Treating Advanced #ProstateCancer with a High PSA | #MarkScholzMD #AlexScholz #PCRI

0:22 Can patients with extremely high PSA's still achieve remission?
3:34 Do extremely high PSA's always correlate with aggressive disease?
4:52 What is monitoring like for a patient following intensive treatment for high PSA cancer?
6:55 Is triple therapy required for a patient with a PSA of over 1,000?
7:29 How rare is it for a patient with a PSA over 1,000 to achieve remission?
8:23 What are the options for those patients who don't achieve remission?
10:42 Is extremely high PSA cancer inherently more urgent?
12:16 What options are there if Pluvicto fails to control the growth of the disease?
13:12 Is Xofigo often used in combination on oligometastatic patients?
14:03 Can immune treatments like Provenge be used in combination therapy?
15:38 How effective are PARP inhibitors?
16:31 Alex's conclusions
17:57 If you need more help

Who we are:

[brandywvstrong]

Stay strong everyone. Keep fighting and keep informed and updated
🙏🏻💙🙏🏻

[aidanmiller]

Alex you are a beautiful girl. Thank you so much for hosting these videos. You and Dr. Scholz are fantastic. I have been diagnosed with 3+4 prostate cancer 3 years ago but have not had treatment so far. My original urologist wanted to schedule surgery immediately but since watching your videos I have waited. My PSA is rising gradually up to 11 from 6 four years ago. The MRIs show slow progression for the last 3 years. I am under the care of UofM Ann Arbor Oncology. They seem very willing to work with me on what I would like to do. Based on your videos I am leaning toward radiation if it comes to that. Please continue your videos. Thank you.

[paulsmith]

I am 70 yrs old and was diagnosed Stage 4 in July 2019 with PSA of 5375. Went on ADT Lupron along with Zolomax for bone mets for 2 years. PSA dropped to 4. Couldn't continue treatment due to COVID pandemic etc. Went back into hospital in July 2023 with PSA of 1530, blocked ureters and tumor that was the size of a grapefruit. Put back on Lupron which dropped PSA down to 235 - then it started going up again so the Dr added Abiraterone which slowed PSA rise. I am going to start Taxotere in a couple weeks. My Dr is going to do genetic testing on the tissue from the 2019 biopsy to see what other treatments could be available in case the chemo doesn't succeed. It's been a long almost 5 year battle - but I am positive, I am still pain free and have been working 40-50 hours a week ( even with a urinary catheter). I appreciate all the tips on how to minimize the side effects of chemo. I will do the fasting suggestion and see how that helps - I will let you know. If you know of any additional actions that I can be taking on the natural/holistic side of the fence to augment my treatment I would appreciate it!

[barbaraabbott]

Sadly, my son has been treated with every treatment available in PC metastatic disease without remission. He is currently at MD Anderson starting a phase 2 clinical trial. He has been fighting aggressively since day one of diagnosis…with the best care at Sloan Kettering, Detroit Michigan when PSMA was brand new, Mayo Clinic, Cleveland clinic, and now MD ANDERSON in Texas. Nothing had brought remission. Some cases are not able to end up on the list of cured, remission, ect. He’s looking at his last hope.

[Mark_Lacey]

Nov '23 my initial PSA was 3, 500 and heavily metastasized in my upper skeleton. Started 1st & 2nd generation ADT straight away. Feb '24 I had a bilateral orchiectomy. and stopped the Firmagon. March '24 PSA had dropped to 0.7 I asked the Med Onc about triple therapy but he said he wants to keep further treatment in reserve. I get the feeling I'm on the treatment treadmill, simply following a palliative treatment process in stages instead of being aggressive with treatment. His view is I'm incurable. I'm getting a second opinion.

[sgtbosshog]

Thank you helpful information my psa was 247 now after 6 months chemo and hormone therapy number at 1.0 still have more work to do stay positive and everything will work don't stop bless

[dcplunkett]

I had a five-digit PSA when initially diagnosed. That was almost five years ago. Lupron and six cycles of docetaxel brought my PSA down to single digits. When it doubled from nadir, I was started on abiraterone and had six cycles of cabazitaxel. Last chemo infusion was three years ago. I'm still on quarterly Lupron and daily abiraterone. PSA has been at or near 0.01 for two years now. I don't claim to be in remission, because quarterly CT scans and bone scans still show a lot of lymph node mets and bone mets, but they are not growing or spreading. The side effects are no fun, but the medications are doing what I need them to do.

Some day the cancer will start to grow again. That might (or might not) be accompanied by an increase in PSA. It is encouraging to know that the variety of treatment option that will be available to me when that happens continues to grow.

[barrie]

tks the effort to discuss this important topic

[mikeoniones]

Thanks for hope Dr. I'm On docetaxel 2nd time. ADT washed out-So did Radiation..

[marvinsmith]

I was diagnosed with intraductal carcinoma contained with in the prostate. Gleason score of 3+4, PSA was around 12 when i got the news. After 28 sessions of radiation therapy PSA is now 4.25. Everything I've read about this type of cancer refers to an unfavorable outcome. The cancer becomes therapy resistant. I can't really get a straight answer from my oncologist to my question. Am I one of the unfortunate ones Dr Scholz sometimes mentions?

[TERRY-cbku]

I have a cousin who's PSA levels range at around ten. He says that's normal for him as he gets tested at regular intervals. He's had a biopsy that was negative for cancer. I'm of the opinion that he might have something else going on such as inflammation or Chronic UTIs causing his PSA levels to stay high.

[carmenvilleneuve]

Great information
I was diagnosed in March 2023 with advanced prostate cancer mets to bones and Liver .
PSA at time of diagnosis was 204
I was referred to an Oncologist and Urologist they quickly had me in the Chemo Lazy Boy
and started hormone therapy.
I was surprised how quickly they got me to 0.1 .
12 months later my psa is at 0.3
My Oncologist will monitor my situation again on May 24 and go from there .
My last psa test was near the end of my Zoladex next injection
I'm not sure if that is the reason for the slight increase .
Thank you for the information Dr Scholz and Alex .
More tools and options 🙂

[xtob]

Thank you so much for this video. I had an initial PSA above 1, 600 with over 25 bone mets at age 51. My team put me on 1st and 2nd gen ADT but NOT chemo. Question, does it make sense for me to start chemo 3 years after my diagnosis? I know every situation is different, but all things being equal, is it too late to start me on triplet therapy?

[JSmith-pi]

Any comment about FAPI pet scans for PSMA negative cancer such as sensitivity compared to PSMA and when they might be available?

[rytenny]

Is Intermittent Hormone therapy an option for cases with Advanced Prostate Cancer but has become undetectable within 6 months? If so what is the general length of time they stay on hormone therapy? Dr. Scholz mentioned his patient was on hormone therapy for 18 months then taken off and in other cases I have heard people going on "vacation" at 9-12 months? Thanks for the great information!

[JasonRoberts]

For all of those with extremely high PSA’s ~ How did your PSA’s get that high & How old were you when you found out your high PSA level.

[zenman]

Ive heard that chemo wipes out the major tumours but does not kill off the cancer stem cells which go on spreading and the cancer 'comes back', .. after a few years with a vengeance and that the immune system has been weakened or destroyed by the chemo and not able to mount a defence. I this true with the treatments for PC that you're talking about in this video? so are these patients you are talking about in real remission or are they likely to encounter the scenario just mentioned?

[jabster]

He doesn't say how bad the side effects are that make you deathly ill.

[shannonrogers]

My husband had high PSA and advanced disease at diagnosis 1 year ago. We asked about chemo upfront and oncologist said no need, so he only did hormone therapy. He is now castrate resistant and starting chemo. Oncologist dropped him when disease worsened. We are in a new system with new doctor, and don't like it. Trying to find a good oncologist that will be aggressive and fight this thing. Every doctor weve talked with seems so hopeless. The wait to get into the Mayo Clinic is also very frustrating. It takes months.

[orangeguy]

I hear there's a test call PSE. That's more accurate than the standard PSA. Why isn't everyone going to get the PSE test?.