Video: Is Chemotherapy the Last Resort? | Ask a Prostate Expert, Mark Scholz, MD
Ask a Prostate Expert | Transcription
Alex: So, Dr. Scholz. In the grand scheme of prostate cancer treatments, is chemotherapy the last resort?
Dr. Scholz: So, chemotherapy we're talking with prostate, Taxotere, Jevtana, occasionally something called Carboplatin. These medicines are very effective and they have been pushed down the line due to the advent of new perhaps you could describe better treatments—oral medicines, powerful second-generation hormone treatments, injectable radiation treatments like Xofigo, and the fact that chemotherapy has to be given by an intravenous infusion every three weeks… It can cause some hair loss, cause some fatigue, and so—and it requires doctor's visits, so when you can just prescribe a pill, the chemotherapy tends to be postponed and I suppose that's reasonable. It doesn't mean that the chemotherapy is any less effective; it's still very effective and we're very grateful that we have that there is a backup.
There is one exception and that is in men who are newly diagnosed with what we call high-risk prostate cancer, and these men may have a little neglectful when they were diagnosed and perhaps the PSA is 20 or 30 or 40, and they have a high Gleason score—maybe there's even some spread to the lymph nodes or the seminal vesicles—and hormone therapy alone, hormone therapy plus radiation alone will cure a good number of them, but there are some studies now showing that if you add 4-6 cycles of chemotherapy to that regimen that the cure rates the survival will be better. And so, chemotherapy is also used at the get-go in the early stages of prostate cancer in men that have more high-risk prostate cancer.
Alex: When you are in your practice on a daily basis, are you giving men early Taxotere or Jevtana in these high-risk cases?
Dr. Scholz: Yes, we do, and it something that comes up for discussion. Now, if someone's 75 or 80 years old and we know that they're going to respond well to second-generation hormonal agents and radiation, we may forgo it, but in the younger men that we're concerned about their long-term survival we will definitely discuss the use of early Taxotere or early Jevtana.