PCRI’s Executive Director, Mark Scholz, MD, defines "High-Royal," the highest stage of prostate cancer, and gives an overview of the newest therapies available for treating it.
0:38 High-Royal is the most advanced stage of prostate cancer and is defined as a situation in which there are five or more metastases with at least one being outside of the pelvic region.
0:56 Treatment protocols for High-Royal are aggressive since the disease has advanced to the stage where it can be life-threatening. There are many pharmaceutical options, and ideally, you would want to use them all as early as possible, but in practice, the body can only tolerate so much at once. There is a preferred sequence to balance anti-cancer efficacy and quality of life, and this video follows the order. Close monitoring is essential because there are a number of factors that can change the protocol such as PSA response to treatments, changes in scans, etc.
4:02 Many men in High-Royal have developed a resistance to androgen deprivation medications (also called testosterone inactivating pharmaceuticals), but for those who haven't, the first agents to consider are Lupron along with a second-generation hormone treatment such as Xtandi or Zytiga.
5:16 If hormone treatments are insufficient, then men should consider immune therapy such as Provenge. With Provenge, immune cells are taken out of the body, activated in a lab, and then put back into the body. Immune therapy is unique in the prostate cancer world because it does not always cause a sharp PSA decline. This does not mean that it is not working. Studies have proven that Provenge increases longevity. Unlike other therapies which fight cancer directly, cause PSAs to drop, but then stop working once they are no longer being taken, immune therapy permanently changes the immune system to be more effective against prostate cancer.
6:31 The side effects of Provenge are mild, and so men can consider chemotherapy or Xofigo relatively soon after receiving immune therapy. Xofigo is an injectable form of radium that targets bone metastases, and since it has fewer side effects, it's generally preferable to use it before chemotherapy. After Xofigo, men should consider Taxotere or Jevtana chemotherapies. Taxotere is the preferred agent, and it is given with supportive medications to support the immune system such as Neulasta and Neupogen. Some studies have shown fewer side effects from Jevtana, so that is a good consideration for men who cannot tolerate Taxotere.
8:00 If all the aforementioned medicines have been used, and more is needed, then clinical trials are an option. Currently, there are trials across the United States using Lutetium-177, and the results have been promising.
8:40 Good fitness (or the best possible fitness) is imperative for tolerating the effects of these treatments (especially fatigue). A low-fat diet with minimal animal products is the best diet for inhibiting the progression of cancer.
9:17 Long term hormone treatment causing leeching of calcium from the bones called Osteoporosis. There is a medication called Xgeva which preventing this from occurring, but repeated use has caused issues with the teeth and jaws.
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
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