Advanced #ProstateCancer Treatments | Eugene Kwon, MD | DIY Combat Manual | Part 5 #PCRI

0:12 Building Blocks for Treatment Plan
0:42 Who is the lecture for?
0:51 Advanced Cancer outside the Prostate
1:03 What is the problem?
1:27 Oversimplification?
1:49 Too many diagnostic options?
1:59 Multiplicity of practice and business models?
2:24 Misunderstood terms and concepts?
2:40 Outdated perceptions?
3:04 Too much information
3:30 Goals of this presentation
4:02 The Basics of Advanced Prostate Cancer
6:13 "Updated" Biology of Advanced Prostate Cancer
6:38 "Clonal" theory of Cancer
6:45 The Heterogeneity of Prostate Cancer Cells
10:20 Systemic treatments as of 2023
10:48 What is a systemic therapy?
11:28 Suppressive therapies
13:05 Cytotoxic therapies
14:12 Mechanism of Action (MOA)
14:52 Testosterone promotes prostate cancer growth
16:01 GnRH Hormone Therapy
16:27 Anti-Androgen Hormone Therapy
16:58 Hormone (Castrate) Resistant Prostate Cancer
17:28 ARPI Hormone Therapy
18:55 Chemotherapy
19:55 Immunotherapy
20:37 Radioligand Therapy
21:40 What's the best way to create a treatment plan?
25:03 Abbreviations pertaining to forms of therapy
25:46 Case study: Newly diagnosed Advanced Prostate Cancer
27:39 Triple therapy
28:51 What if you didn't start with Triple Therapy?
29:48 Case 1: Failing HT?
32:51 Chemotherapy first
34:12 Case 2: Failing HT + ARPI?
38:50 Less differentiated = more aggressive cancer = LESS PSA & PSMA
39:36 PSA Zero
40:24 Case 3: Failing HT + prior CHtx?
42:19 Case 4: Failing HT + ARPI + prior CHtx?
45:35 Proper "care and feeding" of your treatment plan
46:00 Regular and comprehensive follow up is key
47:13 Prior genetic testing
49:36 Updating genetic testing
50:43 Mutations relevant to PARPi
52:13 Mutations relevant to immunotherapy
54:07 Mutations relevant to PARPi or immunotherapy
57:05 Regular and comprehensive follow summary
57:24 Direct treatments as of 2023
58:15 DIY Combat Manual for Beating Prostate Cancer Videos
59:02 Multiple ways that residual disease can be eliminated
59:21 Chest surgery example
59:47 Radiation therapy example
1:01:25 Minimal invasive procedures
1:02:33 Misunderstood concepts
1:03:18 Stand-of-Care
1:05:11 Guidlines
1:05:58 Clinical trials
1:09:43 Oversimplified view of disease
1:10:08 List to bring to with you to physician meetings
1:10:48 Dr. Kwon's Team

Who we are:

[ThePCRI]

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[elawton]

I have prostate cancer Gleason 3+3=6, I'm 62 and have been watching this channel for a week or so. My father, died this year, age 93. He had his prostate removed in the 1980's (age~ 58) surgically from the rear (at that time this was state of the art and promised less side effects). Then a few months later, he had radiation for three or four months. The cancer returned and his PSA was over twenty in around ten years. He was put on hormone therapy every time his psa would go up very quickly to the upper teens or over twenty. Anyway, his prostate cancer was in his bones ect.. The last three year of his life he began taking some sort of chemo tablets, two per day. This was a last resort by an oncologist and he lived a few more years and was fairly happy despite having to run to the mens room often. Let's hope we can all live to our nineties cancer be darned.

[marvwittrock]

Dr Kwon's presentation was very informative and easy to understand. I first got prostate cancer in 2011 and have had 3 reocurrences since. Starting with my 2nd go-round, I have worked with Dr. Kwon and his staff at Mayo Clinic. Care has been excellent. Last visit, all scans were clear! There are 7 boys in my family and 5 of us have had prostate cancer. Mine is connected by the VA with Agent Orange, while serving in Viet Nam. Dr Kwon, has been very professional and yet personal in his meetings with me. I believe he is the expert in this field and I attribute my good health to his advance knowledge in the area of prostate cancer. Because of his continued research and looking for possibilities, I'm sure he has helped many patients with prostate cancer. He truly has helped me.
Thank you, Dr. Kwon. Please continue the good work!

[hertub]

I found the presentation on the topic of prostate cancer to be the most amazing and comprehensive one I've seen to date. I would like to express gratitude to Dr. Kwon and the PCRI (Prostate Cancer Research Institute) for the presentation and for sharing. I am 66-year-old individual with prostate cancer, specifically a Gleason Score (GS) of 9, and have undergone a prostate operation (2017), hormone therapy, and salvage radiotherapy (2021). My PSA (Prostate-Specific Antigen) has risen to 0.12 ng/mL. I am in a stage of contemplating their next steps in treatment and found the information session to be educational and helpful in providing guidance for their future treatment plan.

[rambv]

There can be no better lucid and indepth explanation all about prostate cancer and it's ramifications. I am an advance prostste cancer with metastatis..but the way this dr is pressenting so passionately and qualitatively, at 72 I wish I was a dr like this dr ..I have forgotten about my cancer after listening this dr .great..i am from India

[davidvasko]

I'm 60 and had a radical robot prostatectomy 7 months ago. I just had a PSA .10 and I am now on Androgen and started 48 radiation treatments as we think the cancer is in my Lymphatic near operation site nothing showed on bone scan or other scans, but we believe this treatment plan should be done anyway as one of my nodes that was removed had cancer. I only had 5 radiation treatments so fare and only had talked to doctor about my treatment plans for only 5 minutes, so I know very little about my condition and treatments at this time. Thank you for helping me get up to speed. I'm so hungry for info that I hit up all sites to learn all I can, and this site was the most informative by far.

[williamsnover]

Dr. Kwon and his team and associates are national treasures. I remember sitting on a chair for my first visit and the APRN introduced herself and asked me if I wasted to pursue containment or cure. I was speechless. Cure was not on the radar. Cure is not guaranteed. An associate said I had a 14 percent chance of not being cured. Meeting Dr Kwon was one of the most awesome moments of my life. I have trouble believing he is human and not angelic. Humility, compassion, empathy and caring do not always accompany genius. May God and the real angels protect and bless Dr. Kwon as he is a National treasure and his team sent by God to battle for our lives. Hopefully his understanding of Prostate cancer will spread across the world. God bless the Kwon Team. Thank you.

[tomswoverland]

Dr Kwon has been my Doctor for over 3 years the guy knows what he’s doing so listen to him. I started with stage 4 and a PSA of 93 and a Gleason 8. My first doctor started me with 44 radiation treatments. After that luckily my wife got me into Dr Kwon. I have had several different treatments that helped but always came back.I have done 5 of 6 treatments called Lutitium 177. So far my PSA is undetectable nothing new and nothing showing. I am hoping for a remission to last for longer 6 months. I’m very fortunate to have Dr Kwon and once he gets ahold of you he doesn’t let go. Thanks for all he has done.

[timelesswisdom]

This is the best summary I have ever seen -- excellent information, clearly organised and presented!

[tboyleninetynine]

As usual, Dr, Kwon is articulate and to the point. Best presenter out there!

[DaveHansen-gz]

Probably the most concise and informative video I have seen since I was diagnosed with prostate cancer in 2018. wish I saw back then.
Thanks to you Dr. Kwon and your entire staff.

[gw]

Absolutely brilliant presentation. UK based here, starting PSA over 1300. Enzalutamide working so far. Long conversation with my oncologist needed now.

[ga]

Thank you so much for this clear and informative video!  
My husband is a Mayo Clinic/Rochester patient- diagnosed with low volume mets, Gleason 9, 2 1/2 years ago. Initially treated with 26 rounds of radiation and has been on ADT (Lupron/Abiraterone) since then. PSA remains at <.02. His oncologist did not recommend chemo, as the PEACE study hadn't shown any survival benefit (as of yet) for oligometastatic disease. Chemo will be considered if and when his PSA starts rising and a new scan shows evidence of spread. Listening to Dr. Kwon, it sounds like he recommends chemo, along with ADT therapy, right out of the gate with advanced disease, regardless of whether or not it's low or high volume metastasis.

[garymitchell]

Excellent overview of treatments and options - thankyou!!

[urielgottesman]

I was diagnosed with prostate cancer in 1993. PSA was 300 with every bone in my body having cancer. Given 6 months to live. Oncologists told me Thai is unlikely I will walk in 3 months. My urologist decided to try Lupron to see it would help. Also added casidex.
Within one year my PSA dropped to zero.
Stayed that way for 28 years testosterone was less than 3.for the last 2 years, psa started creeping up. Reaching 3.3 this year. Started Nubeqa earlier this year. PSA dropped to 0.2.
Getting weaker each year. Can’t open soda bottle. I will be 84 next year. Made decisio last week to stop all treatments. Will test again in 3 months to see results.
What do you think of my decision?

[Mark_Lacey]

A big thank you for all the information in this video. 58 yrs old, diagnosed last week with skeletal metastasized prostate cancer PSA 2, 000, Gleason score of 9. Started Firmagon yesterday, meeting the oncologists tomorrow to discuss starting radiation treatment within the next three weeks. I now have a lot more confidence in the diagnostic process (PSA, prostate biopsy and bone density scan completed) and will take the lists with me tomorrow. Thanks again.

[Reggie-me]

Great video that covers all the important points of advanced prostate cancer treatment in plain English. If you want a detailed overview and you are new to this disease, start with this video.

Dr. Kwon's approach to curing advanced prostate cancer rather than using a palliative approach gives hope to afflicted patients.

Thank you, Dr. Kwon!

[carladerenzy]

Extremely interesting presentation.

I was diagnosed in March with 525 PSA. Metastatic. Prostate cancer in 5-6 areas (back, ribs, pelvis). Started Orgovyx right away and NUBEQA. Soon after, Lutetium. So far I've had 4 of 6 infusions.

PSA down to 2.3 so far and next read-out should be around 1.1. No increase in lesions and decrease in cancer presence.

I have been told that there is no "cure" for what I have, so it's encouraging to hear a different perspective here. My own fight has involved shifting to a plant-based diet (not a big shift), daily resistance exercise, white, green and black tea drinking, and a lot of quick walking/fast running in spurts (morning and evening).

For me, hot flashes are minimized significantly by exercise and some supplement additions (D3, B1, Calcium, Magnesium Glycinate, 5-HTP and Melatonin). The drugs (Orgovyx mostly) definitely increase my anxiety (something I had little of before), but, as I just mentioned, all side effects are reduced or neutralized by vigorous exercise in particular.

I've gained no weight, have gained muscle mass, and focus on this form of exercise as loss of bone and muscle mass is common.

My "fantasy, " which is to ultimately take ADT's in intervals, or go off them altogether, seems a little closer after this discussion.

Appreciate this presentation very much.

[georgefitzhugh]

Dr. Kwon, this presentation was excellent and extremely informative. I will be meeting with my doctor shortly and plan to discuss some of your points presented here. Thank you again.

[andrewsimmons]

Fascinating presentation. I am not like a lot of others here because I am just starting and scared out of my shoes. I don't want to make an error. Local Urologist in Greenville SC. I want to do what is best but have no idea where to start. Travel to someplace like Mayo?WU here? of 6 segmennts Gl score of 6 in 5 and 7 in one. However my PSA is>30 which started this.Dr Kwon is the first person who has given me any hope at all. PET Scan scheduled locally.