Understanding Treatment for High-Risk Prostate Cancer | Prostate Cancer Staging Guide

Hi, I’m Dr. Scholz, let’s talk about prostate
cancer. In today’s video we are going to cover the
Azure stage of prostate cancer. We always talk about stages of prostate cancer
because the whole topic of prostate canceris so vast that you gotta break it down into
categories. The Azure category is actuallya relatively small segment of prostate cancer
which varies from harmless to people thathave cancer that has spread or metastasized.
Azure means someone that is newly diagnosed,but it appears that the disease is localized
at least into the area of the pelvic region. However, Azure men have certain factors that
suggest a higher-risk type of prostate cancer. As you no doubt know, some types of prostate
cancer are harmless; others are minimallydangerous. Azure needs real treatment and
the best chance to cure it is on your firsteffort. Now that doesn’t mean that with
prostate cancer you don’t have second chancesand third chances, which is one of the unique
aspects of prostate cancer. Many other typesof cancer you have one chance to cure it.
Even so, it’s best to try and cure prostatecancer with the first effort. Your quality
of life is better. Who wants to go throughanother treatment down the line and who wants
to experience anxiety that’s associatedwith the possibility of a cancer being out
of control?When we’re talking about Azure we divide
it into Low, Basic, and High. Low-Azure isbasically small amounts of grade 8 that can
be treated in many ways very similar to High-Teal. And I’ll let you look up the video on that
for further information about how to treatLow-Azure. Basic and High-Azure are more consequential
types of prostate cancer. The real issue isthe possibility of spread outside the prostate
and Basic-Azure or High-Azure have at leastsome risk of spread outside the prostate–possibly
into the lymph nodes and the surrounding area. It is possible to calculate the risk of microscopic
spread outside the prostate with somethingcalled the Yale Formula. Y-A-L-E Formula.
You can Google that and put your numbers into that formula,
and it will tell you the percentage likelihoodthat there’s cancer spread outside the gland.
This is an incredibly consequential fact becauseyou can do things about the possibility of
spread. You can give radiation to the lymphnodes, you can take hormone therapy, you can
take augmented hormone therapy , you can even take chemotherapy
(although that’s usually reserved for menwho have scans that show unequivocal spread
into the lymph nodes, not just people whohave a possibility of microscopic spread). Basic-Azure, High-Azure — how do you make
that distinction? Anyone that has a Gleason9 or 10 grade, a PSA above 40, or has a scan
showing spread into the seminal vesicles orinto the pelvic lymph nodes has High-Azure.
Other men in the Azure category (and you knowhow to find out of you’re in the Azure category,
you have to take the PCRI staging quiz) othermen in the Azure category if they’re not
High-Azure are Basic. So how do you treatthose differently? Well, Basic-Azure typically
is managed with a seed implant, intensitymodulated radiation , and 18 months
of hormone therapy. Whether or not the radiation–theIMRT radiation–is directed to the lymph nodes
is based on the results of the Yale Formulawe talked about previously. If the chance
of spread according to the Yale Formula isover 15% you should probably treat the pelvic
lymph nodes. How do we treat High-Azure? Wegive all the same treatments that we give
to Basic-Azure except we consider adding Zytigaor Xtandi for the 18 month period, or if a
person has unequivocal lymph node enlargementon a scan, then even the possibility of four
to six cycles of a type of chemotherapy calledTaxotere. So in summary, Azure is a more consequential
type of prostate cancer. We always like toemphasize that most men with Azure are curable,
and of course curable means getting optimaltherapy. There are many centers that are still
recommending surgery for Azure, and I don’tthink that’s a good idea. The cure rates
are much lower and the side effects tend tobe even higher with surgery compared to the
other options that we have already covered.

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