How Does Prostate Cancer Spread to the Bones? | Spot & Injectable Radiation | Mark Scholz MD

Medical oncologist Mark Scholz, MD, goes into more depth about the newest scans and treatments available for men with advanced prostate cancer. He describes the various contexts in which any one of these treatments would or would not be included in a patient's treatment plan, and some of the factors involved in fine-tuning each patient's upfront treatment to maximize the odds of achieving a long, durable remission. Phase III clinical trials are demonstrating that these types of patients are benefiting from more precise and aggressive treatment upfront, which reduces the risk of future relapse, the need for further intervention--which may include indefinite hormone therapy--and potentially even prostate cancer-related mortality.

0:07 Can you explain the process by which prostate cancer spreads?

1:43 Which body scans should men be getting if they are high-risk?

2:07 If a man does not have access to PSMA PET scans, which scans should they be doing?

2:43 How does the treatment protocol differ if someone has oligometastatic disease (only a few metastatic lesions) versus someone with extensive metastatic disease?

3:49 Does spot radiation to bone metastases cause any pain for the patient?

5:30 If spot radiation weakens the bone to which it was directed, then how do you think about patients with osteoporosis, for example, who may already have weakened bones, but need spot radiation for prostate cancer control?

8:00 How often, or in which cases, do you consider the addition of chemotherapy in patients with oligometastatic disease?

9:24 Do treatments like Xofigo (injectible radiation) or Provenge (immune therapy) have any effect on metastatic lesions?

10:28 Which metastatic patients are the best candidates for Xofigo considering the possibility of spot radiation. Is there a maximum or minimum number of metastases that you use to determine in whom Xofigo would be most effective?

11:06 Is IMRT (lower doses over a longer period of time) or SBRT (higher doses over shorter time frame) better for treating bone metastases?

11:36 What are the side effects for patients who are going through aggressive combination therapy?

12:26 What is lutetium-177 and how does it work?

13:34 How many 6-week rounds of lutetium-177 would a patient receive?

13:53 Do you expect a PSA decline after lutetium-177 if it is working?

14:12 How effective is lutetium-177 for disease control?

14:29 How does lutetium-177 compare to Xofigo?

15:52 How many patients have you personally known to be treated with lutetium-177 and how successful has it been?

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