Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: September 04, 2015
Dr. Mark Scholz is medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA a medical oncology practice exclusively focused on prostate cancer. He is also past President and co-founder of Prostate Cancer Research Institute (PCRI), an organization dedicated to improving the quality of prostate cancer patients’ lives by supporting research and disseminating information that educates and empowers patients, families and the medical community.
Can you tell our audience about the progression of your career?
I did my training at USC. I was the only oncologist for a large HMO in Orange County for a couple years. But HMO work just didn’t seem like what I wanted to do. I joined Robert Leibowitz in private practice for four years. Dr. Leibowitz was seeing more prostate cancer patients than most medical oncologists.
After four years, Dr. Leibowitz took a sabbatical and I joined Dr. Stephen Strum. We worked together for about 5 years. Dr. Strum’s practice was about 50% prostate cancer when I joined him.
After working together for a year we decided together to only specialize in prostate cancer. That was a good choice for us. After he retired, I worked alone for about a year, but was so busy that Dr. Richard Lam, who trained at UCLA, joined me and we’ve both been treating only prostate cancer for over ten years.
In late 2012, Dr. Jeffrey Turner, who had also previously worked with Dr. Robert Leibowitz, joined us full time.
You presented a paper at ASCO earlier year on using Xtandi in men with prostate cancer resistant to Zytiga and and Taxotere. Can you explain your results and what they mean for patients.
As medical oncologists, we’re always trying to find the most effective and least toxic medicine. It’s a very natural thing to try Xtandi, also known as Enzalutamide, if the other popular products—i.e. Zytiga and Taxotere—aren’t working. We treated about 66 or 67 patients who had become resistant to Taxotere and to Zytiga. We saw that about 1/3 of the men responded. About 1/3 of the men remained stable. And 1/3 of the men had progressive disease. We found that Xtandi was very well tolerated. We did have two patients who had to stop treatment because of excess fatigue, but overall it was very well tolerated.
You co-authored a book about prostate cancer entitled Invasion Of The Prostate-Snatchers. Can you tell our audience about the book?
Invasion of the Prostate-Snatchers is focused on the newly diagnosed. My co-author came up with a catchy title, but a less creative title could have been Anything But Surgery. The book talks about all the alternatives to surgery: active surveillance; hormone treatments; radiation; seed implants; cryotherapy; and focal treatment. It makes a clear message that almost any other option has fewer side effects and better cure rates than surgery. But the popularity of surgery is not likely to change in the near future because right now mainly urologists are treating prostate cancer. I felt compelled to write the book because people generally do not get an opportunity to hear a medical oncologist’s viewpoint.
You’re also the head of PCRI, one of the leading prostate cancer non-profits dedicating to educating patients. What can you tell our audience about the organization?
PCRI was designed to try to fill a knowledge gap. Before the advent of the internet, the only way men could get information about prostate cancer was from their doctor who was a urologist. Since the advent of the Internet and the explosion of knowledge, our problem is not these days insufficient knowledge, but too much knowledge. There is a flood of information and no one knows what to do with it all. PCRI’s role now is to help people manage and sort the information that is accurate and reliable so they can apply the information that is pertinent to their case. To that end, we’ve developed the Shades of Blue program, which divides men up into five different types of prostate cancer. Of course, we have our annual conferences and a free newsletter, which is available to anyone who wants it. We also have a Helpline, so people can call up and talk to experienced lay people who know a lot about prostate cancer.
PCRI is still designed to help empower people with the best knowledge, but the focus has changed over the years from getting the word out to helping people understand which knowledge is pertinent to their case.
I believe PCRI is working on a new program for patients interested in clinical trials. Can you talk a little about that?
Finding the right clinical trial is a huge challenge. Trials open and close quickly. Some trials are patient-friendly while others are not. It takes a very experienced doctor to know when a clinical trial is likely to be beneficial, but it’s very hard to keep up in such a rapidly changing landscape. This new program that PCRI is developing probably won’t go live for another six to twelve months.
Do you have any advice for newly diagnosed men? Or men facing recurrent disease?
For the newly diagnosed, it’s all about getting information that is not slanted towards one thing or another. Oftentimes, some of the best information comes through support groups because you can talk to other people who don’t really have a dog in the race. They don’t have a conflict of interest. They’re just telling you what they really believe. I think the support groups can be incredibly helpful to the newly diagnosed. Support groups also calm people down so they take enough time to make sure they really understand what’s going on before they make an important decision.
In terms of the relapsed patients, newer scanning techniques mean we’re often better able to find where the cancer is located. In the past, with a rising PSA we were just blind. Typically, we were forced to rely simply on hormones. Now, when we can find areas of recurrent disease, men can be treated with focus radiation. Some of these men can still be cured.
In the very advanced stage, awareness of all these new medicines that are coming out, like Xofigo and Provenge and Xtandi, is critical. A lot of men who are suffering with advanced disease aren’t seeing a medical oncologist or a urologist who is up to date and they’re just wasting time when they really could be getting state-of-the art treatment.
I have a blog. I’ve written in the past about the difference between prostate cancer, which is predominately managed by prostate cancer surgeons, called urologists, and the majority of other cancers, which are mostly managed by cancer specialists, otherwise known as medical oncologists. Dr. Snuffy Myers is a medical oncologist and I am a medical oncologist. As far as I know there are only four free-standing medical oncology prostate cancer-dedicated clinics in the whole United States.
Why is that?
Medical oncology was originally developed as a specialty for the administration of chemotherapy because that took special expertise. The medical oncologists have never really moved into the early stage prostate cancer arena because there is no chemotherapy to be given. They just left it to the urologists who have been treating early stage prostate cancer for over 100 years. But modern medicine is moving so quickly that urologists are over their heads right now and men are suffering because they’re not getting the best advice.
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