What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their cancer. PROSTATE PROS talks about unapproved use for approved drugs that may benefit men with prostate cancer. Dr. Scholz:    [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.  I’m your host, Dr. Mark Scholz. Liz:      [00:08] And I'm your cohost, Liz Graves.  Dr. Scholz:      [00:13] Welcome to the PROSTATE PROS podcast.  Liz:      [00:20] In past episodes we've covered a variety of options for men with prostate cancer.  This episode, we're going to consolidate some effective options that are not yet FDA approved.  Dr. Scholz:      [00:31] Liz, as you know, we've been doing this a long time and because we only see one type of cancer, we've learned some tricks along the way.  I don't think you're going to find these things in books, or at least if you do find it in books, it's going to be mentioned in passing without much context.  I think back when I was volunteering over at USC to teach fellows in cancer, back in 1996 and Taxotere, which is one of the most effective medicines for advanced prostate cancer was just released for the treatment of lung cancer.  People were getting amazing responses from men who had lung cancer that had spread to their bones.  When I heard “bones,” of course, a light bulb went off in my head and I thought, “This might work for our prostate cancer patients.”  Indeed we found that it did.  Early reports from other practices were also showing effectiveness.  Interestingly, it wasn't until six or seven years later that the FDA finally approved Taxotere for prostate cancer.  Throughout those years, we were using Taxotere regularly with good results, but it was not an approved therapy.  Liz:      [01:41] When I was researching for this episode, it was really hard for me to find information about this.  You Google “off-label therapy, alternative medicine,” there are tons of ads you can't really figure it out, “how would I know if a lung cancer drug would work for prostate cancer?”  How do people find this information?  Dr. Scholz:      [02:01] I think this is sort of insider knowledge.  There are specialists throughout the country that narrowly treat one type of disease.  They talk and they meet at meetings and they share their insights.  In a clinic where there's a high volume of patients, you can quickly determine if something actually works.  You’ll know, within a few months, usually within three or four weeks even, after you start Taxotere, if the PSA is dropping and the bone scans are improving.  It is insider knowledge and it doesn't get published unfortunately, sometimes for years.  There were small phase two trials coming out about Taxotere, but it took six or seven years before the phase three trials led to FDA approval of Taxotere and prostate cancer.  Liz:      [02:49] So this can be frustrating for patients because there are patients who are starting to run out of options, or maybe they're not liking the side effect profile and they really need to find these alternative options.  Dr. Scholz:      [03:02] Yeah, of course the online forums are really helpful for patients and the internet is a great resource.  To illustrate, we've had patients that couldn't tolerate every three week Taxotere.  I remember a patient who came to me with the PSA over a thousand and we gave him a standard Q3 week dose of Taxotere, 70 mg/m2.   He just felt so terrible that he refused to take any f