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Metastatic Prostate Cancer: What Actually Matters After the Cancer Has Spread · Intellectual Medicine

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  I've heard too many stories of men who suffered, then died.
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  It's hard for the family to bear witness to this.
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  How do you get through this phase?
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  I advocate for rectangular living.
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  Vitality, vitality, vitality. We're not being passive.
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  We're not being nihilistic. I'm going to die.
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  Screw everything. You can support your vitality,
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  you can do things have potential to mitigate cancer progression.
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  However in my opinion, those things ought to be safe.
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  They ought not to compromise your party of life, our goal
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  vitality, longevity. The way to get there is to avoid
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  toxic interventions. You know, I talk a lot about
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  what they call early stage prostate cancer, a high PSA, an
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  abnormal prostate MRI, avoiding biopsies, maintaining vitality.
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  But what if, what if it's metastasized?
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  What if the cancer spread beyond the gland?
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  Gentlemen, as long as you avoid castration resistance, prognosis
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  looks favorable. You can run for years with good
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  vitality but you can't walk the traditional path.
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  In my opinion it will lead to castration resistance which is a
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  pre morbid fatal pathway. So what to do?
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  Talk about both. First, how do you avoid
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  castration resistance? Well don't get castrated.
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  Instead of traditional testosterone obliteration, we do
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  bipolar testosterone mitigation. This is not FDA approved, it is
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  considered experimental. Then again, we know conventional
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  therapy doesn't work that great. When you start castration
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  therapy, when a man begins it, 100% of the time the disease
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  will progress. Typically within one to two
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  years. Castration resistance sets in
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  the prostate. Cancer is exposed to a low
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  testosterone environment. It adapts to that, and it breaks
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  through it. So you simply cannot continue
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  blocking testosterone with this hope that somehow, magically
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  it's going to work. First of all, you'll feel
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  terrible. All the negative effects of
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  testosterone blocking combined, compounded by its progression.
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  So I advocate that we go a different path, which is bipolar
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  therapy. High dose testosterone has been
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  shown to be disruptive to the DNA of prostate cancer cells
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  when they've become acclimated to a low testosterone
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  environment. So you can go low, then high,
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  then low. This type of sawtooth pattern
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  has been shown to interfere with the DNA of prostate cancer,
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  which has the potential to extend the benefit of the
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  intermittent androgen deprivation therapy.
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  It has the potential to avoid the dreaded castration
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  resistance while you're maintaining the benefit of high
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  testosterone. To me, this is breakthrough
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  stuff. In my opinion, this should be
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  offered right alongside other therapies.
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  Now I'm going to give you some insight as to why it's not so
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  widely embraced, all right? It's not as deeply studied.
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  Why not? Testosterone cost pennies, dual
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  dollars per month. It's inexpensive, it's generic.
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  The androgen deprivation drugs that I prefer are inexpensive
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  and generic. Now.
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  I like inexpensive, but not at the price of better outcome, So
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  I wouldn't compromise that. But there's a reason why this
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  isn't more widely utilized, and there's a reason why
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  conventional therapy doesn't embrace it more thoroughly.
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  The research is not as robust. Nobody's paying for it.
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  So what happens if suppose you're listening to me and you
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  have castration resistance and the cancer is now progressing?
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  You're in a tough spot, gentlemen.
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  When you have castration resistant prostate cancer, you
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  must face your fate like a man, and that begins with getting
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  honest information. When you have castration
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  resistance, your cancer is incurable.
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  It will progress and it will take your life unless you die of
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  something else first. So you now have a fatal
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  condition. It's not the end of your life in
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  the moment, but it's out there. Unavoidably.
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  When you're managing your life, you have to contemplate managing
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  the last chapter. It's uncomfortable, but it's
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  important to talk about and it's important for you to contemplate
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  so you don't feel backed into the corner.
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  You have to do blank. There's some things I think
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  should never be done regardless of the stage of a cancer.
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  There are other things that are not unreasonable to consider as
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  long as you go in there with your eyes wide open.
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  So I can tell you what I would do based upon my knowledge, my
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  philosophy, and my desire to live vitally.
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  If I had castration resistant prostate cancer, I'd continue
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  with my protocol. I'd continue with intermittent
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  testosterone therapy. I would not do any of the
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  aggressive androgen deprivation. I would not do chemotherapy, and
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  I would not do what's called PARP, Poly, ADT, ribose
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  polymerase therapy. We'll talk about that in a
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  moment. All these treatments out there
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  are heavily promoted in conventional oncological
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  settings because it's what they were trained to do.
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  They're good people. They're trying to help.
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  They're very uncomfortable telling you these drugs are
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  horribly high in side effects. The extent the benefit is
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  marginal. You may be just as well off
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  doing nothing and enjoying your life.
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  That's a fair approach, gentlemen.
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  If you choose to just enjoy your life and manage the end of it
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  without the intervention and the medicalization and the side
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  effect and the cost and the running around the doctors, I
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  support that. I think it's reasonable.
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  Well, let's talk for a moment then about why I've reached that
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  conclusion. Chemotherapy, I don't know why
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  they still offer it. It's been around for 20 years.
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  It still hasn't worked. It's genesis is from a study
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  published in the New England Journal in 2004.
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  In that study, chemotherapy specifically was shown to extend
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  life. Chemotherapy was shown to be
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  effective, but you have to look at the details.
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  This is a New England Journal Medicine article.
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  They looked at dosataxel and compared it to conventional
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  chemotherapy. Now the conventional
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  chemotherapy they compared it to has already been shown not to
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  extend survival. So they're comparing doxetaxel,
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  a form of taxane chemotherapy, to a drug that was already shown
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  not to extend survival. In this study, there was a there
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  was an extension of overall survival, 18.6 months versus
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  16.5 months. An extension of 2.4 months with
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  a chemotherapy compared to the older chemotherapy, bear in
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  mind, was proven not to work. Now here's a wrinkle.
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  However, the three-week interval of the dosataxel drug therapy
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  had a better survival rate than the one week interval.
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  In other words, increasing the frequency of dosing actually
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  decreased lifespan to paradoxical makes you question
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  its merit overall, even if you accept that outcome
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  statistically significant. But a mere 2.4 weeks at the
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  price of all the horror of chemotherapy, nausea, vomiting,
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  hair loss, fatigue, weight loss, immune suppression for at best
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  2.4 months. What are we doing folks?
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  Why are we promoting this? Why is it out there?
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  We know that prostate cancer is very slow in its division, and
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  we know that chemotherapy works best when there's a rapidly
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  dividing cancer. So it's not a good fit and it's
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  a high side effect profile and you're not gaining any
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  significant survival, clinically speaking, and you're sacrificing
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  quality of life. But it's your prerogative.
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  Some men just want to grasp at that straw.
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  It's OK. It's OK to do that.
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  You just want to go in there with your eyes wide open.
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  Now, what about more aggressive androgen deprivation therapies?
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  You know, testosterone obliteration.
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  If it's not working, let's try blocking it even further.
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  More harm done, more adverse effects.
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  Might you live longer? It's muddled.
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  It really is. The studies on this is a peace
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  trial that showed that when you combine all these drugs, there
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  was a survival benefit, but survival benefit comes at a high
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  cost. Grade three or more adverse side
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  effects were in over half the patients.
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  Grade 3 is considered quality of life altering, interfering with
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  activities of daily living. You know, stuff like eating,
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  walking, enjoying life. That's grade three.
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  Grade 4 is potentially life threatening, white blood cell
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  diminishing infections, fevers, pneumonia.
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  Over half the patients had grade 3 or 4 complications.
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  You know what they concluded in one of the studies?
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  Yeah, it's an acceptable side effect profile without
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  significant effect on quality of life.
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  Despite that level of side effect.
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  Really, who's making the judgement about what's
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  acceptable here? I've heard too many stories of
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  men who suffered, then died. It is hard, guys and the
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  gentlemen. It's hard for the family to bear
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  witness to this. How do you get through this
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  phase? I advocate for rectangular
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  living, vitality, vitality, vitality, brief illness and
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  death. I'd rather you not die.
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  We're not being passive. We're not being nihilistic.
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  I'm going to die. Screw everything.
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  You can support your vitality. You can do things have potential
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  to mitigate cancer progression. However, in my opinion, those
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  things ought to be safe. They ought not to compromise
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  your quality of life. Unfortunately, chemotherapy does
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  that. Androgen deprivation therapy
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  does that. Pluvicto.
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  Pluvicto is a drug that is utilized intravenously.
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  It attaches to the prostate specific membrane antigen PSMA.
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  It has been shown to extend overall survival when compared
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  to conventional androgen deprivation treatment problem.
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  It's radioactive, so they're ingesting this drug through your
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  vein and it's engineered to go to where the tumors are.
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  It sounds neat, it sounds effective, and it sounds
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  targeted, but it's none of the above.
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  The efficacy of it compared to conventional treatment, you're
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  gaining statistically significant life extension.
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  You got to ask your doc tell me that in English.
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  What does that mean in months? Lived 44 extra months in the
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  study. When you get this therapy, you
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  become radioactive, literally radioactive.
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  You can't be around other people for seven days.
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  So of those four months, you're spending some of that time in
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  relative isolation, not to mention the side effects, not to
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  mention the cost. The cost can run into the
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  hundreds of thousands, 10s of thousands.
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  Crazy money. See, I have AI have a crazy
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  idea. Suppose we gave men an option.
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  We'd say, well, we can do this treatment for you, Mr. Smith,
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  and it's going to cost $100,000. Or you cannot do the treatment.
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  We'll give you a check for 50,000 just to do what you want
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  with it, right? So it's kind of strange, but how
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  many people would grab the money?
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  It's a sure thing. Quality of life baby.
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  Taking that 50,000. I'm going to give it to my kid
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  for college. I'm going to take a trip to
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  Europe. I'm going to do something versus
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  giving it to the pharmaceutical company so I can maybe grab an
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  extra few months. This kind of bold thinking needs
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  to be embraced. Now there is a, a form of
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  therapy. It's the Poly ADT ribose
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  polymerase therapy and it is designed for men in particular
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  who have a BRCA gene deficiency or mutation, I should say BRCA
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  mutation. And it too has been shown to
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  statistically significantly extend life expectancy problem
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  with these drugs. And they're one of the drugs in
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  the class olaparib. Olaparib ARIB, ARIB is the
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  ending to all these drugs at the same ending.
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  And this class of drugs has been shown to help extend life.
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  It works by interfering with cancer's ability to repair
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  itself when the DNA has been ruptured and damaged.
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  It works best in the minority of men that have this BRCA
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  mutation, but like other drugs, when they're released it gets
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  extended and offered to some men without the mutation.
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  It has some life extending potential if you have a BRCA
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  mutation in the face of metastatic castration resistant
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  cancer. But if you don't have the
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  mutation, the benefit Withers and the benefit comes at a high
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  price. Side effects 90 to 98% of
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  patients who take the drug experience side effects.
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  Over 50% of them experience grade 3 or 4 side effects.
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  It's a lot. It's a high price to pay, a high
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  price to pay for extension compared to conventional
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  therapy. 7.4 versus 3.6 months of progression free interval
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  compared to overall survival was 18.5 to 15.1 months.
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  So once again, compared to other therapy, you're looking at,
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  overall survival measured a few months at a cost of $16,000 a
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  month, 16,000 a month. So if you did this therapy for
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  one year, do the math. Yeah, that's some big change.
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  I'm back to my original idea of give me a check.
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  That is one of the reasons why these drugs are heavily
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  promoted. Profit margins are really
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  significant. Doctors encourage them for
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  several reasons. One, they really are trying to
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  help you and they really believe what they've been taught and
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  what they've been guided to believe by the heavily promoted
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  pharmaceutically financed studies in educational
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  interventions, which are all focused on the drugs that are
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  high-priced, the drugs that are currently out there.
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  In a patented world, you're not going to see a ton of convention
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  of non conventional generic therapies being promoted.
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  It's a natural course of financial incentives.
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  So what should you do? You got to get a lot of
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  information. You've got to be prepared to ask
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  tough questions. Doctor tell me in months what's
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  my average extension? Doctor tell me what my side
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  effects are going to look like. Doctor tell me the difference
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  between that and just doing supportive care, nutritional
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  support? How about bipolar therapy?
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  Doc? Ask them.
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  They can prescribe it. Folks, your conventional
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  oncologist, urologist, they have the legal, medical, ethical
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  authority to offer it to you. You have to be willing to accept
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  uncertainty, which in this case is absolutely worth embracing.
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  Uncertainty with potential benefit versus certainty of
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  adverse effect with marginal benefit.
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  So the metastatic castration resistant cancer, it's a tough,
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  tough place to be. Embrace your vitality.
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  Your lifespan will come to its close.
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  Right now, today, there's nothing out there that looks
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  highly promising to prevent your death from prostate cancer.
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  If you're at that stage, you still may have months to years
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  of life in front of you. So embrace it.
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  Enjoy it as best you can. Yes, the end is coming, but
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  what's today look like? That's that's the point of
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  emphasis. How do you want to spend that
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  time and prior to getting to that level, avoiding castration
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  resistance by avoiding androgen obliteration treatments.
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  Our goal is to put risk in perspective.
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  If your disease progresses, hope is never lost.
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  Suffering should never be passively accepted.
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  There are means of mitigating pain at the very last phase, so
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  don't let docs scare you into taking a therapy that's going to
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  rob you of some today's vitality with this false hope of
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  preventing tomorrow's hardship. All right, guys, little bit of
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  sunshine. Let's all be positive.
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  We'll we're all terminal. I don't care where you stand,
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  but today. I'm talking.
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  I feel great. You're listening.
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  We have a day to celebrate. Celebrate vitality.
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  Pursue it at every step. Alright team, until next time,
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  thanks for listening.