Alex sits down the PCRI's executive director, Mark Scholz, MD, to discuss commonly asked questions from the PCRI Helpline on the topics of Casodex (bicalutamide), SpaceOAR, and questions related to pathology (e.g. biopsies, Gleason score). You can ask your own questions by calling the PCRI Helpline at 310-743-2116 or by emailing us at help@pcri.org. 1:01 Why is Casodex added to everything?
Originally Casodex was added to Lupron (or another hormonal agent) to counteract the testosterone flare that occurs in the first month of hormonal treatment. Additionally, studies showed a slight survival advantage—without significant additional side effects—in men who continued to use the Casodex and the Lupron together for the entire duration of the treatment. However, Casodex's high cost made it impractical to use for longer than the first month to suppress the Lupron flare. Recently, though, it has become much more affordable, and so it's prudent to take advantage of the survival benefit by continuing to use Casodex for the entire duration of the hormonal therapy.
3:01 Is Casodex Chemotherapy?
While Casodex is often designated at a chemotherapy for billing reasons, it is in a totally different class of medications than chemotherapies like Taxotere and Jevtana.
3:50 What are the side effects of Casodex?
The side effects of Casodex are similar to Lupron, except usually milder; when added to Lupron, some men will experience increased fatigue. In a small number of patients, Casodex can cause liver irritation, and so it is recommended that patients speak with their physician about checking their liver function with a hepatic panel about 4-6 weeks after starting Casodex. When used alone, Casodex can cause breast tenderness and enlargement. This can be counteracted by radiation to the nipples prior to treatment, the use of an aromatase inhibitor, or both.
6:18 What is SpaceOAR?
SpaceOAR is an injectible gel (administered through the perineum) that separates the prostate from the rectal wall to prevent radiation proctitis. Although increasingly rare as technology and practices improve, radiation proctitis can be disastrous if it occurs, and so the use of SpaceOAR is a wise choice. The gel will remain in place for the length of the radiation treatments, and will eventually be naturally removed from the body.
10:16 Which doctors provide SpaceOAR? How do I find one?
You can find doctors that use SpaceOAR on the SpaceOAR website, or you can ask your radiation oncologist if they are familiar with the technology. If they are not, then that may be a good indication that this physician is not up to speed with the latest developments in the field.
11:37 How do I interpret my biopsy report?
Biopsy reports are given for 12-core random biopsies. Each core ought to be labeled with the location within the prostate from which it was taken. This is not universal, unfortunately, but it is good practice. Physicians are looking for the number of cores that contain cancer cells. If a core has cancer cells, then the biopsy report will say what percentage of the core involved cancer cells. The Gleason score is the final significant component of the biopsy report. Essentially, your doctor wants to know "How big is the tumor?" and "What grade is the tumor?"
15:03 How accurate are biopsy reports? Should I get a second opinion?
There is oftentimes disagreement among pathologists as to the exact grade of a given sample. It's a good idea, then, to get a second opinion on a pathology report. There are many good options. Jonathan Epstein of John Hopkins, for example, has a good reputation and a convenient system for sending in reports for a second opinion.
16:53 What can I do with my Gleason score?
Gleason score, among other factors, determines the best treatment (or non-treatment) for a man to balance achieving a cure (if necessary) and avoiding the side effects of overtreatment.
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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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