Recovering Testosterone After Hormone Therapy for #ProstateCancer | #MarkScholzMD #AlexScholz #PCRI

in today's video we're going to talk about hormone therapy and prostate cancer but specifically intermittent hormone therapy and what it's like taking a holiday Dr Mark sches who's a 30-year medical oncologist focusing solely in prostate cancer is going to talk about what the situation looks like in order to go off of hormone therapy what the monitoring process looks like and what happens when the testosterone comes back I hope you find this helpful today Dr scholes were talking about men who have been on hormone therapy for quite some time and their PSA is stable and is there any reason for them to come off of hormone therapy so let's just say that you have a 65-year-old man and when he comes into your office he has a PSA of 400 he has a psma scan and it does show metastic activity in the bones and so he has multiple metastatic lesions and then he goes on Lupron and zga and over the next 6 months we just see his PSA Decline and the dis scans are now clear is there really a reason for this man to continue hormone therapy because that's a huge psychological moment to say well this this treatment is keeping my cancer in check so why would we go off yeah this situation comes up frequently starting with a high PSA these individuals um never got screened they'll show up in an emergency room with some bone pain and they're very discouraged to discover that they've got widespread metastatic cancer and most cancers that would be a terminal event prostate cancer can have incredible uh remissions with the use of hormone treatment first and second generation hormone treatment and uh these individuals can go and achieve a PSA that's undetectable and maintain that sometimes indefinitely a repeat psma pet scan can show complete resolution of all the previous activity in that circumstance this issue comes up do we need to continue administering the hormone treatment for the rest of the patient's life because the idea was that it's widespread metastatic disease potentially fatal why would we consider stop stoping the treatment the um answer has been tested in clinical trials uh more just with Lupron loone first generation but surprisingly the results uh in men that would take a holiday perhaps they've been on the hormone treatment for 12 to 18 to 24 months everything's PSA is undetectable studies that have been performed show that those uh men that stop treatment and take a holiday allow their PSA to rise to a certain degree and then restart treatment let's say the PSA reaches a threshold of five or 10 uh that those individuals have the same 10year survival rates as men who continued on treatment continuously and never took a holiday this question I think um comes up quite a bit and and the industry um seems unaware the the oncologists and urologists that these studies were done back in the 1990s and a lot of patients when they talk about taking a holiday with their Physicians they will get uh comments like we're going to throw gasoline on the fire we don't want the testosterone to come back you had a life-threatening illness and uh we don't want to endanger your life not realizing that there are clinical trials that have looked at the safety of this sort of thing and uh established that if people are monitored closely that they uh can have treatment reinitiated with the expectation that they'll go back into a complete remission please click that subscribe button when you do this it tells the YouTube algorithm that this video is helpful for you and they'll push our videos out to people who need them also if you would like to donate and join our cause you can do so at pc.org donate now back to my video with Dr sches so can we cover some of the side effects of these therapies because I think that that is a big reason why men are having a hard time staying on the treatment and then you know it's more desirable to come off the treatment and I think that those side effects have a huge psychological impact on a man when they're dealing with prostate cancer the idea of course by stopping treatment is to allow testosterone to come back to help build muscle Mass um lose weight uh regain libido have hot flashes go away and uh be less emotionally labile uh so there's a lot of upside to being able to get testosterone back that is uh is available to the men that have gone into what we call a complete remission the ones that get their PSA down to less than 0.1 who have had another pet scan that shows no active disease yeah there's definitely a big upside and I think men in ly know this but they're surprised when their caregivers their urologists and their oncologists tell them that that would be imprudent usually because they're not familiar with these clinical trials that were done maybe 20 years ago we've talked quite often about how the word cancer is so scary and even the concept of cancer being in stabilized or in remission to a certain extent is still scary that the cancer can come back and this is an overwhelming emotion that comes to many men and just it's Justified it's absolutely understandable but how are you assuring patients that if they go off of hormone therapy you know that they're going to be safe how do we know whether it's going to come back or not and what are the um what are the tools that you implement through that process I trust the clinical trials that were done uh that examined this particular question specifically but I'm also encouraged by the uh Advent of these new psma pet scans we know that U metastatic prostate cancer is a multiclonal disease so some of the metastatic lesions can be so sensitive to hormone treatment hormone deprivation that uh they'll never come back and other lesions are going to be a little more stubborn so although they may have gone into remission they may be hibernating when the testosterone comes back when the hormone treatment is stopped uh those other spots uh may start to appear again as the PSA Rises and I'm kind of excited about the potential of what psma pet scans can do in this setting so someone may have come with a PSA of 400 originally and had 25 spots but after getting into a remission and uh taking a holiday they may as the testosterone starts coming out maybe only two or three of the spots will Revitalize and when we have a limited number of spots say less than five spots we can access modern spot radiation to sterilize those bad actor Spots I'm encouraged that taking a holiday may actually leverage uh other therapies and Aid in producing better longevity longer remissions longer holidays with the with the select utilization of spot radiation uh in the men who are taking these holidays and may have one or two areas of cancer come back uh one unanswered question is should they go back on the hormone therapy at the same time that they have these types of Salvage spot radiation or should we rely on the spot radiation alone uh in patients that have one or two spots we are starting to forego the hormone treatment and monitor PSA closely after the radiation to ensure that the PSA goes back to zero and if it doesn't then maybe get another scan and see if another spot has shown up so the idea of a holiday then allows men to take advantage of some of this new technology that we didn't have I've had patients come to me that were have been in remission five six years even before we had psma pet scans and they've been very frightened and nervous about taking a holiday because when they were initially diagnosed they had a very terrifying life-threatening situation with PSA in the hundreds multiple metastatic lesions but hormone therapy is so powerful it can take these patients not all of them but many of them and put them in a complete remission and and in some cases I think that remission will last the rest of their life if they stay on hormone treatment continually but the question is do they really need to be on hormone treatment for the rest of their life can we take a holiday maybe improve their quality of life and in some instances maybe we can utilize some of these other newer Technologies to keep them in remission so they're able able to stay off the hormone deprivation therapy for a longer period of time what is the typical timing that you have when you see a patient like let's say they did come in with those 25 spots and their PSA was 400 how long you know would you wait to take them off hormone therapy if it is effective and then how long do you see typical holidays literature that looked at giving hormone treatment to men who are newly diagnosed with high-risk disease so they get radiation uh they'll get 18 months of hormone treatment let's say they had glein 8 I'm talking about a newly diagnosed Pati with a PSA of 25 have radiation to their prostate perhaps to their lymph nodes get 18 months of hormone deprivation therapy Studies have shown that going a lot past 18 months maybe maybe as long as 24 months really is just diminishing returns that whatever cancer that is going to die as a result of hormone deprivation will have died within an 18 to 24mth period in men that achieve a remission and when we initiate hormone treatment in men that have high PSAs initially diagnosed with metastatic disease we would expect if they're going to get a complete remission that their PSA will decline into the down to less than .1 within 6 to 8 months of starting treatment so men that aren't getting there within 6 to8 months men with a so-called high PSA nator that's a different story and we're not talking about taking holidays in those individuals they need additional treatment to get into a complete remission but those that do achieve a complete remission we'll leave them on the Androgen deprivation therapy for a good 18 to 24 months and then we start talking about taking a holiday and and see if they uh when their testosterone comes back what kind of uh results we would see with further scanning and possibly with radiation if a new spots show up so one of the things you mentioned in your previous in a previous question I had was the concept that these men if you know a spot or two does show up that you can spot radiate and possibly not go back on hormone therapy you have treated thousands of prostate cancer patients how many patients in your practice have you seen go through this process and what did you see the outcomes look like does dozens and dozens I don't keep track of them by number but I'm excited about the uh results that we're seeing and in the old days we used to talk about giving radiation to metastatic lesions with the old bone scans and CAT scans and uh the euphemism was you know we're playing whacka mole and you'd smack one metastatic leion and other one would show up later and then you smack that one with the PSA pet scans which are finding much smaller earlier lesions in many cases these patients are not going to manifest further metastatic lesions so in its early years psma pet scans have been out now for about 2 years commercially uh we're very uh very encouraged that uh this approach is a very non-toxic and a very efficacious way to um to control the disease with a lot less side effects than what the testosterone deprivation causes so at what level does the PSA have to get before you would say okay it's time to come off a holiday or is it just a matter of we're going going to look at the PSA psma scans right historically the intermittent studies would allow the PSA to rise up to five or or sometimes 10 and some of the clinical trials U but these days when the PSA starts going 0. 2 to 04 we'll get a psma pet scan and act on it so we're not typically allowing PSAs to rise as high as they used to because we have an alternative strategy that's very effective and and non-toxic I appreciate you talking about that because one of the psychological impacts I see when it comes to prostate cancer patients specifically is the timing of it all you know if there's if PSA is rising even a little bit they get concerned and they want to scan the next day because they want to know wait why is my PSA rising and there are obviously things a lot of things that can affect uh PSA but especially in hormone therapy patients you know checking that PSA level they're so dedicated to it because they want to make sure that this treatment is effective and psma scans are not something that you're necessarily just going to get tomorrow you know it's usually a couple weeks if you have to schedule it so when it comes comes to these types of patients and you know they're on an extended holiday and the PSA is staying stable would you give testosterone replacement therapy to a patient who was previously on hormone therapy their PSA is stabilized and now they're in a position where they like some testosterone back typically after people stop Lupron or other uh anren deprivation type methodologies uh we'll wait about six months for the body to recalibrate and start making testosterone again but the goal of stopping treatment is for the men to recover testosterone and sometimes in the more elderly and those that have been on hormone treatment for a long time they're not going to recover testosterone so yes we do talk about administering testosterone to those individuals and uh that also seems to unsettle other Physicians who hear about such things but the testosterone that comes from a from a cream or from a shot is exactly the same molecule that comes from the testicles and the idea that somehow administering testosterone is different than stopping Lupron and allowing testosterone to be uh manufactured in the testicles and get into the bloodstream uh is ridiculous they're entirely the same thing so the goal of taking a holiday is to get some testosterone back not just to forego getting a shot every three months or stop a few pills the quality of life that people will experience that improves is a result of the recovery of testosterone so other factors that I see patients encounter when they're in this position is outside voices you know they have the medical teams that they're working with they have caregivers you know spouses or Partners or children that are concerned you're getting off this life-saving therapy do you have any advice for patients who are going through that process and they are getting pushed back from the medical community or their family family Dynamics and uh communication are a challenging aspect of uh of any difficult situation that we run into and I think the only uh remedial resource is education and bring the family to the doctor visits so that everyone can be on the same page as to what's going on at once people understand the backstory I think it starts to make sense that the tools that we have in the prostate cancer world are in many ways much more efficacious than what we have for the other cancers in that they're much much more effective and as a result I think in some cases we have the luxury of taking a holiday being diagnosed with prostate cancer finding a medical team trusting the medical team and building a relationship with them choosing a treatment and then going on something like hormone therapy is already an arduous process and now you're dealing with the side effects of hormone therapy but your PSA may be stable and your scans may be clear what I would do is I would ask your doctor is intermittent therapy an option for me and if it's not why I will go ahead and Link the clinical trials that Dr sches mentioned in the description below this video and you can bring that up to your doctor and just say hey I heard about this I think it's an option I really don't like the side effects of this hormone therapy and I would like to know whether or not this is an option for me those are great conversations to have with your medical team and whether you decide to do it or not at least you know your options and whether or not the reasons why you would or would not do it if you would like to talk to someone who has gone through intermittent hormone therapy and has gotten their testosterone back and gone back on it our heline is a great resource for that you can reach them at pc.org helpline and if you just need more information about prostate cancer you can visit our website at pcer high.org or search our YouTube channel we have a lot of topics covered here now if there is a topic that you do not see covered and you would like to see it covered you can go ahead and leave your questions and your topic ideas in the description or in the comment section below this video and Dr scholes and I can film it from there we really appreciate that you trust us we hope that you are having a good week and please remember that you're not [Music] alone

Channel: Prostate Cancer Research Institute

Views: 17,685

Keywords: prostate cancer, prostate, prostate PSA, PSA, Gleason Score

Id: IIkY-cq32xo

Length: 15min 55sec (955 seconds)

Published: Sat Mar 16 2024