Hi, I’m Dr. Scholz.  Let’s talk about prostate cancer.

In this video we’re going to cover Azure otherwise known as high-risk prostate cancer. I’m always concerned about that terminology “high-risk” and that was one of the reasons for selecting colors to describe these different stages.  High risk of what? High risk of dying? Actually, not. The risk of succumbing to prostate cancer if you’re an Azure is maybe anywhere between 3-15% over the next fifteen years (using older technologies of course, you can’t have fifteen year outcomes unless you go back fifteen years) and now we’re in an era of galloping technology, things are getting better every year.  So what might have been a 15% mortality rate 15 years ago may be much lower for someone today. But we are talking about a possibility of mortality, even though it might be delayed and even though it might be uncommon. Therefore, if you’re thinking about Azure, this is a stage where we say don’t fool around.  There’s a lot of slack and room for mistakes when you’re talking about Sky and Teal and you can come back, but doing Azure right the first time will pay rich dividends for you in your future.  

So as we go through and talk about Azure what we’re really concerned about is the possibility of metastatic disease.  This is what defines the dangers that we see in any kind of cancer including prostate cancer. So there’s two types of metastatic situations.  One is where you can detect them with a scan or some other methodology and unequivocal metastatic disease is present. This may be the case if the doctor says there’s some seminal vesicle invasion or an enlarged lymph node in your pelvis.  But there’s something before that called micro-metastasis where the disease is in those areas but the specks of cancer are too small to be detected, even with the human eye—a scan is not going to reveal them.

Experience has shown that we can predict whether or not microscopic metastatic disease is present by looking at the Gleason score, looking at how high the PSA is, and other factors, and this is the basis of dividing Azure into three subtypes: Low, Basic, and High.  I’m not going to go into the specifics on how you make those subdivisions.  (The PCRI will provide the information and it’s available on our website.) But each of these different subtypes Low, Basic, and High is like a different stage of prostate cancer.  The type of treatment will vary depending on which of these substages you fall into.  This is just an introductory short video about Azure, and I want to briefly comment on therapies, but when you get down to the bottom line, the choice of therapy is rather straightforward with Azure.  In fact, this is one stage in my opinion you can simply draw a line through surgery.  A large study was done at John Hopkins treating 9300 men with radical prostatectomy. These men had Azure, the average PSA was about 7.5, and they didn’t appear to have anything outside the prostate on digital rectal exam.  80% of those men relapsed over the next 15 years. The cure rates for surgery with Azure are very low.  Other approaches using radiation, seed implants, and hormone therapy will provide much better cure rates than surgery can.  These combination approaches using testosterone inactivating pharmaceuticals, seed implants, and IMRT (usually to the lymph nodes around the prostate) can provide cure rates close to 75, 80, 85% in Azure—dramatically better than what can be achieved with surgery.

We are going to be doing a series of videos on Azure going through these different types of treatment covering this in more detail and helping you to figure out which subtype you belong into.  But the take home message for Azure is first get the appropriate staging done, make sure there’s no obvious diseases outside the prostate, find your subtype, and when you start reflecting on treatment shy away from surgery and start looking towards combination therapy with seed implants, hormone therapy, and intensity modulated radiation.

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