Selecting Treatment for Hormone-Sensitive Prostate Cancer
An in-depth look at the treatment decision process for hormone-sensitive prostate cancer and how a patient can prepare for therapy.
PUBLISHED May 10, 2019
Susan F. Slovin, M.D., Ph.D.: So Andy, we’ve talked about the diagnosis and of course with any patient who has newly diagnosed disease, there has to be a treatment plan. You obviously were not a surgical candidate because you had disease that was outside the prostate, lightly metastatic to the bones and/or lymph nodes. Did you consider yourself a partner in your own care when this whole scenario unfolded? Because people are telling you, you probably should do this. Another one is telling you to do that. And obviously you need a pathway to choose. And so some people feel somewhat, I would use the word cautiously, which is impotent.
Andy Rochester: I would think daunting.
Susan F. Slovin, M.D., Ph.D.: Daunting.
Andy Rochester: Daunting to the consumer patient.
Susan F. Slovin, M.D., Ph.D.: The question is, how do you proceed? Were you involved essentially or did somebody say, “Well this is what you have to do,” and that’s it.
Andy Rochester: No. The way that it was set up for us is that we were presented with appointments to three different specialty areas. So I was set up. We didn’t have confirmation in the METs, the metastasis, at the time. So I was set up with a surgeon just to discuss the surgical possibilities. I was set up with your office to visit with you.
Susan F. Slovin, M.D., Ph.D.: Right.
Andy Rochester: And then I was set up with radiology. And in the radiology discussion we talked about the confirmation of whether there was something, you know, let’s really be sure about the metastasis. And so it’s part of the surgical work-up, the PET [positron emission tomography] scans and the other scans came back, and absolutely. So at that point surgery dropped out of the equation. And then we followed your lead.
So the lead of working with you and looking at radiology, the approach that you explained about dealing with ADT [androgen deprivation therapy] made the most sense. And so we embarked on that. And as I remember, you started me on degarelix … to reduce the testosterone. And then moved me to the Lupron. But the thing is it was very much still this team approach, which is radiology being involved in the PET scans and working with you, and surgery is available if it’s necessary. The part that I took was basically trying to remake myself so that I could accept also the future treatments that were coming my way. Because I was, frankly, in terrible shape. And so that’s when I started embarking on exercise and diet, and try and turn my own body around because I knew that there was going to be a lot of work to do.
Susan F. Slovin, M.D., Ph.D.: So essentially you were really more than a partner in your own care, you were actually a leader in your own care. Because as physicians we all can tell patients what to do, but not everybody necessarily wants to engage. And I think one of the main issues for our audience to understand is that many years ago if you had metastatic disease to bone or lymph node at the time of diagnosis, you were pretty much on hormonal therapy for the rest of your lives. And the novelty now is that we have three approaches for people with metastatic disease.
One that is straight up hormonal manipulation, which is standard for many a person. We could give a combination of a drug, abiraterone, and prednisone, along with androgen deprivation therapy, which is also a standard of care based on a number of New England Journal of Medicine trials. And then thirdly we could give chemotherapy, and we talked about the role of docetaxel along with androgen deprivation therapy, but one has to keep in mind chemotherapy is not for everyone. You didn’t have a particularly high tumor burden, which is why we elected to go with the Zytiga, prednisone and the androgen deprivation therapy.