA scan will also be talked about by Thomas Hope.   Dr. Scholz, what are you looking forward to with the PCRI Mid-Year Conference? &lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [10:28] Both the topics are so relevant, but the new PSMA PET scans, which we've talked about extensively really can't be talked about enough.&amp;nbsp; They're going to have relevance for men with advanced disease and men who are dealing with early stage disease. &amp;nbsp;This information is going to be very helpful, but it is so new, I don't even know all the things that are going to be coming.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [10:52] My personal favorite part is always when you and Dr. Moyad talk.&amp;nbsp; So I'm looking forward to hearing some great questions and seeing what you have to say.&amp;nbsp; Thank you for listening.&amp;nbsp; You can email any questions or topics to podcast@prostateoncology.com.&lt;/p&gt;</description>

PSA (prostate-specific antigen) is essential for prostate cancer screening and monitoring. This episode explores the PSA controversy, explains why annual PSA screening is crucial, and talks about the importance of PSA testing for monitoring prostate canc

PSA (prostate-specific antigen) is essential for prostate cancer screening and monitoring. This episode explores the PSA controversy, explains why annual PSA screening is crucial, and talks about the importance of PSA testing for monitoring prostate cancer treatment. Understand the benefits and drawbacks of PSA, and use this incredible tool to your advantage.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I'm your host, Dr. Mark Scholz.&nbsp;



Liz:&nbsp; [00:10] And I’m your cohost, Liz Graves.



Dr. Scholz:&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.



Al Roker: &nbsp;[00:16] I've been feeling great, but my doctor discovered I had an elevated PSA level in my blood work, PSA standing for prostate-specific antigen. &nbsp;It's the first line of defense when detecting possible prostate cancer.



Dr. John Torres:&nbsp; [00:32] Today, an influential medical task force is changing those screening guidelines. &nbsp;Now, urging all men ages fifty-five to sixty-nine to talk to their doctor about getting a PSA test. &nbsp;Men ages seventy and older should not get screened.



Dr. Kirsten Bibbins-Domingo: &nbsp;[00:46] This should really be a personal choice that a man makes together with his doctor, and the goal of these conversations is really to understand benefits and harms.



Dr. John Torres:&nbsp; [00:57] Previously experts…&nbsp;



Liz:&nbsp; [00:58] There's a lot of confusion and hesitation surrounding PSA screening. &nbsp;What are the proper steps? &nbsp;What do you do if the PSA test does come back abnormal?&nbsp; This episode, Dr. Scholz and I are going to talk about the importance of PSA testing, what a high PSA actually means, and what the best steps to take are to further investigate.



Dr. Scholz:&nbsp; [01:21] The PSA blood test has been around since 1987, about the time my career started it up.&nbsp; I can't tell you how revolutionary this blood test has been.&nbsp; Really, we don't have another blood test like this for other cancers.&nbsp; In some ways, PSA makes prostate cancer a much easier cancer to treat.&nbsp; In other ways, like any powerful tool, if it's misused, it can create confusion and problems.&nbsp; I hope we'll be able to bring some clarity to why this blood test can be controversial.&nbsp;



Liz:&nbsp; [01:57] Everyone knows that PSA tests for prostate cancer. &nbsp;PSA stands for prostate-specific antigen. &nbsp;And when this is screened annually in men, it is to look for prostate cancer, but that is not all that PSA does.



Dr. Scholz:&nbsp; [02:15] The problem with PSA as a screening tool and PSA is used for other things besides screening.&nbsp; But, as a screening tool, men still have a prostate gland.&nbsp; Typically if they have a small tumor in their prostate, the lion's share of the PSA is actually coming from the gland, the benign prostate, not the cancer.&nbsp; This is where the confusion comes.&nbsp; Men will have inflammation of their prostates, and the PSA will be high.&nbsp; Men will have enlarged prostates, and their PSA will be high.&nbsp; Or, of course, they could have a low-grade, or a more consequential cancer, and their PSA could be high.&nbsp; One savvy patient once told me, tell your patients to think of the PSA as a check engine light on the dashboard of your car.&nbsp; Something's going on in the prostate, it could be cancer, and it could be one of these other causes.&nbsp;



Liz:&nbsp; [03:12] When a PSA comes back elevated, taking time to understand what that means is crucial.&nbsp; PSA can be a great tool to tell people they have prostate cancer, but it also has all of these other possible complications.&nbsp; In 2011, the US Task Force advised against PSA testing.&nbsp; Why was this Dr. Scholz?



Dr. Scholz:&nbsp; [03:35] Small cancers that don't spread are the root difficulty we have. &nbsp;There have been active discussions about renaming certain types of prostate cancer as something non-c

The Brief on PSA

Prostatitis is inflammation of the prostate gland that can affect PSA and cause symptoms such as urinary frequency and urgency, fever, and pelvic pain. Prostatitis can be difficult to identify and hard to treat. This episode discusses diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. &nbsp;I'm your host, Dr. Mark Scholz.



Liz:&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz: &nbsp;[00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; [00:16] Prostatitis is inflammation of the prostate, which can have a huge negative impact on quality of life. &nbsp;This episode, we're going to talk about diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.&nbsp;



Dr. Scholz:&nbsp; [00:31] The real reason this topic comes up is because PSA goes up in men that have inflammation in their prostate, which is what we're calling prostatitis.&nbsp; There are many causes, we're going to go into that, but the confusing factor is that we're using PSA to diagnose prostate cancer, to monitor prostate cancer for treatment effect, and for relapse.&nbsp; If inflammation in the prostate intervenes and causes the PSA to go up, everyone gets frightened about the possibility of prostate cancer being out of control. &nbsp;So this podcast will cover trying to make a distinction between a high PSA from prostatitis and a high PSA from prostate cancer.&nbsp;



Liz:&nbsp; [01:17] So prostatitis is inflammation of the prostate, and there can actually be no known cause of this, or it can be due to bacterial infection and it can also manifest in many different ways.&nbsp;



Dr. Scholz:&nbsp; [01:31] There's so much confusion about what really is prostatitis.&nbsp; It may be sort of an autoimmune phenomenon, the way people get asthma or eczema on their skin, some sort of over activity of the immune system, but it's quite common and it's often asymptomatic.&nbsp; So that means that the PSA goes up, but men may not be feeling any urinary irritation.&nbsp; At the other end of the spectrum, of course you have the people that have real discomfort and pain with urination and are getting up at night a lot.&nbsp; When men have these symptoms, it doesn't necessarily mean that it is prostatitis, it could be a large prostate, it could be an irritable bladder, it could be a urinary tract infection, but prostatitis certainly is on the list of possibilities.&nbsp;



Liz:&nbsp; [02:19] So you mentioned asymptomatic prostatitis, which still has an effect on PSA.&nbsp; Can you distinguish a rise in PSA from prostatitis from a rise from prostate cancer?&nbsp;



Dr. Scholz:&nbsp; [02:32] Actually, PSA is very nonspecific.&nbsp; So when we see a PSA rise, we have to start doing all kinds of tests.&nbsp; The most popular one in the community of course, is to do a prostate biopsy. Our policy has been to do MRI testing, and there are certain blood tests and urine tests like OPKO 4K and SelectMDx that can help sniff out whether prostate cancer is really the problem.&nbsp; But many times, we are left with an ambiguous situation; an elevated PSA without a clear cause.&nbsp; And that's when people start calling it prostatitis.&nbsp;



Liz:&nbsp; [03:12] For people who do have symptoms, there are two or three different types. There's acute bacterial, chronic bacterial, and chronic prostatitis.&nbsp;



Dr. Scholz:&nbsp; [03:23] Years past when this problem was encountered, the reflex reaction was just to give some antibiotics.&nbsp; If the PSA would drop after a couple of weeks of antibiotics, then it must be prostatitis.&nbsp; The problem with that is that the antibiotics have potential bad effects.&nbsp; Secondly, they're not always effective because the many types of prostatitis are not bacterial.&nbsp; Thirdly, the problem with prostatitis is it usually isn't permanently cured with antibiotics, you get a temporary remission, but then you're back to having to do antibiotics again and again.&nbsp; Now, these days we don't usually jump on people with antibiotics, but some doctors still like to use this approach.&nbsp;



Liz:&nbsp; [04:10] This seems like a difficult condition to manage.&nbsp; What other medicines, other than antibiotics do you use?&nbsp;



Dr. Scholz:&nbsp; [04:18] So sometimes we just wait and keep checking the PSA and the inflammation will tend to die down on its own.&nbsp; There are things that are popular over the counter products like Saw Palmetto, anti-inflammatories that you can pick up at the pharmacy like Aleve or Advil.&nbsp; Sometimes a course of anti-inflammatories will cause a PSA decline and encourage us that the underlying problem is related to prostatitis as cancer won't respond to an anti-inflammatory.&nbsp;



Liz:&nbsp; [04:52] So if someone goes on anti-inflammatories and their PSA declines, and they just have prostatitis and no prostate cancer, should their PSA be zero?



Dr. Scholz:&nbsp; [05:03] So men have to always calculate the normal PSA by looking at the size of the prostate.&nbsp; This is usually determined with an MRI or an ultrasound.&nbsp; The ten-to-one ratio is that if the prostate's 40 CCS in size, a normal PSA will be around four.&nbsp; So PSAs will typically run in the one to eight range, but there's so much variability in prostate size.&nbsp; A normal PSA can vary from individual to individual.&nbsp;



Liz:&nbsp; [05:33] PSA is one way to possibly diagnose prostatitis. &nbsp;What other ways do you figure out that this is the problem?&nbsp;



Dr. Scholz:&nbsp; [05:42] Well you mentioned before that there's certain men that get bacterial infections and they're uncomfortable: they have soreness in their pelvis, they have pain with urination.&nbsp; If it gets out of hand, it can even cause a fever. &nbsp;So diagnosing prostatitis when there are symptoms like that is really easy. &nbsp;The problem is that 90% of the time, perhaps the prostatitis is asymptomatic and we're dealing with PSA's running high over periods of time. &nbsp;This becomes super relevant in men that are on active surveillance because we check PSA frequently in these people and creates real concern that if the PSA is running high, that maybe we're missing some cancer somewhere.&nbsp;



Liz:&nbsp; [06:22] So there are a lot of symptoms with prostatitis, but these symptoms can also just occur in regular, healthy, aging men.&nbsp; Is telling the difference between those two different people difficult?



Dr. Scholz:&nbsp; [06:36] What you're referring to is the fact that our aging bladder gets more irritable and you can get up at night more frequently, also prostate glands get bigger and create blockage and all kinds of inconveniences related to the urinary tract. &nbsp;That is a real diagnostic dilemma.&nbsp; There are all kinds of tests to try and sort out which of these issues are going on like imaging tests and urinary flow tests. &nbsp;People should usually get a urinary culture and make sure there's no infection.&nbsp; So these methodologies are all used to try and sort out what is really going on. &nbsp;After it's all said and done, if we don't have a clear answer, usually the term prostatitis is applied to the situation.&nbsp;



Liz:&nbsp; [07:20] Another thing that I've read about is tracking your PSA, and if your PSA is fluctuating pretty frequently, that might be a sign of prostatitis.



Dr. Scholz:&nbsp; [07:31] Exactly.&nbsp; Inflammation comes and goes. &nbsp;It's not a steady, smooth, growth, the way something such as cancer might occur. &nbsp;So the ups and downs when you have men with PSAs that are running high, that suddenly dropped, we know that PSA levels don't drop in people with cancer. &nbsp;So that's another strong indication that prostatitis may be the cause of the PSA elevation.&nbsp;



Liz:&nbsp; [07:58] Okay, Dr. Scholz, let's say you have someone who is suffering with symptoms and you've tried antibiotics, you've tried anti-inflammatories, and none of it really seems to be providing relief. &nbsp;What do you do next?&nbsp;



Dr. Scholz:&nbsp; [08:12] It's a tough, tough situation. &nbsp;Consulting an expert is the next step.&nbsp; Sometimes mild doses of Proscar or Avodart to try and shrink the prostate will have some benefit, but there is no satisfying one treatment for prostatitis.&nbsp; Some men have to suffer chronically with only partially resolved symptoms. &nbsp;It's a very controversial area in terms of what proper treatment is because no one treatment is all that satisfying.&nbsp;



Liz:&nbsp; [08:46] Some men who are newly diagnosed with prostate cancer also have prostatitis. What kind of treatment options can these men look at that don't inflame the prostate?&nbsp;



Dr. Scholz:&nbsp; [08:57] You can go forward with just about any of the common treatments. &nbsp;This is one potential argument for surgery, because if the inflamed prostate is a big problem, removing it surgically should improve symptoms. &nbsp;Sadly, that's not universally the case. &nbsp;Sometimes the discomfort that people are having turned out in retrospect to not be from the prostate and men have operations and still have urinary difficulties and issues. There've been some that have said that radiation shouldn't be done because radiation causes a transient increase in inflammation.&nbsp; When the prostate gland is radiated, getting people through that tough period three to six to eight weeks after the radiation can be challenging sometimes, but after the radiation starts to grab hold, the prostatitis symptoms oftentimes will become less and less over time. &nbsp;Hormone therapy will typically improve urinary symptoms in some men and others, for reasons we don't know, it seems to make the problem worse. &nbsp;When I'm talking about the problem, I'm talking about people waking up at night or having to urinate frequently.&nbsp; When I first started giving hormone therapy to men with prostate cancer, my hope was that since we're shrinking the prostate that urinary symptoms would universally improve, but that's not always the case. Why that is, is not clearly understood. &nbsp;There's a lot going on in the prostate with all these symptoms that we'd still don't completely understand.&nbsp;



Liz:&nbsp; [10:26] One interesting thing about radiation is that a couple months after the radiation or even up to a few years, you can have a delayed PSA bounce that isn't cancerous, but it's due to inflammation of the prostate.&nbsp;



Dr. Scholz:&nbsp; [10:42] It is frequent and this is more frequent in people that have seed implant radiation, so-called brachytherapy.&nbsp; You're absolutely correct, people can have a normal PSA after radiation and everything’s looking fine with a PSA less than one. &nbsp;Then, all of a sudden, the PSA is rising up to two, three, or four. &nbsp;The suspicion, of course, is that the cancer is coming back.&nbsp; In the old days, which really means just last year, we had to just sit this out and hope that it would go away and watch the PSA go up and reassure people that this type of thing can happen and maybe it isn't cancer. &nbsp;With these new PSMA PET scans, which are very accurate, we can have people get scanned when their PSA goes above one to detect if there is any cancer causing a problem and make that distinction between delayed PSA inflammation from radiation induced prostatitis, the so-called PSA bump, versus the cancer having a recurrence.&nbsp;



Liz:&nbsp; [11:45] You mentioned this is a really frequent occurrence. &nbsp;When PSAs go up, patients really tend to panic. &nbsp;How do you talk about this with them?&nbsp;



Dr. Scholz:&nbsp; [11:55] Well, it is a common enough thing that there's plenty of research out there showing that oftentimes a PSA would go right back down after a few months, two to six months, and remain low for the rest of their lives. &nbsp;Unfortunately, I've seen patients treated perhaps by doctors that don't see as much prostate cancer where they assume that it's a relapse and put them on hormone therapy. &nbsp;Hormone therapy will always cause the PSA to go down.&nbsp; This validates the idea that there was a cancer that now is under treatment. &nbsp;This is a really tragic thing because hormone therapy has a lot of side effects and it certainly shouldn't be used to treat a PSA bump.



Liz:&nbsp; [12:39] After radiation, the policy is to get PSA tested every three months for two years, then every six months for three years, and annually after that.&nbsp; If the PSA rises over 0.5, you should get the new PSMA PET scan.&nbsp;



Dr. Scholz:&nbsp; [12:58] That's right, Liz, this technology to finally be able to sort out whether it's a PSA bump or a cancer recurrence is incredibly valuable.&nbsp;



Liz:&nbsp; [13:08] Prostatitis is a really ambiguous situation and a lot of men have symptoms.&nbsp; Googling symptoms can lead to men believing they're from prostate cancer.&nbsp; However, localized prostate cancer never has symptoms, so it's clear these symptoms are from some other condition.&nbsp;



Dr. Scholz:&nbsp; [13:28] Exactly right. &nbsp;So often we were unable to use the word never in the world of treating humans. &nbsp;You know, we said, well, there's one of this and one of that, but it really is almost universally true that early stage prostate cancer is free of symptoms. &nbsp;People that have an ache here or a pain there and they're newly diagnosed with a PSA in the 10 to 20 range, they're wondering if their cancer has spread, should be greatly reassured that it's almost impossible for prostate cancer to cause any symptoms at these early stages.&nbsp; However, prostatitis and other issues are very common.&nbsp; They certainly do cause symptoms. &nbsp;Thankfully prostatitis doesn't turn into cancer. &nbsp;They are separate problems and one causes symptoms and the other doesn’t.&nbsp; &nbsp;&nbsp;



Liz:&nbsp; [14:19] This is a great reminder to take things slow when you get back a high PSA.&nbsp; In a future episode, we're going to talk about men who haven't been diagnosed with prostate cancer, but who have high PSAs and what the next steps are they should take. &nbsp;Thank you for listening, email questions or topics to podcast@prostateoncology.com. &nbsp;Remember to help us out by rating, reviewing and subscribing on Apple Podcasts.

<description>&lt;p&gt;&lt;em&gt;Prostatitis is inflammation of the prostate gland that can affect PSA and cause symptoms such as urinary frequency and urgency, fever, and pelvic pain. Prostatitis can be difficult to identify and hard to treat. This episode discusses diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.&lt;/em&gt;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&amp;nbsp; &lt;/strong&gt;[00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. &amp;nbsp;I'm your host, Dr. Mark Scholz.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:09] And I'm your cohost, Liz Graves.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt; &amp;nbsp;[00:13] Welcome to the PROSTATE PROS podcast.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [00:16] Prostatitis is inflammation of the prostate, which can have a huge negative impact on quality of life. &amp;nbsp;This episode, we're going to talk about diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [00:31] The real reason this topic comes up is because PSA goes up in men that have inflammation in their prostate, which is what we're calling prostatitis.&amp;nbsp; There are many causes, we're going to go into that, but the confusing factor is that we're using PSA to diagnose prostate cancer, to monitor prostate cancer for treatment effect, and for relapse.&amp;nbsp; If inflammation in the prostate intervenes and causes the PSA to go up, everyone gets frightened about the possibility of prostate cancer being out of control. &amp;nbsp;So this podcast will cover trying to make a distinction between a high PSA from prostatitis and a high PSA from prostate cancer.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [01:17] So prostatitis is inflammation of the prostate, and there can actually be no known cause of this, or it can be due to bacterial infection and it can also manifest in many different ways.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [01:31] There's so much confusion about what really is prostatitis.&amp;nbsp; It may be sort of an autoimmune phenomenon, the way people get asthma or eczema on their skin, some sort of over activity of the immune system, but it's quite common and it's often asymptomatic.&amp;nbsp; So that means that the PSA goes up, but men may not be feeling any urinary irritation.&amp;nbsp; At the other end of the spectrum, of course you have the people that have real discomfort and pain with urination and are getting up at night a lot.&amp;nbsp; When men have these symptoms, it doesn't necessarily mean that it is prostatitis, it could be a large prostate, it could be an irritable bladder, it could be a urinary tract infection, but prostatitis certainly is on the list of possibilities.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [02:19] So you mentioned asymptomatic prostatitis, which still has an effect on PSA.&amp;nbsp; Can you distinguish a rise in PSA from prostatitis from a rise from prostate cancer?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [02:32] Actually, PSA is very nonspecific.&amp;nbsp; So when we see a PSA rise, we have to start doing all kinds of tests.&amp;nbsp; The most popular one in the community of course, is to do a prostate biopsy. Our policy has been to do MRI testing, and there are certain blood tests and urine tests like OPKO 4K and SelectMDx that can help sniff out whether prostate cancer is really the problem.&amp;nbsp; But many times, we are left with an ambiguous situation; an elevated PSA without a clear cause.&amp;nbsp; And that's when people start calling it prostatitis.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [03:12] For people who do have symptoms, there are two or three different types. There's acute bacterial, chronic bacterial, and chronic prostatitis.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [03:23] Years past when this problem was encountered, the reflex reaction was just to give some antibiotics.&amp;nbsp; If the PSA would drop after a couple of weeks of antibiotics, then it must be prostatitis.&amp;nbsp; The problem with that is that the antibiotics have potential bad effects.&amp;nbsp; Secondly, they're not always effective because the many types of prostatitis are not bacterial.&amp;nbsp; Thirdly, the problem with prostatitis is it usually isn't permanently cured with antibiotics, you get a temporary remission, but then you're back to having to do antibiotics again and again.&amp;nbsp; Now, these days we don't usually jump on people with antibiotics, but some doctors still like to use this approach.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [04:10] This seems like a difficult condition to manage.&amp;nbsp; What other medicines, other than antibiotics do you use?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [04:18] So sometimes we just wait and keep checking the PSA and the inflammation will tend to die down on its own.&amp;nbsp; There are things that are popular over the counter products like Saw Palmetto, anti-inflammatories that you can pick up at the pharmacy like Aleve or Advil.&amp;nbsp; Sometimes a course of anti-inflammatories will cause a PSA decline and encourage us that the underlying problem is related to prostatitis as cancer won't respond to an anti-inflammatory.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [04:52] So if someone goes on anti-inflammatories and their PSA declines, and they just have prostatitis and no prostate cancer, should their PSA be zero?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [05:03] So men have to always calculate the normal PSA by looking at the size of the prostate.&amp;nbsp; This is usually determined with an MRI or an ultrasound.&amp;nbsp; The ten-to-one ratio is that if the prostate's 40 CCS in size, a normal PSA will be around four.&amp;nbsp; So PSAs will typically run in the one to eight range, but there's so much variability in prostate size.&amp;nbsp; A normal PSA can vary from individual to individual.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [05:33] PSA is one way to possibly diagnose prostatitis. &amp;nbsp;What other ways do you figure out that this is the problem?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [05:42] Well you mentioned before that there's certain men that get bacterial infections and they're uncomfortable: they have soreness in their pelvis, they have pain with urination.&amp;nbsp; If it gets out of hand, it can even cause a fever. &amp;nbsp;So diagnosing prostatitis when there are symptoms like that is really easy. &amp;nbsp;The problem is that 90% of the time, perhaps the prostatitis is asymptomatic and we're dealing with PSA's running high over periods of time. &amp;nbsp;This becomes super relevant in men that are on active surveillance because we check PSA frequently in these people and creates real concern that if the PSA is running high, that maybe we're missing some cancer somewhere.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [06:22] So there are a lot of symptoms with prostatitis, but these symptoms can also just occur in regular, healthy, aging men.&amp;nbsp; Is telling the difference between those two different people difficult?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [06:36] What you're referring to is the fact that our aging bladder gets more irritable and you can get up at night more frequently, also prostate glands get bigger and create blockage and all kinds of inconveniences related to the urinary tract. &amp;nbsp;That is a real diagnostic dilemma.&amp;nbsp; There are all kinds of tests to try and sort out which of these issues are going on like imaging tests and urinary flow tests. &amp;nbsp;People should usually get a urinary culture and make sure there's no infection.&amp;nbsp; So these methodologies are all used to try and sort out what is really going on. &amp;nbsp;After it's all said and done, if we don't have a clear answer, usually the term prostatitis is applied to the situation.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [07:20] Another thing that I've read about is tracking your PSA, and if your PSA is fluctuating pretty frequently, that might be a sign of prostatitis.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [07:31] Exactly.&amp;nbsp; Inflammation comes and goes. &amp;nbsp;It's not a steady, smooth, growth, the way something such as cancer might occur. &amp;nbsp;So the ups and downs when you have men with PSAs that are running high, that suddenly dropped, we know that PSA levels don't drop in people with cancer. &amp;nbsp;So that's another strong indication that prostatitis may be the cause of the PSA elevation.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [07:58] Okay, Dr. Scholz, let's say you have someone who is suffering with symptoms and you've tried antibiotics, you've tried anti-inflammatories, and none of it really seems to be providing relief. &amp;nbsp;What do you do next?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:12] It's a tough, tough situation. &amp;nbsp;Consulting an expert is the next step.&amp;nbsp; Sometimes mild doses of Proscar or Avodart to try and shrink the prostate will have some benefit, but there is no satisfying one treatment for prostatitis.&amp;nbsp; Some men have to suffer chronically with only partially resolved symptoms. &amp;nbsp;It's a very controversial area in terms of what proper treatment is because no one treatment is all that satisfying.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [08:46] Some men who are newly diagnosed with prostate cancer also have prostatitis. What kind of treatment options can these men look at that don't inflame the prostate?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [08:57] You can go forward with just about any of the common treatments. &amp;nbsp;This is one potential argument for surgery, because if the inflamed prostate is a big problem, removing it surgically should improve symptoms. &amp;nbsp;Sadly, that's not universally the case. &amp;nbsp;Sometimes the discomfort that people are having turned out in retrospect to not be from the prostate and men have operations and still have urinary difficulties and issues. There've been some that have said that radiation shouldn't be done because radiation causes a transient increase in inflammation.&amp;nbsp; When the prostate gland is radiated, getting people through that tough period three to six to eight weeks after the radiation can be challenging sometimes, but after the radiation starts to grab hold, the prostatitis symptoms oftentimes will become less and less over time. &amp;nbsp;Hormone therapy will typically improve urinary symptoms in some men and others, for reasons we don't know, it seems to make the problem worse. &amp;nbsp;When I'm talking about the problem, I'm talking about people waking up at night or having to urinate frequently.&amp;nbsp; When I first started giving hormone therapy to men with prostate cancer, my hope was that since we're shrinking the prostate that urinary symptoms would universally improve, but that's not always the case. Why that is, is not clearly understood. &amp;nbsp;There's a lot going on in the prostate with all these symptoms that we'd still don't completely understand.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [10:26] One interesting thing about radiation is that a couple months after the radiation or even up to a few years, you can have a delayed PSA bounce that isn't cancerous, but it's due to inflammation of the prostate.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [10:42] It is frequent and this is more frequent in people that have seed implant radiation, so-called brachytherapy.&amp;nbsp; You're absolutely correct, people can have a normal PSA after radiation and everything’s looking fine with a PSA less than one. &amp;nbsp;Then, all of a sudden, the PSA is rising up to two, three, or four. &amp;nbsp;The suspicion, of course, is that the cancer is coming back.&amp;nbsp; In the old days, which really means just last year, we had to just sit this out and hope that it would go away and watch the PSA go up and reassure people that this type of thing can happen and maybe it isn't cancer. &amp;nbsp;With these new PSMA PET scans, which are very accurate, we can have people get scanned when their PSA goes above one to detect if there is any cancer causing a problem and make that distinction between delayed PSA inflammation from radiation induced prostatitis, the so-called PSA bump, versus the cancer having a recurrence.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [11:45] You mentioned this is a really frequent occurrence. &amp;nbsp;When PSAs go up, patients really tend to panic. &amp;nbsp;How do you talk about this with them?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [11:55] Well, it is a common enough thing that there's plenty of research out there showing that oftentimes a PSA would go right back down after a few months, two to six months, and remain low for the rest of their lives. &amp;nbsp;Unfortunately, I've seen patients treated perhaps by doctors that don't see as much prostate cancer where they assume that it's a relapse and put them on hormone therapy. &amp;nbsp;Hormone therapy will always cause the PSA to go down.&amp;nbsp; This validates the idea that there was a cancer that now is under treatment. &amp;nbsp;This is a really tragic thing because hormone therapy has a lot of side effects and it certainly shouldn't be used to treat a PSA bump.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [12:39] After radiation, the policy is to get PSA tested every three months for two years, then every six months for three years, and annually after that.&amp;nbsp; If the PSA rises over 0.5, you should get the new PSMA PET scan.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [12:58] That's right, Liz, this technology to finally be able to sort out whether it's a PSA bump or a cancer recurrence is incredibly valuable.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [13:08] Prostatitis is a really ambiguous situation and a lot of men have symptoms.&amp;nbsp; Googling symptoms can lead to men believing they're from prostate cancer.&amp;nbsp; However, localized prostate cancer never has symptoms, so it's clear these symptoms are from some other condition.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; [13:28] Exactly right. &amp;nbsp;So often we were unable to use the word &lt;em&gt;never&lt;/em&gt; in the world of treating humans. &amp;nbsp;You know, we said, well, there's one of this and one of that, but it really is almost universally true that early stage prostate cancer is free of symptoms. &amp;nbsp;People that have an ache here or a pain there and they're newly diagnosed with a PSA in the 10 to 20 range, they're wondering if their cancer has spread, should be greatly reassured that it's almost impossible for prostate cancer to cause any symptoms at these early stages.&amp;nbsp; However, prostatitis and other issues are very common.&amp;nbsp; They certainly do cause symptoms. &amp;nbsp;Thankfully prostatitis doesn't turn into cancer. &amp;nbsp;They are separate problems and one causes symptoms and the other doesn’t.&amp;nbsp; &amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; [14:19] This is a great reminder to take things slow when you get back a high PSA.&amp;nbsp; In a future episode, we're going to talk about men who haven't been diagnosed with prostate cancer, but who have high PSAs and what the next steps are they should take. &amp;nbsp;Thank you for listening, email questions or topics to podcast@prostateoncology.com. &amp;nbsp;Remember to help us out by rating, reviewing and subscribing on Apple Podcasts.&lt;/p&gt;</description>

Prostatitis is inflammation of the prostate gland that can affect PSA and cause symptoms such as urinary frequency and urgency, fever, and pelvic pain. Prostatitis can be difficult to identify and hard to treat. This episode discusses diagnosing prostati

Prostatitis is inflammation of the prostate gland that can affect PSA and cause symptoms such as urinary frequency and urgency, fever, and pelvic pain. Prostatitis can be difficult to identify and hard to treat. This episode discusses diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.



Dr. Scholz:&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. &nbsp;I'm your host, Dr. Mark Scholz.



Liz:&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz: &nbsp;[00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; [00:16] Prostatitis is inflammation of the prostate, which can have a huge negative impact on quality of life. &nbsp;This episode, we're going to talk about diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.&nbsp;



Dr. Scholz:&nbsp; [00:31] The real reason this topic comes up is because PSA goes up in men that have inflammation in their prostate, which is what we're calling prostatitis.&nbsp; There are many causes, we're going to go into that, but the confusing factor is that we're using PSA to diagnose prostate cancer, to monitor prostate cancer for treatment effect, and for relapse.&nbsp; If inflammation in the prostate intervenes and causes the PSA to go up, everyone gets frightened about the possibility of prostate cancer being out of control. &nbsp;So this podcast will cover trying to make a distinction between a high PSA from prostatitis and a high PSA from prostate cancer.&nbsp;



Liz:&nbsp; [01:17] So prostatitis is inflammation of the prostate, and there can actually be no known cause of this, or it can be due to bacterial infection and it can also manifest in many different ways.&nbsp;



Dr. Scholz:&nbsp; [01:31] There's so much confusion about what really is prostatitis.&nbsp; It may be sort of an autoimmune phenomenon, the way people get asthma or eczema on their skin, some sort of over activity of the immune system, but it's quite common and it's often asymptomatic.&nbsp; So that means that the PSA goes up, but men may not be feeling any urinary irritation.&nbsp; At the other end of the spectrum, of course you have the people that have real discomfort and pain with urination and are getting up at night a lot.&nbsp; When men have these symptoms, it doesn't necessarily mean that it is prostatitis, it could be a large prostate, it could be an irritable bladder, it could be a urinary tract infection, but prostatitis certainly is on the list of possibilities.&nbsp;



Liz:&nbsp; [02:19] So you mentioned asymptomatic prostatitis, which still has an effect on PSA.&nbsp; Can you distinguish a rise in PSA from prostatitis from a rise from prostate cancer?&nbsp;



Dr. Scholz:&nbsp; [02:32] Actually, PSA is very nonspecific.&nbsp; So when we see a PSA rise, we have to start doing all kinds of tests.&nbsp; The most popular one in the community of course, is to do a prostate biopsy. Our policy has been to do MRI testing, and there are certain blood tests and urine tests like OPKO 4K and SelectMDx that can help sniff out whether prostate cancer is really the problem.&nbsp; But many times, we are left with an ambiguous situation; an elevated PSA without a clear cause.&nbsp; And that's when people start calling it prostatitis.&nbsp;



Liz:&nbsp; [03:12] For people who do have symptoms, there are two or three different types. There's acute bacterial, chronic bacterial, and chronic prostatitis.&nbsp;



Dr. Scholz:&nbsp; [03:23] Years past when this problem was encountered, the reflex reaction was just to give some antibiotics.&nbsp; If the PSA would drop after a couple of weeks of antibiotics, then it must be prostatitis.&nbsp; The problem with that is that the antibiotics have potential bad effects.&nbsp; Secondly, they're not always effective because the many types of prostatitis are not bacterial.&nbsp; Thirdly, the problem with prostatitis is it 

Do I Have Prostatitis?

Correctly assessing prostate cancer’s spread is essential for staging and treatment options. Until now, scanning technology has lacked both clarity and specificity, leaving treatment recommendations to partial information and guesswork. The new PSMA PET scan changes this. This episode of PROSTATE PROS explores the benefits of the PSMA PET scan and how it can be used to make intelligent treatment decisions. READ MORE ABOUT ON OUR <a rel="noreferrer noopener" href="https://www.prostateoncology.com/2020/10/29/the-imaging-advancement-psma-pet-scan-for-tracking-prostate-cancer-spread/" target="_blank">PROS BLOG</a>.



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I’m your host, Dr. Mark Scholz.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz: &nbsp;&nbsp;&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:17] Prostate cancer imaging has improved tremendously over the last decade. Advanced imaging means safer screening, more accurate staging, monitoring, and targeting.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:29] Liz, I'm glad we're going to address this new area of prostate cancer imaging because there's one scan in particular called PSMA PET scan, which is revolutionizing the field.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:42] So PSMA stands for prostate specific membrane antigen.&nbsp; This is a scan that I hear you talk about all of the time in the office.&nbsp; Can you tell us what it does?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:55] Whenever we're talking about scans we're always trying to answer the $64,000 question: Where is the cancer?&nbsp; The scary thing about cancer is it can spread and with prostate cancer, of course, ideally we want the cancer to stay confined inside the prostate gland.&nbsp; Historically, we've had a variety of scans to look throughout the body, MRI scans, bone scans.&nbsp; The problem has been that these scans are nonspecific, they can light up with injuries and other cancers and all kinds of confusing things. And they're not really that accurate so they can miss cancers outside the prostate, even when they're there.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [01:37] PSMA only shows where the prostate cancer is located in the body.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [01:43] That's right.&nbsp; And let's reiterate, of course, that prostate cancer that spreads to a lymph node or to the bones doesn't become bone or lymph node cancer, it's still prostate cancer. And the PSMA signature stays intact, even if it gets into another part of the body.&nbsp; So if a spot lights up on the scan, this new PSMA PET scan that we're talking about, it means there's some prostate cancer there.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:09] I'd imagine this is really important for staging.&nbsp; Right now you are using a lot of different ways to predict if the cancer has spread, but with this PSMA scan, you'll know for sure.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:22] That's very well stated.&nbsp; The historical use of Gleason Score was to try and predict the likelihood of something being outside the prostate or how high the PSA is.&nbsp; High PSAs were statistically more likely.&nbsp; This scan is so much more accurate than anything we've had.&nbsp; Now, if the scan is negative, it doesn't entirely prove there's no cancer outside the prostate, but it gives us a lot more confidence that the cancer is still confined inside the gland.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:50] The scan seems pretty revolutionary, is everybody getting this?



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:55] PSMA PET scans are available in a number of research centers, university centers around the country right now.&nbsp; And they are usually associated with some sort of a financial charge, but the information is so valuable, the money is usually dollars well spent.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [03:13] Besides having enough money to afford the scan who's eligible, is it every stage?



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [03:19] It is almost every stage.&nbsp; The exception would be men with what we call SKY or Low-Risk prostate cancers, MRIs are more accurate for delineating the exact size of spots inside the prostate, but for pretty much every other stage this is the best scan experience has shown that men with PSS that are below 0.2 are not going to light up on the scan.&nbsp; That’s a pretty remarkable threshold because with older scans, people needed PSAs of one to two, with something like Axumin perhaps, or 10 to 20, if it was a regular bone scan.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [04:00] So you mentioned Low-Risk, and these are cancers that as far as we know, haven't spread, is there a situation where these men would want to get a PSMA scan?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [04:11] You know, I have used it.&nbsp; That's not normally the way we would use the scan, but there's a situation where men are thought to have SKY, Grade 6, prostate cancer, but many times we run into men that have high PSA levels, perhaps from prostatitis or big prostates.&nbsp; There's this nervous niggling concern that could the cancer have spread somewhere outside the prostate.&nbsp; So it brings a lot of comfort when you have a high powered scan like this into play and show that no, indeed it is only still in the prostate.&nbsp; So while we don't routinely use this type of scanning, the PSMA PET scan for men with localized disease, certain men that are running high PSA density, that means the PSA is higher than we would expect in regard to how big the prostate is.&nbsp; We might consider doing a PSMA PET scan, and we have done that in a few cases.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [05:06] So let's say one of these men does want a PSMA PET scan before that because they have local disease.&nbsp; They would probably have had a 3T mp MRI or a color Doppler ultrasound.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [05:20] Yes, exactly.&nbsp; So we have literally hundreds of men we're monitoring on active surveillance.&nbsp; Our typical policy is to do imaging with 3T multiparametric MRI and/or color Doppler ultrasound.&nbsp; These provide the greatest resolution for imaging inside the prostate gland.&nbsp; So if a person's previously had a biopsy and we know where the cancer is and what the grade is, and they're under surveillance, sequential scanning can determine if those spots are growing. And so that is how we determine if someone will need further biopsies.&nbsp; Secondarily, we do look at PSA, but PSA is just not very accurate for this sort of purpose.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [06:03] We talked about Low-Risk, but how does this new scan help men with High-Risk prostate cancer?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [06:10] So what High-Risk means, and it's good to define terms, it doesn't mean a High-Risk of dying, it means a higher risk of microscopic spread outside the gland so that men who would undergo surgery or radiation would be at a higher risk of not being cured.&nbsp; So to compensate for that doctors give men TIP or testosterone inactivating pharmaceuticals, androgen deprivation, to try and mop up those little specks that might be out there just because someone has a higher Gleason Score or a higher PSA, but this scan is so much more accurate.&nbsp; It raises the question: If the scan doesn't show any spread can men with High-Risk disease skip taking the testosterone blockade and simply monitor with sequential scans annually after the treatment?&nbsp; And if some little tiny speck shows up in the future then treat it with radiation and perhaps some hormone therapy at that point.&nbsp; This would be a wonderful advantage for men because as we all know, four to 18 months of testosterone blockade is a very onerous treatment with a lot of side effects.&nbsp; So these scans may enable men to either reduce or eliminate the testosterone blockade.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [07:24] You just mentioned sequential scanning.&nbsp; How often would you do that for someone with the PSMA scan?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [07:30] So if someone has High-Risk disease and they're in complete remission, it would probably depend on how High-Risk, but it's funny how often in the scanning world, like for instance, with SKY, we do MRIs once a year, color Doppler once a year, and annual follow up is sort of a common rhythm.&nbsp; Unfortunately, we don't have any studies yet to tell us what is going to be the optimal scanning period.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [07:56] I know that a lot of scans have a lot of radiation or you have to use contrast.&nbsp; And these are a couple of things that can make it a little messy when considering getting a lot of scans in a row, is that something people need to be worried about?



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [08:10] It could be.&nbsp; The contrast or the radiation exposure does incur a small risk.&nbsp; Of course, in men with sky cancers, doing a lot of scanning that has radioactivity would be inappropriate, but as people get higher risk cancers, of course the disease itself becomes more risky than the side effects of the radiation.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [08:31] We've been talking about a lot of applications for this, but the most common application is finding relapsed disease.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [08:40] Exactly.&nbsp; So people that have had surgery or radiation, their PSA should go down to very low levels and remain there indefinitely.&nbsp; But PSA relapse is really common about 25% to 35% of men will have a rising after surgery or radiation someday.&nbsp; Then the big question is, well, where's it coming from?&nbsp; In the past, we really just had to deal with guesswork.&nbsp; There is another type of scan called Axumin, which is FDA approved, which was definitely progress because when the PSA got to be around one, two, or three oftentimes it was possible to find the location of the cancer.&nbsp; What’s marvelous about the PSMA PET scan is you can start scanning when the PSA is as low as 0.2.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [09:27] So I would imagine if something's found that relapsed disease is happening and there are mets that you can start treatment right away.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [09:36] Yes.&nbsp; And it's directed treatment.&nbsp; Usually the problem is located in the pelvic lymph nodes.&nbsp; That's the first jumping off spot.&nbsp; The doctors, now with modern radiation, can safely zap those spots and people get a second chance for cure.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [09:53] Moving on to men with advanced prostate cancer.&nbsp; These are men that have mets outside the lymph nodes and maybe even in the bones.&nbsp; So in the past, these men had to get all sorts of scans.&nbsp; They had to get bone scans, CT scans, but now with the PSMA PET scan, they might only have to get this one scan.&nbsp;



Dr. Scholz: &nbsp;&nbsp;&nbsp; [10:16] I think that's a great advantage with these scans, but in addition, of course, this is even more accurate.&nbsp; So if the CAT scan showed one or two enlarged lymph nodes and the bone scan showed one or two spots, the PSMA PET scan is so much more powerful and accurate, it may reveal significant numbers of new spots that weren't seen on the old scans.&nbsp;



Liz: &nbsp;&nbsp;&nbsp; [10:42] How is that helpful? &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [10:45] Well, treatment is tailored to how many spots are present because if only two or three spots are present, you can zap them with beams of radiation and try and sterilize them.&nbsp; But if there's a myriad of spots out there, medicines that circulate through the bloodstream, hormone therapy, chemotherapy, immunotherapy, is the best way to go.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [11:07] So the PSMA PET scan can be used for people with all different stages, and it can really help guide treatment and stage patients.&nbsp; Dr. Scholz, it seems like almost every person with prostate cancer should get this scan, but it's only approved in other countries, why is that?



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [11:26] There's been a lag in the United States with the completion of the clinical trials. And I'm not sure exactly why.&nbsp; This technology was actually invented 20 years ago.&nbsp; A guy named Neil Bander came up with a PSMA antigen and thank God now fruition is near.&nbsp; The studies have been completed and we're waiting for them to break the code and render proof that these scans are actually as good as we're talking about.&nbsp; And we know that they will be.&nbsp; Once the code is broken and the studies are published, there's usually a three to six month delay until the FDA approves the scans for commercial use.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [12:04] So for now finding PSMA PET scans is usually at a university or through a clinical trial.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [12:12] Yes.&nbsp; And unfortunately it's associated with a charge sometimes $1,000 to $3,000 per scan.&nbsp; They're pretty pricey, but I've found that the information has been so useful that many patients are willing to invest the dollars necessary to get the information.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [12:30] Let's say someone doesn't have the resources or the money to get a PSMA PET scan. What are these people supposed to do?&nbsp;&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [12:37] Well, we've been getting by without PSMA PET scans for 20 or 30 years and the PET bone scans, the Axumin PET scans, and good high quality MRIs have enabled us to improve prostate care to a tremendous degree.&nbsp; The PSMA PET scan is definitely an advance.&nbsp; In fact, I've been billing it as the biggest discovery since PSA, but it is the way we've been practicing without PSMA PET scans is certainly viable.&nbsp; And with expert care, doctors can use these slightly inferior technologies to make reasonable decisions and gage what the best approach will be.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [13:20] So this is a really exciting topic, and we are a little early talking about it as it isn't FDA approved yet, but it will be soon.&nbsp; We're posting more information about it on our blog, prostateoncology.com/blog.&nbsp; We're really excited to keep you up on the latest in prostate cancer.&nbsp; You can email any questions or topics to podcast@prostateoncology.com.&nbsp; Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.

<description>&lt;p&gt;&lt;em&gt;Correctly assessing prostate cancer’s spread is essential for staging and treatment options. Until now, scanning technology has lacked both clarity and specificity, leaving treatment recommendations to partial information and guesswork. The new PSMA PET scan changes this. This episode of PROSTATE PROS explores the benefits of the PSMA PET scan and how it can be used to make intelligent treatment decisions.&lt;/em&gt; READ MORE ABOUT ON OUR &lt;a rel="noreferrer noopener" href="https://www.prostateoncology.com/2020/10/29/the-imaging-advancement-psma-pet-scan-for-tracking-prostate-cancer-spread/" target="_blank"&gt;PROS BLOG&lt;/a&gt;.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&amp;nbsp; I’m your host, Dr. Mark Scholz.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:09] And I'm your cohost, Liz Graves.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:17] Prostate cancer imaging has improved tremendously over the last decade. Advanced imaging means safer screening, more accurate staging, monitoring, and targeting.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:29] Liz, I'm glad we're going to address this new area of prostate cancer imaging because there's one scan in particular called PSMA PET scan, which is revolutionizing the field.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:42] So PSMA stands for prostate specific membrane antigen.&amp;nbsp; This is a scan that I hear you talk about all of the time in the office.&amp;nbsp; Can you tell us what it does?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:55] Whenever we're talking about scans we're always trying to answer the $64,000 question: Where is the cancer?&amp;nbsp; The scary thing about cancer is it can spread and with prostate cancer, of course, ideally we want the cancer to stay confined inside the prostate gland.&amp;nbsp; Historically, we've had a variety of scans to look throughout the body, MRI scans, bone scans.&amp;nbsp; The problem has been that these scans are nonspecific, they can light up with injuries and other cancers and all kinds of confusing things. And they're not really that accurate so they can miss cancers outside the prostate, even when they're there.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [01:37] PSMA only shows where the prostate cancer is located in the body.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [01:43] That's right.&amp;nbsp; And let's reiterate, of course, that prostate cancer that spreads to a lymph node or to the bones doesn't become bone or lymph node cancer, it's still prostate cancer. And the PSMA signature stays intact, even if it gets into another part of the body.&amp;nbsp; So if a spot lights up on the scan, this new PSMA PET scan that we're talking about, it means there's some prostate cancer there.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:09] I'd imagine this is really important for staging.&amp;nbsp; Right now you are using a lot of different ways to predict if the cancer has spread, but with this PSMA scan, you'll know for sure.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:22] That's very well stated.&amp;nbsp; The historical use of Gleason Score was to try and predict the likelihood of something being outside the prostate or how high the PSA is.&amp;nbsp; High PSAs were statistically more likely.&amp;nbsp; This scan is so much more accurate than anything we've had.&amp;nbsp; Now, if the scan is negative, it doesn't entirely prove there's no cancer outside the prostate, but it gives us a lot more confidence that the cancer is still confined inside the gland.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:50] The scan seems pretty revolutionary, is everybody getting this?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:55] PSMA PET scans are available in a number of research centers, university centers around the country right now.&amp;nbsp; And they are usually associated with some sort of a financial charge, but the information is so valuable, the money is usually dollars well spent.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [03:13] Besides having enough money to afford the scan who's eligible, is it every stage?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [03:19] It is almost every stage.&amp;nbsp; The exception would be men with what we call SKY or Low-Risk prostate cancers, MRIs are more accurate for delineating the exact size of spots inside the prostate, but for pretty much every other stage this is the best scan experience has shown that men with PSS that are below 0.2 are not going to light up on the scan.&amp;nbsp; That’s a pretty remarkable threshold because with older scans, people needed PSAs of one to two, with something like Axumin perhaps, or 10 to 20, if it was a regular bone scan.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [04:00] So you mentioned Low-Risk, and these are cancers that as far as we know, haven't spread, is there a situation where these men would want to get a PSMA scan?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [04:11] You know, I have used it.&amp;nbsp; That's not normally the way we would use the scan, but there's a situation where men are thought to have SKY, Grade 6, prostate cancer, but many times we run into men that have high PSA levels, perhaps from prostatitis or big prostates.&amp;nbsp; There's this nervous niggling concern that could the cancer have spread somewhere outside the prostate.&amp;nbsp; So it brings a lot of comfort when you have a high powered scan like this into play and show that no, indeed it is only still in the prostate.&amp;nbsp; So while we don't routinely use this type of scanning, the PSMA PET scan for men with localized disease, certain men that are running high PSA density, that means the PSA is higher than we would expect in regard to how big the prostate is.&amp;nbsp; We might consider doing a PSMA PET scan, and we have done that in a few cases.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [05:06] So let's say one of these men does want a PSMA PET scan before that because they have local disease.&amp;nbsp; They would probably have had a 3T mp MRI or a color Doppler ultrasound.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [05:20] Yes, exactly.&amp;nbsp; So we have literally hundreds of men we're monitoring on active surveillance.&amp;nbsp; Our typical policy is to do imaging with 3T multiparametric MRI and/or color Doppler ultrasound.&amp;nbsp; These provide the greatest resolution for imaging inside the prostate gland.&amp;nbsp; So if a person's previously had a biopsy and we know where the cancer is and what the grade is, and they're under surveillance, sequential scanning can determine if those spots are growing. And so that is how we determine if someone will need further biopsies.&amp;nbsp; Secondarily, we do look at PSA, but PSA is just not very accurate for this sort of purpose.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [06:03] We talked about Low-Risk, but how does this new scan help men with High-Risk prostate cancer?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [06:10] So what High-Risk means, and it's good to define terms, it doesn't mean a High-Risk of dying, it means a higher risk of microscopic spread outside the gland so that men who would undergo surgery or radiation would be at a higher risk of not being cured.&amp;nbsp; So to compensate for that doctors give men TIP or testosterone inactivating pharmaceuticals, androgen deprivation, to try and mop up those little specks that might be out there just because someone has a higher Gleason Score or a higher PSA, but this scan is so much more accurate.&amp;nbsp; It raises the question: If the scan doesn't show any spread can men with High-Risk disease skip taking the testosterone blockade and simply monitor with sequential scans annually after the treatment?&amp;nbsp; And if some little tiny speck shows up in the future then treat it with radiation and perhaps some hormone therapy at that point.&amp;nbsp; This would be a wonderful advantage for men because as we all know, four to 18 months of testosterone blockade is a very onerous treatment with a lot of side effects.&amp;nbsp; So these scans may enable men to either reduce or eliminate the testosterone blockade.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [07:24] You just mentioned sequential scanning.&amp;nbsp; How often would you do that for someone with the PSMA scan?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [07:30] So if someone has High-Risk disease and they're in complete remission, it would probably depend on how High-Risk, but it's funny how often in the scanning world, like for instance, with SKY, we do MRIs once a year, color Doppler once a year, and annual follow up is sort of a common rhythm.&amp;nbsp; Unfortunately, we don't have any studies yet to tell us what is going to be the optimal scanning period.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [07:56] I know that a lot of scans have a lot of radiation or you have to use contrast.&amp;nbsp; And these are a couple of things that can make it a little messy when considering getting a lot of scans in a row, is that something people need to be worried about?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [08:10] It could be.&amp;nbsp; The contrast or the radiation exposure does incur a small risk.&amp;nbsp; Of course, in men with sky cancers, doing a lot of scanning that has radioactivity would be inappropriate, but as people get higher risk cancers, of course the disease itself becomes more risky than the side effects of the radiation.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [08:31] We've been talking about a lot of applications for this, but the most common application is finding relapsed disease.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [08:40] Exactly.&amp;nbsp; So people that have had surgery or radiation, their PSA should go down to very low levels and remain there indefinitely.&amp;nbsp; But PSA relapse is really common about 25% to 35% of men will have a rising after surgery or radiation someday.&amp;nbsp; Then the big question is, well, where's it coming from?&amp;nbsp; In the past, we really just had to deal with guesswork.&amp;nbsp; There is another type of scan called Axumin, which is FDA approved, which was definitely progress because when the PSA got to be around one, two, or three oftentimes it was possible to find the location of the cancer.&amp;nbsp; What’s marvelous about the PSMA PET scan is you can start scanning when the PSA is as low as 0.2.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [09:27] So I would imagine if something's found that relapsed disease is happening and there are mets that you can start treatment right away.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [09:36] Yes.&amp;nbsp; And it's directed treatment.&amp;nbsp; Usually the problem is located in the pelvic lymph nodes.&amp;nbsp; That's the first jumping off spot.&amp;nbsp; The doctors, now with modern radiation, can safely zap those spots and people get a second chance for cure.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [09:53] Moving on to men with advanced prostate cancer.&amp;nbsp; These are men that have mets outside the lymph nodes and maybe even in the bones.&amp;nbsp; So in the past, these men had to get all sorts of scans.&amp;nbsp; They had to get bone scans, CT scans, but now with the PSMA PET scan, they might only have to get this one scan.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp; [10:16] I think that's a great advantage with these scans, but in addition, of course, this is even more accurate.&amp;nbsp; So if the CAT scan showed one or two enlarged lymph nodes and the bone scan showed one or two spots, the PSMA PET scan is so much more powerful and accurate, it may reveal significant numbers of new spots that weren't seen on the old scans.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt; &amp;nbsp;&amp;nbsp;&amp;nbsp; [10:42] How is that helpful? &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [10:45] Well, treatment is tailored to how many spots are present because if only two or three spots are present, you can zap them with beams of radiation and try and sterilize them.&amp;nbsp; But if there's a myriad of spots out there, medicines that circulate through the bloodstream, hormone therapy, chemotherapy, immunotherapy, is the best way to go.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [11:07] So the PSMA PET scan can be used for people with all different stages, and it can really help guide treatment and stage patients.&amp;nbsp; Dr. Scholz, it seems like almost every person with prostate cancer should get this scan, but it's only approved in other countries, why is that?&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [11:26] There's been a lag in the United States with the completion of the clinical trials. And I'm not sure exactly why.&amp;nbsp; This technology was actually invented 20 years ago.&amp;nbsp; A guy named Neil Bander came up with a PSMA antigen and thank God now fruition is near.&amp;nbsp; The studies have been completed and we're waiting for them to break the code and render proof that these scans are actually as good as we're talking about.&amp;nbsp; And we know that they will be.&amp;nbsp; Once the code is broken and the studies are published, there's usually a three to six month delay until the FDA approves the scans for commercial use.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:04] So for now finding PSMA PET scans is usually at a university or through a clinical trial.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:12] Yes.&amp;nbsp; And unfortunately it's associated with a charge sometimes $1,000 to $3,000 per scan.&amp;nbsp; They're pretty pricey, but I've found that the information has been so useful that many patients are willing to invest the dollars necessary to get the information.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:30] Let's say someone doesn't have the resources or the money to get a PSMA PET scan. What are these people supposed to do?&amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:37] Well, we've been getting by without PSMA PET scans for 20 or 30 years and the PET bone scans, the Axumin PET scans, and good high quality MRIs have enabled us to improve prostate care to a tremendous degree.&amp;nbsp; The PSMA PET scan is definitely an advance.&amp;nbsp; In fact, I've been billing it as the biggest discovery since PSA, but it is the way we've been practicing without PSMA PET scans is certainly viable.&amp;nbsp; And with expert care, doctors can use these slightly inferior technologies to make reasonable decisions and gage what the best approach will be.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [13:20] So this is a really exciting topic, and we are a little early talking about it as it isn't FDA approved yet, but it will be soon.&amp;nbsp; We're posting more information about it on our blog, prostateoncology.com/blog.&amp;nbsp; We're really excited to keep you up on the latest in prostate cancer.&amp;nbsp; You can email any questions or topics to podcast@prostateoncology.com.&amp;nbsp; Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.&lt;/p&gt;</description>

Correctly assessing prostate cancer’s spread is essential for staging and treatment options. Until now, scanning technology has lacked both clarity and specificity, leaving treatment recommendations to partial information and guesswork. The new PSMA PET 

Correctly assessing prostate cancer’s spread is essential for staging and treatment options. Until now, scanning technology has lacked both clarity and specificity, leaving treatment recommendations to partial information and guesswork. The new PSMA PET scan changes this. This episode of PROSTATE PROS explores the benefits of the PSMA PET scan and how it can be used to make intelligent treatment decisions. READ MORE ABOUT ON OUR PROS BLOG.



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I’m your host, Dr. Mark Scholz.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:09] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz: &nbsp;&nbsp;&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:17] Prostate cancer imaging has improved tremendously over the last decade. Advanced imaging means safer screening, more accurate staging, monitoring, and targeting.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:29] Liz, I'm glad we're going to address this new area of prostate cancer imaging because there's one scan in particular called PSMA PET scan, which is revolutionizing the field.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:42] So PSMA stands for prostate specific membrane antigen.&nbsp; This is a scan that I hear you talk about all of the time in the office.&nbsp; Can you tell us what it does?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:55] Whenever we're talking about scans we're always trying to answer the $64,000 question: Where is the cancer?&nbsp; The scary thing about cancer is it can spread and with prostate cancer, of course, ideally we want the cancer to stay confined inside the prostate gland.&nbsp; Historically, we've had a variety of scans to look throughout the body, MRI scans, bone scans.&nbsp; The problem has been that these scans are nonspecific, they can light up with injuries and other cancers and all kinds of confusing things. And they're not really that accurate so they can miss cancers outside the prostate, even when they're there.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [01:37] PSMA only shows where the prostate cancer is located in the body.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [01:43] That's right.&nbsp; And let's reiterate, of course, that prostate cancer that spreads to a lymph node or to the bones doesn't become bone or lymph node cancer, it's still prostate cancer. And the PSMA signature stays intact, even if it gets into another part of the body.&nbsp; So if a spot lights up on the scan, this new PSMA PET scan that we're talking about, it means there's some prostate cancer there.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:09] I'd imagine this is really important for staging.&nbsp; Right now you are using a lot of different ways to predict if the cancer has spread, but with this PSMA scan, you'll know for sure.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:22] That's very well stated.&nbsp; The historical use of Gleason Score was to try and predict the likelihood of something being outside the prostate or how high the PSA is.&nbsp; High PSAs were statistically more likely.&nbsp; This scan is so much more accurate than anything we've had.&nbsp; Now, if the scan is negative, it doesn't entirely prove there's no cancer outside the prostate, but it gives us a lot more confidence that the cancer is still confined inside the gland.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:50] The scan seems pretty revolutionary, is everybody getting this?



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:55] PSMA PET scans are available in a number of research centers, university centers around the country right now.&nbsp; And they are usually associated with some sort of a financial charge, but the information is so valuable, the money is usually dollars well spent.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [03:13] Besides having enough money to afford the scan who's eligible, is it every stage?



Dr. Scholz

PSMA Imaging Detects Prostate Cancer Spread

What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their cancer. PROSTATE PROS talks about unapproved use for approved drugs that may benefit men with prostate cancer.



Dr. Scholz:&nbsp;&nbsp;&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I’m your host, Dr. Mark Scholz.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:08] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:20] In past episodes we've covered a variety of options for men with prostate cancer.&nbsp; This episode, we're going to consolidate some effective options that are not yet FDA approved.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:31] Liz, as you know, we've been doing this a long time and because we only see one type of cancer, we've learned some tricks along the way.&nbsp; I don't think you're going to find these things in books, or at least if you do find it in books, it's going to be mentioned in passing without much context.&nbsp; I think back when I was volunteering over at USC to teach fellows in cancer, back in 1996 and Taxotere, which is one of the most effective medicines for advanced prostate cancer was just released for the treatment of lung cancer.&nbsp; People were getting amazing responses from men who had lung cancer that had spread to their bones.&nbsp; When I heard “bones,” of course, a light bulb went off in my head and I thought, “This might work for our prostate cancer patients.”&nbsp; Indeed we found that it did.&nbsp; Early reports from other practices were also showing effectiveness.&nbsp; Interestingly, it wasn't until six or seven years later that the FDA finally approved Taxotere for prostate cancer.&nbsp; Throughout those years, we were using Taxotere regularly with good results, but it was not an approved therapy.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [01:41] When I was researching for this episode, it was really hard for me to find information about this.&nbsp; You Google “off-label therapy, alternative medicine,” there are tons of ads you can't really figure it out, “how would I know if a lung cancer drug would work for prostate cancer?”&nbsp; How do people find this information?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:01] I think this is sort of insider knowledge.&nbsp; There are specialists throughout the country that narrowly treat one type of disease.&nbsp; They talk and they meet at meetings and they share their insights.&nbsp; In a clinic where there's a high volume of patients, you can quickly determine if something actually works.&nbsp; You’ll know, within a few months, usually within three or four weeks even, after you start Taxotere, if the PSA is dropping and the bone scans are improving.&nbsp; It is insider knowledge and it doesn't get published unfortunately, sometimes for years.&nbsp; There were small phase two trials coming out about Taxotere, but it took six or seven years before the phase three trials led to FDA approval of Taxotere and prostate cancer.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:49] So this can be frustrating for patients because there are patients who are starting to run out of options, or maybe they're not liking the side effect profile and they really need to find these alternative options.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [03:02] Yeah, of course the online forums are really helpful for patients and the internet is a great resource.&nbsp; To illustrate, we've had patients that couldn't tolerate every three week Taxotere.&nbsp; I remember a patient who came to me with the PSA over a thousand and we gave him a standard Q3 week dose of Taxotere, 70 mg/m2. &nbsp; He just felt so terrible that he refused to take any further treatment.&nbsp; We finally talked him into taking a much smaller dose on a weekly basis, which was not in the original format for the way Taxotere is used.&nbsp; Quite surprisingly, he tolerated that nicely.&nbsp; His PSA ended up dropping down to less than one, he had a multiyear remission, and unfortunately down the line developed colon cancer and passed away from that.&nbsp; He survived his prostate cancer for many years.&nbsp; So again, weekly Taxotere in small doses for men that can't seem to tolerate the larger doses is something that's not talked about much anymore, but is just as effective as getting the larger dose every three weeks.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [04:16] What other types of drugs are you using in an off-label way?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [04:20] Well, until recently we were using Olaparib, which is a BRCA medicine approved for ovarian cancer, but thankfully the FDA just approved Olaparib.&nbsp; This is now available for people that have the BRCA mutation.&nbsp; Another medicine that is, I think, widely known in inner circles in prostate cancer is a medicine called Carboplatin.&nbsp; It's an injectable type of chemotherapy that's FDA approved for the treatment of lung cancer.&nbsp; It synergizes with Taxotere and Taxotere’s cousin, Jevtana.&nbsp; We've seen a number of men who have become resistant to Taxotere when they have Carboplatin added in small, weekly doses, couple hundred milligrams, turn around and respond again.&nbsp; Quality of life is good, usually it's a weekly or every other week infusion.&nbsp; So these medicines are effective, but you may not hear about them.&nbsp; It's certainly not something that's quote, FDA approved and it flies under the radar.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [05:28] Off-label drugs can be drugs used that are already approved for other cancers, or they can be drugs that are approved for a different stage of the same cancer.&nbsp; Can you talk a little bit about how Zytiga and Xtandi can be used in an off-label way?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [05:44] So both of those medicines are FDA approved for men with more advanced stages of prostate cancer.&nbsp; They're both well tolerated and they're certainly effective.&nbsp; It's an artifice, the way the FDA approves drugs for one stage of a disease and then refuses to approve it for another stage until studies prove that it's effective.&nbsp; It's the same disease, we know it's going to be effective.&nbsp; So men that have what we call High-Risk prostate cancer, in my Key to Prostate Cancer book, we talk about the AZURE stage.&nbsp; These are men that have Gleason 8 or 9, PSA is above 20, or maybe seminal vesicle invasion or lymph node spread, serious cancer, but Zytiga or Xtandi, oral medicines that are commonly used for advanced prostate cancer, are sometimes covered by insurance sometimes not because it's called off-label.&nbsp; These medicines are known to be effective against very advanced cancer.&nbsp; Why wouldn't they be effective against an earlier stage of a more serious type of cancer?&nbsp; So we often talk with our patients who are usually getting treatment with radiation and Lupron for 12 months, sort of 12 to 18 months, sort of a standard approach.&nbsp; Why wouldn't we give the best available hormone medicine, which is either Xtandi or Zytiga to enhance the cure rates?&nbsp; Studies are ongoing and perhaps sometime in the future, this will be the standard approach, but right now it's considered off-label.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [07:16] So off-label drugs deviate from the standard of care.&nbsp; The standard of care is how all of the insurance companies know what drugs can be paid for certain patients.&nbsp; The standard of care is determined by the NCCN guidelines.&nbsp; These are consensus driven management to ensure that all patients get optimal outcomes.&nbsp; So insurance companies look at those and decide, “Yes, we will pay for this specific medicine and this specific patient.”&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [07:48] Yes, doctors follow these criteria as well.&nbsp; The general oncologists are getting so busy with over a hundred different cancers.&nbsp; They really need guidelines to know what the next step is.&nbsp; If one medicine stops working, what should they do to follow?&nbsp; These guidelines then become sort of like the Bible and thinking outside the box sometimes is discouraged even in clinical circles.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [08:17] In a previous podcast episode, we talked about High-Risk prostate cancer and a couple of things that are not chemotherapy that we talked about in an off-label way are Metformin and statins.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [08:29] Yeah, I'm glad you brought that up, Liz, because these medicines are really relatively nontoxic.&nbsp; It's unusual for people to have to stop them because of side effects.&nbsp; The studies that have been done aren't phase three studies, but the phase two studies that exist seem to show a big advantage.&nbsp; For some reason, Metformin, which is FDA approved for the treatment of blood sugar issues, and the statin drugs like LIPITOR and CRESTOR, which are FDA approved for people with high cholesterol also seem to give better outcomes when it's combined with hormone therapy and radiation. Another issue, that's not going to come up as standard fare.&nbsp; If I was in this sort of a situation with High-Risk prostate cancer, I would make sure I was taking these medicines until proven otherwise.&nbsp; They're affordable and they're nontoxic.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [09:21] One thing I did find in my research was about clinical trials.&nbsp; Clinical trials can be really difficult to get into, but if you look into them and you find a drug that's being used, even if you're not eligible to use it, it can be a great place to start talking about with your doctor, because clinical trials are researching other FDA approved drugs, which means your doctor can write a prescription for the drug without you having to be involved in the clinical trial.&nbsp; For those of you who are eligible for clinical trials, that's easy access to get off-label drugs.&nbsp; One drug that's in a ton of clinical trials right now is KEYTRUDA, but I hear you all the time prescribing this to patients, what's going on?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [10:12] KEYTRUDA is the miraculous medicine that kept President Carter alive after his melanoma had spread to the brain.&nbsp; When you talk about clinical trials, Merck Pharmaceuticals is studying it in probably 10 to 20 different cancer types, including prostate cancer.&nbsp; But Merck has been very generous in distributing this same medicine on a compassionate use basis, which means that we only have to ask Merck Pharmaceuticals for the drug and they provide it free of charge.&nbsp; This is no small thing, it's a very, very expensive medicine.&nbsp; KEYTRUDA is an immune stimulating medicine. It’s infused every three weeks and has activity in prostate cancer.&nbsp; It’s not yet FDA approved, but we have performed our own phase two trial.&nbsp; About half the patients seem to either get PSA stabilization or decline.&nbsp; It's a fascinating medicine because it works by stimulating the immune system and in some patients that effect continues even after the medicine is discontinued.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [11:17] If you want to learn more about KEYTRUDA, listen to our episode about immunotherapy.



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [11:23] While we're talking about immune therapies, we should also cover Leukine, which is GM-CSF a medicine that was originally FDA approved to help people getting chemotherapy keep their immune systems strong.&nbsp; Over time it was noted that some people were getting declines in PSA with this medicine.&nbsp; Dr. Eric Small up at UCLA did some of the early phase two trials.&nbsp; Leukine was also very popular with Charles Snuffy Myers, who is a prostate maven who retired a couple of years ago. Leukine is given by an injection like an insulin shot.&nbsp; We do it three times a week and it oftentimes has no side effects at all.&nbsp; It may cause some chills or some rashes sometimes, but for men that have rising PSA after surgery and are really reluctant to do hormone therapy or radiation, Leukine has achieved stabilization of PSA sometimes for years.&nbsp; I don't think it will ever get FDA approved, but it is something to think about for men that have rising PSA in what we call the INDIGO category that are really reluctant to consider using Lupron or Firmagon.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [12:34] Dr. Scholz, it sounds like you're very creative with all of this and you have a lot of experience seeing patients and offering these options, but what do patients do that can't come see you?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [12:45] I think the safest thing is to visit a reputable university center where they're doing clinical trials.&nbsp; This is where a lot of the new medicines are developed and the universities have institutional review boards to make sure that what they're doing is ethical.&nbsp; The problem with the universities is sometimes they're constrained by only those clinical trials.&nbsp; So if you don't fit the profile of their exact clinical trial that they're offering, they may feel a little nervous about offering you something creative, but the oversight and the professional collegiality that's at the universities generally leads to a cut above in the physician quality.&nbsp; Of course they do have access to some of these new medicines that aren't FDA approved yet.&nbsp;&nbsp;&nbsp;&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [13:38] You can search clinicaltrials.gov to find these trials going on and find a way to search for more off-label options.&nbsp; The logical next topic to follow this up with are alternative, integrative, and natural options.&nbsp; But as we're running out of time, we'll talk about it on the next episode.&nbsp; If you have any questions about alternative therapies, you still have time to email us before the next podcast.&nbsp; You can send your questions to podcast@prostateoncology.com.&nbsp; Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.&nbsp;&nbsp;



Alex:&nbsp; &nbsp;&nbsp;&nbsp; [13:41] Hi everyone.&nbsp; This is Alex with the Prostate Cancer Research Institute.&nbsp; Every year we host our prostate cancer patients and caregivers conference.&nbsp; Usually that is in person, but this year it's going to be virtual and free.&nbsp; On September 11th and 12th we will have prostate cancer experts speaking on treatments, side effects, and lifestyle issues.&nbsp; There will be live Q &amp; A with our doctors and our helpline team, as well as awesome giveaways. &nbsp; Visit our website, pcri.org to RSVP today.

<description>&lt;p&gt;&lt;em&gt;What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their cancer. &lt;strong&gt;PROSTATE PROS&lt;/strong&gt; talks about unapproved use for approved drugs that may benefit men with prostate cancer.&lt;/em&gt;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp;&amp;nbsp;&amp;nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&amp;nbsp; I’m your host, Dr. Mark Scholz.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:08] And I'm your cohost, Liz Graves.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:20] In past episodes we've covered a variety of options for men with prostate cancer.&amp;nbsp; This episode, we're going to consolidate some effective options that are not yet FDA approved.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [00:31] Liz, as you know, we've been doing this a long time and because we only see one type of cancer, we've learned some tricks along the way.&amp;nbsp; I don't think you're going to find these things in books, or at least if you do find it in books, it's going to be mentioned in passing without much context.&amp;nbsp; I think back when I was volunteering over at USC to teach fellows in cancer, back in 1996 and Taxotere, which is one of the most effective medicines for advanced prostate cancer was just released for the treatment of lung cancer.&amp;nbsp; People were getting amazing responses from men who had lung cancer that had spread to their bones.&amp;nbsp; When I heard “bones,” of course, a light bulb went off in my head and I thought, “This might work for our prostate cancer patients.”&amp;nbsp; Indeed we found that it did.&amp;nbsp; Early reports from other practices were also showing effectiveness.&amp;nbsp; Interestingly, it wasn't until six or seven years later that the FDA finally approved Taxotere for prostate cancer.&amp;nbsp; Throughout those years, we were using Taxotere regularly with good results, but it was not an approved therapy.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [01:41] When I was researching for this episode, it was really hard for me to find information about this.&amp;nbsp; You Google “off-label therapy, alternative medicine,” there are tons of ads you can't really figure it out, “how would I know if a lung cancer drug would work for prostate cancer?”&amp;nbsp; How do people find this information?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:01] I think this is sort of insider knowledge.&amp;nbsp; There are specialists throughout the country that narrowly treat one type of disease.&amp;nbsp; They talk and they meet at meetings and they share their insights.&amp;nbsp; In a clinic where there's a high volume of patients, you can quickly determine if something actually works.&amp;nbsp; You’ll know, within a few months, usually within three or four weeks even, after you start Taxotere, if the PSA is dropping and the bone scans are improving.&amp;nbsp; It is insider knowledge and it doesn't get published unfortunately, sometimes for years.&amp;nbsp; There were small phase two trials coming out about Taxotere, but it took six or seven years before the phase three trials led to FDA approval of Taxotere and prostate cancer.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [02:49] So this can be frustrating for patients because there are patients who are starting to run out of options, or maybe they're not liking the side effect profile and they really need to find these alternative options.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [03:02] Yeah, of course the online forums are really helpful for patients and the internet is a great resource.&amp;nbsp; To illustrate, we've had patients that couldn't tolerate every three week Taxotere.&amp;nbsp; I remember a patient who came to me with the PSA over a thousand and we gave him a standard Q3 week dose of Taxotere, 70 mg/m2. &amp;nbsp; He just felt so terrible that he refused to take any further treatment.&amp;nbsp; We finally talked him into taking a much smaller dose on a weekly basis, which was not in the original format for the way Taxotere is used.&amp;nbsp; Quite surprisingly, he tolerated that nicely.&amp;nbsp; His PSA ended up dropping down to less than one, he had a multiyear remission, and unfortunately down the line developed colon cancer and passed away from that.&amp;nbsp; He survived his prostate cancer for many years.&amp;nbsp; So again, weekly Taxotere in small doses for men that can't seem to tolerate the larger doses is something that's not talked about much anymore, but is just as effective as getting the larger dose every three weeks.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [04:16] What other types of drugs are you using in an off-label way?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [04:20] Well, until recently we were using Olaparib, which is a BRCA medicine approved for ovarian cancer, but thankfully the FDA just approved Olaparib.&amp;nbsp; This is now available for people that have the BRCA mutation.&amp;nbsp; Another medicine that is, I think, widely known in inner circles in prostate cancer is a medicine called Carboplatin.&amp;nbsp; It's an injectable type of chemotherapy that's FDA approved for the treatment of lung cancer.&amp;nbsp; It synergizes with Taxotere and Taxotere’s cousin, Jevtana.&amp;nbsp; We've seen a number of men who have become resistant to Taxotere when they have Carboplatin added in small, weekly doses, couple hundred milligrams, turn around and respond again.&amp;nbsp; Quality of life is good, usually it's a weekly or every other week infusion.&amp;nbsp; So these medicines are effective, but you may not hear about them.&amp;nbsp; It's certainly not something that's quote, FDA approved and it flies under the radar.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [05:28] Off-label drugs can be drugs used that are already approved for other cancers, or they can be drugs that are approved for a different stage of the same cancer.&amp;nbsp; Can you talk a little bit about how Zytiga and Xtandi can be used in an off-label way?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [05:44] So both of those medicines are FDA approved for men with more advanced stages of prostate cancer.&amp;nbsp; They're both well tolerated and they're certainly effective.&amp;nbsp; It's an artifice, the way the FDA approves drugs for one stage of a disease and then refuses to approve it for another stage until studies prove that it's effective.&amp;nbsp; It's the same disease, we know it's going to be effective.&amp;nbsp; So men that have what we call &lt;em&gt;High-Risk&lt;/em&gt; prostate cancer, in my &lt;em&gt;Key to Prostate Cancer&lt;/em&gt; book, we talk about the &lt;em&gt;AZURE&lt;/em&gt; stage.&amp;nbsp; These are men that have Gleason 8 or 9, PSA is above 20, or maybe seminal vesicle invasion or lymph node spread, serious cancer, but Zytiga or Xtandi, oral medicines that are commonly used for advanced prostate cancer, are sometimes covered by insurance sometimes not because it's called off-label.&amp;nbsp; These medicines are known to be effective against very advanced cancer.&amp;nbsp; Why wouldn't they be effective against an earlier stage of a more serious type of cancer?&amp;nbsp; So we often talk with our patients who are usually getting treatment with radiation and Lupron for 12 months, sort of 12 to 18 months, sort of a standard approach.&amp;nbsp; Why wouldn't we give the best available hormone medicine, which is either Xtandi or Zytiga to enhance the cure rates?&amp;nbsp; Studies are ongoing and perhaps sometime in the future, this will be the standard approach, but right now it's considered off-label.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [07:16] So off-label drugs deviate from the standard of care.&amp;nbsp; The standard of care is how all of the insurance companies know what drugs can be paid for certain patients.&amp;nbsp; The standard of care is determined by the NCCN guidelines.&amp;nbsp; These are consensus driven management to ensure that all patients get optimal outcomes.&amp;nbsp; So insurance companies look at those and decide, “Yes, we will pay for this specific medicine and this specific patient.”&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [07:48] Yes, doctors follow these criteria as well.&amp;nbsp; The general oncologists are getting so busy with over a hundred different cancers.&amp;nbsp; They really need guidelines to know what the next step is.&amp;nbsp; If one medicine stops working, what should they do to follow?&amp;nbsp; These guidelines then become sort of like the Bible and thinking outside the box sometimes is discouraged even in clinical circles.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [08:17] In a previous podcast episode, we talked about &lt;em&gt;High-Risk&lt;/em&gt; prostate cancer and a couple of things that are not chemotherapy that we talked about in an off-label way are Metformin and statins.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [08:29] Yeah, I'm glad you brought that up, Liz, because these medicines are really relatively nontoxic.&amp;nbsp; It's unusual for people to have to stop them because of side effects.&amp;nbsp; The studies that have been done aren't phase three studies, but the phase two studies that exist seem to show a big advantage.&amp;nbsp; For some reason, Metformin, which is FDA approved for the treatment of blood sugar issues, and the statin drugs like LIPITOR and CRESTOR, which are FDA approved for people with high cholesterol also seem to give better outcomes when it's combined with hormone therapy and radiation. Another issue, that's not going to come up as standard fare.&amp;nbsp; If I was in this sort of a situation with &lt;em&gt;High-Risk&lt;/em&gt; prostate cancer, I would make sure I was taking these medicines until proven otherwise.&amp;nbsp; They're affordable and they're nontoxic.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [09:21] One thing I did find in my research was about clinical trials.&amp;nbsp; Clinical trials can be really difficult to get into, but if you look into them and you find a drug that's being used, even if you're not eligible to use it, it can be a great place to start talking about with your doctor, because clinical trials are researching other FDA approved drugs, which means your doctor can write a prescription for the drug without you having to be involved in the clinical trial.&amp;nbsp; For those of you who are eligible for clinical trials, that's easy access to get off-label drugs.&amp;nbsp; One drug that's in a ton of clinical trials right now is KEYTRUDA, but I hear you all the time prescribing this to patients, what's going on?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [10:12] KEYTRUDA is the miraculous medicine that kept President Carter alive after his melanoma had spread to the brain.&amp;nbsp; When you talk about clinical trials, Merck Pharmaceuticals is studying it in probably 10 to 20 different cancer types, including prostate cancer.&amp;nbsp; But Merck has been very generous in distributing this same medicine on a compassionate use basis, which means that we only have to ask Merck Pharmaceuticals for the drug and they provide it free of charge.&amp;nbsp; This is no small thing, it's a very, very expensive medicine.&amp;nbsp; KEYTRUDA is an immune stimulating medicine. It’s infused every three weeks and has activity in prostate cancer.&amp;nbsp; It’s not yet FDA approved, but we have performed our own phase two trial.&amp;nbsp; About half the patients seem to either get PSA stabilization or decline.&amp;nbsp; It's a fascinating medicine because it works by stimulating the immune system and in some patients that effect continues even after the medicine is discontinued.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [11:17] If you want to learn more about KEYTRUDA, listen to our episode about immunotherapy.&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [11:23] While we're talking about immune therapies, we should also cover Leukine, which is GM-CSF a medicine that was originally FDA approved to help people getting chemotherapy keep their immune systems strong.&amp;nbsp; Over time it was noted that some people were getting declines in PSA with this medicine.&amp;nbsp; Dr. Eric Small up at UCLA did some of the early phase two trials.&amp;nbsp; Leukine was also very popular with Charles Snuffy Myers, who is a prostate maven who retired a couple of years ago. Leukine is given by an injection like an insulin shot.&amp;nbsp; We do it three times a week and it oftentimes has no side effects at all.&amp;nbsp; It may cause some chills or some rashes sometimes, but for men that have rising PSA after surgery and are really reluctant to do hormone therapy or radiation, Leukine has achieved stabilization of PSA sometimes for years.&amp;nbsp; I don't think it will ever get FDA approved, but it is something to think about for men that have rising PSA in what we call the &lt;em&gt;INDIGO&lt;/em&gt; category that are really reluctant to consider using Lupron or Firmagon.&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:34] Dr. Scholz, it sounds like you're very creative with all of this and you have a lot of experience seeing patients and offering these options, but what do patients do that can't come see you?&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Dr. Scholz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [12:45] I think the safest thing is to visit a reputable university center where they're doing clinical trials.&amp;nbsp; This is where a lot of the new medicines are developed and the universities have institutional review boards to make sure that what they're doing is ethical.&amp;nbsp; The problem with the universities is sometimes they're constrained by only those clinical trials.&amp;nbsp; So if you don't fit the profile of their exact clinical trial that they're offering, they may feel a little nervous about offering you something creative, but the oversight and the professional collegiality that's at the universities generally leads to a cut above in the physician quality.&amp;nbsp; Of course they do have access to some of these new medicines that aren't FDA approved yet.&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Liz:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [13:38] You can search clinicaltrials.gov to find these trials going on and find a way to search for more off-label options.&amp;nbsp; The logical next topic to follow this up with are alternative, integrative, and natural options.&amp;nbsp; But as we're running out of time, we'll talk about it on the next episode.&amp;nbsp; If you have any questions about alternative therapies, you still have time to email us before the next podcast.&amp;nbsp; You can send your questions to podcast@prostateoncology.com.&amp;nbsp; Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.&amp;nbsp;&amp;nbsp;&lt;/p&gt;



&lt;p&gt;&lt;strong&gt;Alex:&lt;/strong&gt;&amp;nbsp; &amp;nbsp;&amp;nbsp;&amp;nbsp; [13:41] Hi everyone.&amp;nbsp; This is Alex with the Prostate Cancer Research Institute.&amp;nbsp; Every year we host our prostate cancer patients and caregivers conference.&amp;nbsp; Usually that is in person, but this year it's going to be virtual and free.&amp;nbsp; On September 11th and 12th we will have prostate cancer experts speaking on treatments, side effects, and lifestyle issues.&amp;nbsp; There will be live Q &amp;amp; A with our doctors and our helpline team, as well as awesome giveaways. &amp;nbsp; Visit our website, pcri.org to RSVP today.&lt;/p&gt;</description>

What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their 

What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their cancer. PROSTATE PROS talks about unapproved use for approved drugs that may benefit men with prostate cancer.



Dr. Scholz:&nbsp;&nbsp;&nbsp; [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.&nbsp; I’m your host, Dr. Mark Scholz.



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:08] And I'm your cohost, Liz Graves.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:13] Welcome to the PROSTATE PROS podcast.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [00:20] In past episodes we've covered a variety of options for men with prostate cancer.&nbsp; This episode, we're going to consolidate some effective options that are not yet FDA approved.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [00:31] Liz, as you know, we've been doing this a long time and because we only see one type of cancer, we've learned some tricks along the way.&nbsp; I don't think you're going to find these things in books, or at least if you do find it in books, it's going to be mentioned in passing without much context.&nbsp; I think back when I was volunteering over at USC to teach fellows in cancer, back in 1996 and Taxotere, which is one of the most effective medicines for advanced prostate cancer was just released for the treatment of lung cancer.&nbsp; People were getting amazing responses from men who had lung cancer that had spread to their bones.&nbsp; When I heard “bones,” of course, a light bulb went off in my head and I thought, “This might work for our prostate cancer patients.”&nbsp; Indeed we found that it did.&nbsp; Early reports from other practices were also showing effectiveness.&nbsp; Interestingly, it wasn't until six or seven years later that the FDA finally approved Taxotere for prostate cancer.&nbsp; Throughout those years, we were using Taxotere regularly with good results, but it was not an approved therapy.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [01:41] When I was researching for this episode, it was really hard for me to find information about this.&nbsp; You Google “off-label therapy, alternative medicine,” there are tons of ads you can't really figure it out, “how would I know if a lung cancer drug would work for prostate cancer?”&nbsp; How do people find this information?&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [02:01] I think this is sort of insider knowledge.&nbsp; There are specialists throughout the country that narrowly treat one type of disease.&nbsp; They talk and they meet at meetings and they share their insights.&nbsp; In a clinic where there's a high volume of patients, you can quickly determine if something actually works.&nbsp; You’ll know, within a few months, usually within three or four weeks even, after you start Taxotere, if the PSA is dropping and the bone scans are improving.&nbsp; It is insider knowledge and it doesn't get published unfortunately, sometimes for years.&nbsp; There were small phase two trials coming out about Taxotere, but it took six or seven years before the phase three trials led to FDA approval of Taxotere and prostate cancer.&nbsp;



Liz:&nbsp; &nbsp;&nbsp;&nbsp; [02:49] So this can be frustrating for patients because there are patients who are starting to run out of options, or maybe they're not liking the side effect profile and they really need to find these alternative options.&nbsp;



Dr. Scholz:&nbsp; &nbsp;&nbsp;&nbsp; [03:02] Yeah, of course the online forums are really helpful for patients and the internet is a great resource.&nbsp; To illustrate, we've had patients that couldn't tolerate every three week Taxotere.&nbsp; I remember a patient who came to me with the PSA over a thousand and we gave him a standard Q3 week dose of Taxotere, 70 mg/m2. &nbsp; He just felt so terrible that he refused to take any f

Off-label Treatment Used for Prostate Cancer

Prostate cancer is complex. Patients often struggle to find accurate, stage-specific information.  Listen as prostate specialist and author, Mark Scholz, MD guides you through the 15 stages of prostate cancer, recent updates, and all possible treatment options. Avoid prostate cancer pitfalls and take control of your diagnosis with the PROSTATE PROS podcast.

PROSTATE PROS

Details

Recent Episodes