PSA Relapse after Surgery or Radiation | Prostate Cancer Staging Guide

Описание: PCRI’s Executive Director, Mark Scholz, MD, discusses new imaging scans and treatment options for men with relapsed prostate cancer with suspected microscopic spread into the pelvic lymph nodes.

0:33 This video is for the Basic-Indigo stage of prostate cancer which describes a situation in which there is a relapse with suspected microscopic spread of disease into the pelvic lymph nodes. Low-Indigo, meanwhile, is a relapse that is confined to the prostate or prostate fossa, but our videos on Low-Indigo will be useful for men with Basic-Indigo for treating that part of the relapse. This video is devoted more to treating the microscopic disease which is suspected to be in the pelvic region.

1:58 In the past, treatments for the pelvic lymph nodes were insufficient. Surgeons would try to remove pelvic lymph nodes, but there are hundreds of pelvic lymph nodes and surgeons could only remove a handful. The technology to administer radiation was also bad, and so men would have their entire pelvic region irradiated in order to get all of the pelvic lymph nodes, but then they had to deal with the side effects of the radiation hitting the bladder, rectum, and intestines. Now, however, IMRT has made it so that radiation oncologists can target just the pelvic lymph nodes, and studies show that it is relatively safe.

3:12 When irradiating the pelvic lymph nodes, smaller doses of radiation are used to protect the organs, and so studies have shown that a 6-12 month course of hormone therapy improves cure rates. This is the best protocol for achieving a cure, although it is not guaranteed.

4:08 If for some reason a man cannot have radiation or he does not want it, then intermittent hormone therapy alone is an option for suppressing the disease. Studies show that it can slow the disease by an average of 10 years, but the downside is that this will never be able to achieve a cure.

5:08 PSMA/PET scans are significantly better than any kind of scan we have had before. They can even detect metastases in people with a PSA of less than 1. It is not yet FDA-approved, but it should be in the next couple of years. Until then, the scans are available in other countries or as part of clinical trials at universities like UCLA. It may incur a significant out-of-pocket expense until it is FDA approved, but it might be worth it so that a radiation oncologist can know exactly where to target radiation.

6:04 It is becoming standard to give a short course of Taxotere, a form of chemotherapy, to men with High-Indigo in an effort to prove cure rates. A couple of small trials have been conducted and their conclusions suggest that the same treatment might help improve cure rates for men in Basic-Indigo; however, this is not mainstream protocol.

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