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Speaker 1: Welcome to Symptomatic.

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Speaker 2: Today, we are tackling prostate cancer, the most common cancer

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Speaker 2: men face, something one in eight men will navigate during

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Speaker 2: the course of their lifetime, which also has a ripple

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Speaker 2: effect on their friends and family. And we're recording this

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Speaker 2: episode from the twenty twenty four Asco American Society of

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Speaker 2: Clinical Oncology Annual Meeting. I am joined by a gentleman today,

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Speaker 2: ideally suited.

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Speaker 1: For this complicated conversation.

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Speaker 2: Doctor Mohammad Attique is an assistant professor in the Department

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Speaker 2: of Medicine at University of Chicago Medicine, where he specializes

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Speaker 2: in hematology and oncology, with a focus on genitorinary cancers.

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Speaker 2: His research has appeared in leading publications and has earned

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Speaker 2: him recognition as an American College of Physicians Young Achiever

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Speaker 2: and a Prostate Cancer Foundation Young Investigator.

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Speaker 1: Welcome, Doctor Atique.

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Speaker 3: Thank you, thank you. Happy to be here now.

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Speaker 1: Right out of the gate, What drew you to this specialty?

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Speaker 4: Yeah, so it really kind of started out my father's

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Speaker 4: medical oncologist, and so when I was younger, my siblings

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Speaker 4: and I would kind of go into the clinic maybe

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Speaker 4: help out there, and we grew up in a small

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Speaker 4: town in Arkansas. We really got to see the development

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Speaker 4: of the relations that he had with his patients, and

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Speaker 4: so that development of relations was something that we always

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Speaker 4: kind of grew to admire, But for myself it was

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Speaker 4: really I began to learn more about molecular biology and

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Speaker 4: genetics and getting into that, I became fascinated with the

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Speaker 4: science behind cancer, and so as I went through medical school,

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Speaker 4: I knew that I wanted to do something with it.

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Speaker 3: I just didn't know in what shape, and so.

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Speaker 4: I just kind of found myself gravitating more and more

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Speaker 4: towards medical oncology as I finished residency and I was

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Speaker 4: kind of looking at next steps. I was fortunate enough

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Speaker 4: to have great mentors at University of Arkansas who advised

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Speaker 4: me on considering joining a lab based in oncology or

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Speaker 4: oncologic work that could then help me further delineate my pathway,

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Speaker 4: whether that be in terms of a lab based physician, scientist,

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Speaker 4: or clinical investigator. And I connected with Philip Kantoff at

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Speaker 4: Memorial Sloan Kettering joined his lab and began the work

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Speaker 4: in prostate cancer at that bench side, and that kind

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Speaker 4: of was basically the start of getting into this area.

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Speaker 2: And medicine is a passion shared by your siblings as well.

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Speaker 4: Yeah, yeah, So I have a elder brother who is

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Speaker 4: a oncology resident at Lo Melinda. I have a younger

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Speaker 4: brother who's actually presenting a poster right now. He is

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Speaker 4: a medical oncology fellow at the National Cancer Institute, works

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Speaker 4: in bladder cancer. And then I have a sister who's

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Speaker 4: a first year resident at Cleveland Clinic and interestingly enough,

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Speaker 4: has already kind of gravitated towards one of the gu

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Speaker 4: oncology attendings there and is looking at doing research with her.

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Speaker 1: Wow, that's amazing.

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Speaker 2: If I ever get bad news, I'm going to come

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Speaker 2: to your next family reunion. Now, in terms of breaking

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Speaker 2: down prostate cancer, let's just start at a basic definition,

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Speaker 2: because a lot of people don't even understand what a

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Speaker 2: prostate is, right.

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Speaker 4: So, this is a glendon, and it's anatomical position tends

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Speaker 4: to be you could think more kind of behind the

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Speaker 4: bladder and sort of encompassing a twobe that leads from

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Speaker 4: the bladder that drains out urine. The pro state itself

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Speaker 4: produces a protein, and so this kind of is something

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Speaker 4: we'll probably talk about a little bit more. But prostate

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Speaker 4: specific antigen. This then is a protein that comprises seminal fluid,

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Speaker 4: and so it produces that protein that then becomes a

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Speaker 4: component of that.

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Speaker 1: Do we know why it is such a common cancer, So.

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Speaker 4: We don't really have a clear understanding of why we know.

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Speaker 4: You know, different risk factors we obviously understand for the

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Speaker 4: development of it. So one of the most common things

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Speaker 4: is age, So about seventy percent of the cases diagnosed

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Speaker 4: in men are in men over age sixty five. We

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Speaker 4: know that family history plays a role in this, so

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Speaker 4: those with the first degree relative who have prostate cancer

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Speaker 4: have a two fold risk of developing disease, whereas those

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Speaker 4: with two first three relatives have a.

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Speaker 3: Five fold risk of developing disease.

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Speaker 4: We know that race also plays a role, so there

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Speaker 4: is a much higher incidence of the disease in the

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Speaker 4: United States and African American men. There's not clear evidence

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Speaker 4: that diet is causal, but we know that there are

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Speaker 4: some associations where having a higher red meat consumption the

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Speaker 4: diet can be associated with an increased risk, but nothing

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Speaker 4: that's clearly causal there.

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Speaker 2: It's so interesting to me in how many ways prostate

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Speaker 2: cancer for men almost mirror statistically breast cancer for women.

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Speaker 4: Yeah, you know, we look at both of these cancers,

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Speaker 4: and so even though they are obviously separate cancers, but

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Speaker 4: then in terms of a commonality, you kind of describe

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Speaker 4: it as an indocrine cancer, right, just something that's kind

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Speaker 4: of a gland sort of cancer in that sense, obviously

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Speaker 4: being very common in each individual sex, but also sharing

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Speaker 4: that kind of general category.

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Speaker 2: What is the typical timeline in terms of symptom onset

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Speaker 2: to prostate cancer diagnosis?

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Speaker 4: So this is something that you know is actually kind

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Speaker 4: of where the screening and prostate cancer also comes into

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Speaker 4: play and why there's been a lot of debate and

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Speaker 4: discussion there in the percent decade or so as well.

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Speaker 4: So in terms of the timeline to diagnosis and symptom onset,

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Speaker 4: the way that I kind of look at prostate cancers,

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Speaker 4: we have a lot of diagnosis that happens in the

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Speaker 4: asymptomatic stage, which is through screen, but in the symptomatic

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Speaker 4: stage that can be pretty variable. So symptoms could be

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Speaker 4: anything from what are those associated would say, just an

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Speaker 4: enlarged prostate BPH and so that can just be issues

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Speaker 4: with urinating, There can be some trouble with maybe weak

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Speaker 4: streams et cetera.

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Speaker 3: But then symptoms.

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Speaker 4: Kind of as a sort of spectrum, because it can

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Speaker 4: be as mild as that versus a gentlemen presenting to

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Speaker 4: an emergency room with.

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Speaker 3: Severe back pain or difficulty walking.

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Speaker 4: At that point, the prostate cancer is typically very, very advanced.

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Speaker 4: So it's a bit variable there in terms of that

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Speaker 4: timeline to diagnosis.

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Speaker 2: And then what key role does timing play in terms

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Speaker 2: of fighting prostate cancer and what are the hurdles many

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Speaker 2: patients face in terms of recognizing early symptoms.

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Speaker 4: Yeah, so in prostate cancer, early detection is very important,

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Speaker 4: so you're able to kind of keep an eye on

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Speaker 4: the disease going forward. You want to detect before the

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Speaker 4: cancer has spread or is causing severe symptoms. Now I

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Speaker 4: say severe because there's different kinds of symptoms you can have.

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Speaker 3: When I say.

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Speaker 4: Severe, meaning back pain and ability to walk, or pain

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Speaker 4: in the bone specifically that the prostate cancer is spread there,

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Speaker 4: but also the less severe forms of symptoms, which include

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Speaker 4: urinary hesitancy or weaker streams. And so the ideal timing

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Speaker 4: is obviously going to be before that you have severe

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Speaker 4: pain in the bones. Absolutely, But yes, in that earlier

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Speaker 4: part where maybe it's just in difficulty with urinating or

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Speaker 4: even before that. But we have to differentiate that early

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Speaker 4: detection does not equate early treatment, okay, And the reason

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Speaker 4: for this is that prostate cancer is risk stratified based

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Speaker 4: on some of its components. And so what we look

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Speaker 4: at here are the PSA level, which is a level

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Speaker 4: that's detected from the blood. So this is a protein

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Speaker 4: made by the prostate. If you have prostate cancer, then

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Speaker 4: it tends to be made in higher amounts.

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Speaker 3: So that's one.

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Speaker 4: Thing that we look at in terms of risk stratifying.

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Speaker 4: The other would be how the prostate cancer looks underneath

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Speaker 4: the microscope. This comes out to what's called a gleic

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Speaker 4: In score. And then we also look at what the

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Speaker 4: prostate cancer its extent of involvement is on exam or

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Speaker 4: on imaging, so that's called a clinical stage. So these

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Speaker 4: things help risk stratify prostate cancer. Now, when we have

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Speaker 4: prostate cancer that's detected early.

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Speaker 3: And it falls in the low risk.

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Speaker 4: Categories, these are the ones that are really managed with

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Speaker 4: active surveillance. And what I mean by that is that

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Speaker 4: active surveillance doesn't mean you're not doing anything, but it

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Speaker 4: means you're not going to surgery or radiation. What you're

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Speaker 4: actually doing is having PSA's check, digital rectal exams, repeat

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Speaker 4: biopsies on a periodic basis. And the rationale behind this

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Speaker 4: is that these low risk cancers, it's estimated about fifty

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Speaker 4: to sixty eight percent of the patients who have these

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Speaker 4: when it need treatment within ten years of diagnosis. And

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Speaker 4: so some will say, Okay, well, if I don't need

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Speaker 4: it within ten years, but i'll need it later, why

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Speaker 4: don't I just get it now? And that's because there

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Speaker 4: are side effects and there are issues when you have

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Speaker 4: surgery or radiation, just as within any medical treatment, and

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Speaker 4: so delaying the time to which you would need that

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Speaker 4: treatment and focusing on quality of life for a patient

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Speaker 4: is something that I think is very important. Just because

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Speaker 4: we can do something doesn't happen exactly.

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Speaker 2: So it's not even just a wait and see, it

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Speaker 2: is strategize and observe.

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Speaker 4: Oh absolutely absolutely so. Yeah, it's not just you know,

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Speaker 4: oh you have prostate cancer. I'll see you when I

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Speaker 4: see you, right, it's you have prostate cancer. But we

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Speaker 4: have a plan for this, and our plan is to

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Speaker 4: monitor this in conjunction with you, and we're going to

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Speaker 4: do this together. But like when do you do something right.

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Speaker 4: Let's say it's not ten years. I'm one of the guys.

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Speaker 4: Within ten years. Well, that's based on say the PSA,

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Speaker 4: so if it starts to increase rapidly, if on a

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Speaker 4: repeat biopsy so these are done periodically. If on that

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Speaker 4: say the gleas and score chains or the prostate cancer upgrades,

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Speaker 4: then that would be another trigger to then intervene. So yes,

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Speaker 4: it's not sit and wait, but it's actively watch and

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Speaker 4: make sure nothing's going on.

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Speaker 1: Interesting.

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Speaker 2: What do you think are the biggest misconceptions that people

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Speaker 2: have about prostate cancer in general?

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Speaker 4: One of the biggest things is that you hear the

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Speaker 4: word cancer and you think I need to treat this now, right,

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Speaker 4: And I think that's one of the things that we

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Speaker 4: have to really make sure people understand is that you

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Speaker 4: may not have to immediately proceed to treatment. I think

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Speaker 4: the other thing is that there's a lot of misconceptions

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Speaker 4: about what the treatments mean for a person, and I

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Speaker 4: think it really requires a discussion with a physician about

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Speaker 4: what your treatment options are and where there's ability to

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Speaker 4: do something different than say just what one recommendation may be.

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Speaker 2: That is interesting because you're right when people hear cancer,

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Speaker 2: they want to be as aggressive as possible, and perhaps

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Speaker 2: the best strategy is much more nuanced and measured.

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Speaker 4: Yeah, yeah, you hear cancer and you think I have

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Speaker 4: to fight this. And it's not that you're not fighting this,

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Speaker 4: it's that you are fighting it appropriately in a way

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Speaker 4: that really helps you enjoy life to the best of

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Speaker 4: your ability.

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Speaker 2: It can't be easy delivering that news to anybody. As

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Speaker 2: a doctor, how do you emotionally prepare for that conversation?

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Speaker 4: Right, So, when we've become physicians, we take our hippocratic oath,

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Speaker 4: and as physicians we understand that it truly is a

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Speaker 4: privilege to be caring for someone. When someone comes to

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Speaker 4: you and you're two strangers and you walk in through

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Speaker 4: that patient or the clinic door, all of a sudden,

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Speaker 4: you're the most important person in that room and the

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Speaker 4: connection that you make with that person is very sacred.

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Speaker 4: And so you understand that, yes, this is an honor

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Speaker 4: to be able to take care of someone a major

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Speaker 4: responsibility as well. And so what that means is that

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Speaker 4: you have to focus on your training and preparation for

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Speaker 4: understanding of how to be able to be pragmatic with

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Speaker 4: someone but still balancing that with being too blunt. It's

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Speaker 4: kind of a mix of things that you sort of

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Speaker 4: have experienced during all your training that allows you to

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Speaker 4: be able to walk in that room and be able

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Speaker 4: to share with them the news that's going to be important,

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Speaker 4: but letting them know that we have an idea, we

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Speaker 4: have a plan of what we're going to do.

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Speaker 2: For those and I should imagine anybody in that situation

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Speaker 2: receiving that news is going to immediately go to a

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Speaker 2: place of shock, fear, anxiety. How do you help the

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Speaker 2: patient navigate the information overload but also detach themselves emotionally

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Speaker 2: enough to be able to wrap their head around treatment.

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Speaker 3: That's a great question.

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Speaker 4: Some advice that you know, I generally have for patients

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Speaker 4: is if you have someone who can come with you

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Speaker 4: to an appointment that you you know, involve in these decisions,

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Speaker 4: it's great to bring them along because, as you rightly

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Speaker 4: mentioned there, you know the moment that someone hears about

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Speaker 4: what's going on with them, Sometimes they just shut down

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Speaker 4: and you can be talking and you think they're receiving

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Speaker 4: what you're saying, and at the end they may have

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Speaker 4: no clue. If you ask them to repeat back what

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Speaker 4: you talked about or what their understanding is. It may

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Speaker 4: just be blank stares. And so it's a matter of

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Speaker 4: sort of going through the visit where you've set the

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Speaker 4: stage and you're kind of doing it in increments, so

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Speaker 4: it's not just an information dump all at once, right,

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Speaker 4: you kind.

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Speaker 3: Of work through things.

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Speaker 4: You're frequently checking in with the patient to see, Okay,

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Speaker 4: do you have any questions about that? Are there things

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Speaker 4: is that you know you're wondering about there? I think

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Speaker 4: it's also important for patients. So what I frequently advise

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Speaker 4: is after our initial visit that whenever a random question

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Speaker 4: comes into your head about your disease, you're able to

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Speaker 4: write it down because that way, when you come to

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Speaker 4: see me the next time, we can talk about these

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Speaker 4: things and you're not scrambling, Oh what was it I

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Speaker 4: wanted to ask? So I think it's a matter of

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Speaker 4: just giving information and increments, checking with the patient to

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Speaker 4: see how they're understanding that, and also understanding, you know,

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Speaker 4: how you build on your visits with a patient. So

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Speaker 4: you know, a new patient visit, there's some very important

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Speaker 4: things that need to come across and decisions to be made,

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Speaker 4: and then there are other things that we add in

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Speaker 4: that maybe won't affect the patient's immediate care plan, but

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Speaker 4: would have a role as time goes on.

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Speaker 2: We talked about, you know, the similarities and the parallels

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Speaker 2: between breast cancer for women and crosstate cancer for men.

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Speaker 2: But in terms of the emotional impact and the fear

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Speaker 2: that men have when they get that diagnosis, how do

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Speaker 2: you help them process that in terms of being so

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Speaker 2: attached to their masculinity and other fears.

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Speaker 4: Right, it's through kind of having a very open and

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Speaker 4: honest discussion with them about what it looks like with

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Speaker 4: and without treatment, what things may look like for them.

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Speaker 4: How making the decision to undergo treatment is something that

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Speaker 4: you know, is obviously a very difficult decision, We understand that,

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Speaker 4: but at the same time, you know, is something that

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Speaker 4: they have to balance what kind of priorities are important

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Speaker 4: for them.

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Speaker 2: There are there common misconceptions that patients have about the

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Speaker 2: likely outcome.

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Speaker 4: So I think one of the common misconceptions is that

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Speaker 4: when they are diagnosed with this, that instantly they're like,

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Speaker 4: spend has now just become within a matter of months.

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Speaker 4: And I think that's something that's not necessarily unique to that.

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Speaker 4: I would say in general, patients when they hear the

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Speaker 4: word cancer. There's a lot of images and thoughts that

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Speaker 4: are evoked from just maybe things they've seen in movies

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Speaker 4: or TV shows, et cetera. You know, when patients come

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Speaker 4: to see me, sometimes they say, so it's just a

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Speaker 4: couple of months, like, you know, this is it right?

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Speaker 4: And you know you have to kind of temper that

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Speaker 4: and really let them know that not all cancers are

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Speaker 4: the same things behave differently and kind of let them

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Speaker 4: know where their cases are in terms of the spectrum disease.

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Speaker 2: And so that is probably how you have to individually

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Speaker 2: tailor treatment to each specific patient.

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Speaker 1: Can you just walk me through the stages of doing that.

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Speaker 4: Yeah, So we're talking a little bit about risk stratification,

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Speaker 4: and what I'm referring to here is the National Comprehensive

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Speaker 4: Cancer Network Risk Sertification so NCCN guidelines.

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Speaker 3: So that's something we commonly use.

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Speaker 4: And so that risk traffication goes from very low risk

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Speaker 4: to very high risk, and it depends on PSA Gleason

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Speaker 4: score and then kind of the clinical staging meaning what

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Speaker 4: the prostate cancers and atomic involvement is based on digital

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Speaker 4: rectal examine imaging and so basically when a patient is

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Speaker 4: first diagnosed with prostate cancer. So this, you know, is

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Speaker 4: confirmed on a biopsy, so then that gives us a

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Speaker 4: Gleason score to start, we have a PSA value that

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Speaker 4: we'll get with that. Sometimes there's some imaging indicated there

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Speaker 4: as well, or maybe it's just a digital rectal exam,

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Speaker 4: but that will kind of put the patient in one

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Speaker 4: of these categories. Now, the risk categories are the risk

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Speaker 4: of the patient's cancer progressing or spreading. Essentially, it is

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Speaker 4: kind of what those fall into, and so based on

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Speaker 4: those risk categories, then we kind of look at life

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Speaker 4: expectancy as well. Sometimes you can have men who are

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Speaker 4: diagnosed with a prostate cancer, but they are much later

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Speaker 4: in life, and so at that point whether or not

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Speaker 4: to even pursue the surveillance can be a question simply

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Speaker 4: because there may be other things, natural causes that may

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Speaker 4: shorten one's life versus the prostate cancer itself. So after

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Speaker 4: you do kind of risk traification, life expectancy is a

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Speaker 4: big important part of that. Some patients may have severe

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Speaker 4: other medical issues that are affecting their life expectancy, so

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Speaker 4: those are kind of the initial sort of factors we

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Speaker 4: weigh when trying to decide which sort of treatment route

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Speaker 4: we're going to go with a patient after kind of

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Speaker 4: determining that. So let's say, you know, we have a

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Speaker 4: patient life expectancy, age, etc. Everything is within the range

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Speaker 4: that makes sense to pursue treatment. Then the discussion on

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Speaker 4: what treatment is more appropriate kind of comes down to

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Speaker 4: what the patient's tolerance for particular side effects may be.

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Speaker 4: Sometimes there are medical comorbilities that know they don't necessarily

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Speaker 4: limit someone's life significantly to where treating the prostate cancer

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Speaker 4: is inappropriate, but they still may mean that, say, radiation

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Speaker 4: may be more appropriate than surgery or something along those lines.

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Speaker 2: Assessing a variety of risk factors is just the starting

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Speaker 2: point for creating a personalized treatment plan.

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Speaker 1: Balancing each person's.

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Speaker 2: Unique symptoms and treatment tolerance paves the road to recovery.

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Speaker 2: After the break, we'll continue our conversation with doctor Atique,

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Speaker 2: delving into the advancements made in prostate cancer therapies over

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Speaker 2: the past few decades and how they are reshaping patient outcomes.

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Speaker 2: Now back to my conversation with doctor Atique. Let's talk

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Speaker 2: about advancements and treatment, because obviously there's no good time

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Speaker 2: to receive a diagnosis of cancer, but there's probably been

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Speaker 2: no better time. Right now, tell me about the weapons

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Speaker 2: you would have had in your arsenal thirty years ago

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Speaker 2: as opposed to what you have now.

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Speaker 4: So thirty years ago, we didn't have the radio ligands

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Speaker 4: that we have today. There's a lot of immune therapies

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Speaker 4: that although prostate cancer itself, you know, the disclaimer there

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Speaker 4: is it hasn't been traditionally one where immune therapy has

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Speaker 4: been as successful as compared to say, other gu cancers

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Speaker 4: like renal cancer for example, But we.

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Speaker 3: Didn't have that.

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Speaker 4: Even chemotherapy had really just come about into usage in

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Speaker 4: prostate cancer more in the late nineties. If we go

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Speaker 4: back thirty years, we're talking right about the time that

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Speaker 4: that came in there. Really what we had was hormone injections,

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Speaker 4: androgen approvation therapy and basically steroids, and then there was

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Speaker 4: also an agent called mitoxantrone, but that was really meant

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Speaker 4: to be one that was shown to help with palliation

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Speaker 4: for symptoms, so not really treating the disease. So you know,

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Speaker 4: you're talking about basically a handful of things that really

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Speaker 4: one was using at the time.

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Speaker 2: And why are technological advancements so important in terms of

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Speaker 2: treating cross a cancer.

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Speaker 4: Yeah, So in general, when you look at the population

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Speaker 4: we have, people are living longer, so there are more

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Speaker 4: people who are being diagnosed with prostate cancer. And so

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Speaker 4: while a large number of those people have localized cancers,

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Speaker 4: even out of the localized cancer, so this is about

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Speaker 4: a little bit over our quarter million men are diagnosed

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Speaker 4: every year, and out of that, around thirty to forty

379
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Speaker 4: percent who have treatment will have recurrence of disease and

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Speaker 4: then that eventually can progress to metastatic disease. And so

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Speaker 4: this is metastatic disease currently is an incurable state of disease.

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Speaker 4: But incurable doesn't mean that we can't control or manage it,

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Speaker 4: and that's where having these treatment options is vitally important.

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Speaker 4: And so what we've seen is that while we've been

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Speaker 4: able to add newer treatments in the past decade or

386
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Speaker 4: so to improve on the survival of men in these states,

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Speaker 4: cancer has been able to develop mutations or mechanisms of

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Speaker 4: resistance to get around those treatments. And that's where subsequent

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Speaker 4: treatments are important to be able to have in our

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Speaker 4: arsenal Wow.

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Speaker 2: So for patients, it's important to find a doctor who

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Speaker 2: is evolving their arsenal as these new advancements come out.

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Speaker 4: Right, there's a lot of advancements and options that are

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Speaker 4: available widely available, whether that's a physician in the community

395
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Speaker 4: or at a tertiary academic center. But then there are

396
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Speaker 4: options that you know, include clinical trials, and those tend

397
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Speaker 4: to be more isolated to kind of the larger groups

398
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Speaker 4: or larger centers, and so those are important things that

399
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Speaker 4: you know, we have to have available for patients as options.

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Speaker 2: It's very interesting in terms of cancer trying to outsmart

401
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Speaker 2: the treatments.

402
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Speaker 1: Yeah, what are radiopharmaceuticals?

403
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Speaker 4: So basically you're thinking about a therapy that uses a

404
00:23:04,760 --> 00:23:07,960
Speaker 4: radioactive particle for treatment. So that's kind of the short

405
00:23:08,000 --> 00:23:10,880
Speaker 4: way of thinking about that. We've had that in prostate

406
00:23:10,920 --> 00:23:12,760
Speaker 4: cancer some time. But we've also had kind of a

407
00:23:12,800 --> 00:23:16,000
Speaker 4: newer particle added within the last couple of years getting

408
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Speaker 4: FDA approval in the form of lutetium. So this is

409
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Speaker 4: a beta emitter.

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Speaker 2: We touched upon it a little bit, but why should

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Speaker 2: healthcare providers discuss innovative treatments early with metastatic castration resistant

412
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Speaker 2: prostate cancer patients?

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Speaker 4: So in terms of discussing these early, so patients should

414
00:23:37,320 --> 00:23:40,080
Speaker 4: be able to know what their options are. I think,

415
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Speaker 4: you know, when patient's here they have metastatic cancer, their

416
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Speaker 4: mind just goes to how much time do I have?

417
00:23:45,920 --> 00:23:49,040
Speaker 4: And you have to also let them know that just

418
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Speaker 4: because you've heard this diagnosis doesn't mean there's nothing we

419
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Speaker 4: can do.

420
00:23:52,320 --> 00:23:53,760
Speaker 3: So letting a patient.

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Speaker 4: Know about their options upfront, I think kind of frames

422
00:23:56,400 --> 00:23:59,000
Speaker 4: things for them and gives them a sense that while

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Speaker 4: this is not what we wanted to hear, and this

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00:24:02,000 --> 00:24:05,040
Speaker 4: is not what we would have desired, we are here together,

425
00:24:05,160 --> 00:24:07,280
Speaker 4: we're going to do this together, and we have a

426
00:24:07,320 --> 00:24:07,960
Speaker 4: plan for you.

427
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Speaker 2: Are there certain patients that are better candidates for innovative treatments?

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Speaker 3: Yeah?

429
00:24:14,800 --> 00:24:18,720
Speaker 4: Absolutely so having a number of treatments and metastatic castration

430
00:24:18,840 --> 00:24:22,000
Speaker 4: resistant proces state cancer is great or in metastatic prostate

431
00:24:22,040 --> 00:24:24,520
Speaker 4: cancer in general. But what we're having to learn and

432
00:24:24,640 --> 00:24:28,800
Speaker 4: discover in the current field is the sequencing of these treatments.

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00:24:29,200 --> 00:24:30,960
Speaker 4: So which one should go first?

434
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Speaker 3: Right?

435
00:24:31,680 --> 00:24:34,640
Speaker 4: We know based on some data, you know, okay, well yeah,

436
00:24:34,640 --> 00:24:37,040
Speaker 4: and we might start with X treatment and go.

437
00:24:37,000 --> 00:24:37,840
Speaker 3: To the next one.

438
00:24:38,280 --> 00:24:41,119
Speaker 4: But then there's just kind of a mix of options

439
00:24:41,160 --> 00:24:45,080
Speaker 4: which can all be appropriate, and so which one going

440
00:24:45,200 --> 00:24:48,000
Speaker 4: next and which one is the best to continue and

441
00:24:48,080 --> 00:24:50,320
Speaker 4: linked in to survival is kind of a big poin.

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Speaker 2: Discussion do you have a favorite success story that illustrates that.

443
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Speaker 4: So we had, you know, a great success story, and

444
00:24:58,400 --> 00:25:00,600
Speaker 4: this was at my prior program when I was in

445
00:25:00,640 --> 00:25:03,800
Speaker 4: training and I was working under the guidance of doctor

446
00:25:03,880 --> 00:25:06,720
Speaker 4: Robbie Maddens, one of my mentors and friends. We had

447
00:25:07,119 --> 00:25:09,399
Speaker 4: a patient and this was on a clinical trial that

448
00:25:09,440 --> 00:25:12,879
Speaker 4: we had there using aminocytokine when that was in combination

449
00:25:13,080 --> 00:25:17,520
Speaker 4: with androgen deprivation therapy, so the subcutaneous injections and then

450
00:25:17,560 --> 00:25:21,080
Speaker 4: dose tax which is chemotherapy. And I really like this

451
00:25:21,240 --> 00:25:24,560
Speaker 4: example because this was a much elderly gentleman. He had

452
00:25:24,600 --> 00:25:27,040
Speaker 4: just gone into his early eighties. And you know, when

453
00:25:27,040 --> 00:25:29,639
Speaker 4: you get here and you have a multitude of options,

454
00:25:29,800 --> 00:25:32,639
Speaker 4: choosing one most appropriate for you is always a big question.

455
00:25:33,119 --> 00:25:36,040
Speaker 4: And so there weren't particular mutations or things that would

456
00:25:36,040 --> 00:25:39,480
Speaker 4: have said he should have one treatment versus another. So

457
00:25:39,880 --> 00:25:42,119
Speaker 4: he was a great candidate for this study, and on

458
00:25:42,160 --> 00:25:45,480
Speaker 4: the study he was able to have over year and

459
00:25:45,560 --> 00:25:48,840
Speaker 4: a half two years on the same treatment in metastatic

460
00:25:48,920 --> 00:25:53,280
Speaker 4: castration resistant prostate cancer, which the overall survival for this

461
00:25:53,480 --> 00:25:56,520
Speaker 4: tends to be around years, but he was still on

462
00:25:56,520 --> 00:25:59,439
Speaker 4: one treatment in that area. And the reason that that

463
00:25:59,560 --> 00:26:01,119
Speaker 4: story really stood out to me was, you know, he

464
00:26:01,160 --> 00:26:03,720
Speaker 4: was a big hockey fan. The patient was able to

465
00:26:03,760 --> 00:26:06,840
Speaker 4: go to games frequently, he was able to attend his

466
00:26:06,920 --> 00:26:11,360
Speaker 4: daughter's wedding cross country. He had a very meaningful quality

467
00:26:11,359 --> 00:26:16,440
Speaker 4: of life without having to undergo different or other treatments,

468
00:26:16,840 --> 00:26:20,919
Speaker 4: whereas sometimes certain treatments may be particularly tough for a

469
00:26:20,960 --> 00:26:23,800
Speaker 4: patient tolerate. It may really limit what they're able to

470
00:26:23,840 --> 00:26:25,040
Speaker 4: do on a day to day basis.

471
00:26:25,760 --> 00:26:31,520
Speaker 2: What are you most excited about in terms of the

472
00:26:31,760 --> 00:26:35,320
Speaker 2: advancements in terms of treating pasta cancer.

473
00:26:35,920 --> 00:26:39,320
Speaker 4: There's a couple of different advancements coming into play, some

474
00:26:39,440 --> 00:26:42,480
Speaker 4: with phase one and phase two study data, so meaning

475
00:26:42,520 --> 00:26:45,280
Speaker 4: that you know, they're being shown to have safety and

476
00:26:45,440 --> 00:26:48,280
Speaker 4: or some efficacy in the disease state in the last

477
00:26:48,359 --> 00:26:50,680
Speaker 4: just couple of years here. So we kind of talked

478
00:26:50,680 --> 00:26:54,280
Speaker 4: about radio pharmaceuticals and I use the example of a

479
00:26:54,480 --> 00:26:58,399
Speaker 4: lutetium based radio pharmaceutical you know, and mentioned as that

480
00:26:58,480 --> 00:27:02,080
Speaker 4: was a beta emitterr there, but we also have alpha

481
00:27:02,119 --> 00:27:04,680
Speaker 4: emitters coming into the play, and so a different kind

482
00:27:04,680 --> 00:27:08,119
Speaker 4: of form of a radioactive particle, so phase one study

483
00:27:08,119 --> 00:27:10,399
Speaker 4: ongoing with that. So actinium is one that kind of

484
00:27:10,400 --> 00:27:14,920
Speaker 4: comes to mind currently, another kind of radio pharmaceutical coming

485
00:27:14,960 --> 00:27:17,760
Speaker 4: into play. The other things that you know are pretty

486
00:27:17,760 --> 00:27:21,760
Speaker 4: exciting to me include antibody drug conjugates and so what

487
00:27:21,800 --> 00:27:27,960
Speaker 4: these are are basically molecules here treatments that use a

488
00:27:28,160 --> 00:27:32,040
Speaker 4: targeting moniiclonal antibody. So it's kind of a portion of

489
00:27:32,080 --> 00:27:36,600
Speaker 4: this treatment is designed to target say a protein that's

490
00:27:36,640 --> 00:27:40,360
Speaker 4: expressed on protestate cancer cells. And then the other part

491
00:27:40,440 --> 00:27:42,720
Speaker 4: of the treatment is what's considered to be a payload

492
00:27:42,880 --> 00:27:47,760
Speaker 4: of a cytotoxic particle, and so these have approval and

493
00:27:47,880 --> 00:27:51,040
Speaker 4: other cancers, and so bringing it to prostate cancer is

494
00:27:51,080 --> 00:27:54,080
Speaker 4: something that's pretty exciting. And then another thing that actually

495
00:27:54,160 --> 00:27:56,280
Speaker 4: comes to mind as well. So those are the antibody

496
00:27:56,359 --> 00:27:59,040
Speaker 4: drug conjugates. But then we also have a form of

497
00:27:59,080 --> 00:28:04,120
Speaker 4: immune therapy called bispecific T cell engagers, and so basically

498
00:28:04,160 --> 00:28:07,480
Speaker 4: again has one part of it that targets a certain

499
00:28:07,520 --> 00:28:10,840
Speaker 4: protein and another part of it that brings in a

500
00:28:10,880 --> 00:28:14,240
Speaker 4: T cell. So basically brings a part of your immune

501
00:28:14,280 --> 00:28:18,080
Speaker 4: system to a cancer cell and kind of has it

502
00:28:18,200 --> 00:28:22,560
Speaker 4: recognize it to get a therapeutic event. So basically overall

503
00:28:22,640 --> 00:28:26,480
Speaker 4: kind of summarizing it is all comes back to targeted therapies, right,

504
00:28:26,560 --> 00:28:29,560
Speaker 4: So whether that's in the form of an antibody drug conjugate,

505
00:28:29,680 --> 00:28:33,120
Speaker 4: a BUI specific T cell engager, or in a radio

506
00:28:33,119 --> 00:28:35,400
Speaker 4: pharmaceutical that's you know, targeting psma.

507
00:28:36,119 --> 00:28:41,440
Speaker 2: As somebody who is so on the cusp of advancements

508
00:28:41,480 --> 00:28:46,360
Speaker 2: as they're happening, do you find a hesitancy with more

509
00:28:46,400 --> 00:28:53,440
Speaker 2: traditional or old school providers and patients even to embrace

510
00:28:53,920 --> 00:28:55,000
Speaker 2: these advancements.

511
00:28:55,520 --> 00:28:58,640
Speaker 4: So I think that you know, my interactions with fellow

512
00:28:58,640 --> 00:29:01,040
Speaker 4: physicians and you know call leagues around the country has

513
00:29:01,080 --> 00:29:04,440
Speaker 4: been pretty open to clinical trials because part of your

514
00:29:04,640 --> 00:29:09,400
Speaker 4: training is exposing you to understanding clinical research and trials

515
00:29:09,400 --> 00:29:11,600
Speaker 4: and the importance of these and developing the treatments that

516
00:29:11,600 --> 00:29:15,200
Speaker 4: we currently have. So, especially being at University of Chicago,

517
00:29:15,560 --> 00:29:18,760
Speaker 4: we do get a large number of referrals from physicians

518
00:29:18,760 --> 00:29:21,080
Speaker 4: in the community who have been practicing for a number

519
00:29:21,080 --> 00:29:23,560
Speaker 4: of years because you know, they kind of recognize when

520
00:29:23,600 --> 00:29:27,120
Speaker 4: the standard options may not be appropriate for patients. There

521
00:29:27,160 --> 00:29:30,840
Speaker 4: can be obviously some skepticism and this isn't I don't

522
00:29:30,880 --> 00:29:34,760
Speaker 4: think unique necessarily to physicians in the field for longer

523
00:29:34,840 --> 00:29:37,400
Speaker 4: durations versus you know, some who are just out of

524
00:29:37,480 --> 00:29:39,719
Speaker 4: kind of training. But you know, there can be some

525
00:29:39,760 --> 00:29:43,360
Speaker 4: skepticism about a trial, but that tends to be more

526
00:29:43,600 --> 00:29:47,520
Speaker 4: on scientific merit, So there can be debates about these things, right,

527
00:29:47,560 --> 00:29:50,400
Speaker 4: That's why we're doing trials. We don't know that X

528
00:29:50,480 --> 00:29:53,800
Speaker 4: treatment is really going to change the world. That's why

529
00:29:53,840 --> 00:29:56,160
Speaker 4: we're obviously trying to learn about it. I think for

530
00:29:56,280 --> 00:30:00,240
Speaker 4: patients there can be some hesitancy as well. You know,

531
00:30:00,280 --> 00:30:03,680
Speaker 4: when you use the word clinical trial, sometimes you know

532
00:30:03,800 --> 00:30:05,960
Speaker 4: just kind of flat out responses. You know, Doc, I

533
00:30:06,000 --> 00:30:06,960
Speaker 4: don't want to be a guinea pig.

534
00:30:07,000 --> 00:30:09,520
Speaker 1: I was going to say guinea pig is right.

535
00:30:09,600 --> 00:30:12,440
Speaker 4: And obviously, you know, in past years, with recent climate

536
00:30:12,560 --> 00:30:16,280
Speaker 4: in questions about some treatments that were around during the

537
00:30:16,320 --> 00:30:19,240
Speaker 4: pandemic and all, you know, from patients side, and a

538
00:30:19,280 --> 00:30:21,760
Speaker 4: lot of misinformation that have kind of bempeld around, there's

539
00:30:21,800 --> 00:30:25,280
Speaker 4: a higher sense of sort of maybe a garden nature

540
00:30:25,320 --> 00:30:28,320
Speaker 4: at times from patients that you may meet. But it's

541
00:30:28,360 --> 00:30:31,480
Speaker 4: really on physicians to explain kind of what we're doing

542
00:30:31,480 --> 00:30:33,960
Speaker 4: and why we're doing it. And you know, I think

543
00:30:34,040 --> 00:30:36,719
Speaker 4: through that when you're able to kind of let the

544
00:30:36,720 --> 00:30:40,200
Speaker 4: patient know first you are there to establish a relation

545
00:30:40,360 --> 00:30:43,160
Speaker 4: with the patient. When you are there and they know

546
00:30:43,280 --> 00:30:45,600
Speaker 4: that you're there to care for them and you're on

547
00:30:45,680 --> 00:30:48,000
Speaker 4: the same team with them, then I think that makes

548
00:30:48,040 --> 00:30:50,160
Speaker 4: it easier to bring up these subjects of you know,

549
00:30:50,200 --> 00:30:53,080
Speaker 4: some unknown therapy and when it may or may not

550
00:30:53,120 --> 00:30:54,040
Speaker 4: be appropriate for them.

551
00:30:54,520 --> 00:30:55,440
Speaker 1: You just answered it.

552
00:30:55,480 --> 00:30:58,400
Speaker 2: But I was going to touch upon the challenges that

553
00:30:58,600 --> 00:31:03,280
Speaker 2: healthcare providers in terms of new treatment plans.

554
00:31:03,800 --> 00:31:07,160
Speaker 4: Absolutely, I mean again it comes back to while looking

555
00:31:07,240 --> 00:31:09,800
Speaker 4: up and trying to understand as much about your disease

556
00:31:09,840 --> 00:31:12,200
Speaker 4: as possible is great, there can be a lot of

557
00:31:12,560 --> 00:31:16,560
Speaker 4: less reliable sources out there that you know, make it

558
00:31:16,600 --> 00:31:19,880
Speaker 4: difficult for people to understand their care to the level

559
00:31:19,920 --> 00:31:22,920
Speaker 4: that's needed to make a well informed decision. So that,

560
00:31:23,000 --> 00:31:24,360
Speaker 4: you know, is kind of I think one of the

561
00:31:24,360 --> 00:31:26,000
Speaker 4: bigger challenges.

562
00:31:25,680 --> 00:31:29,600
Speaker 2: In terms of well informed decision how do you navigate

563
00:31:29,960 --> 00:31:33,720
Speaker 2: the topic of risk in terms of treatment with your patients.

564
00:31:34,200 --> 00:31:37,440
Speaker 4: In terms of that, we have adverse effects of treatments

565
00:31:37,440 --> 00:31:40,000
Speaker 4: which are important for patients to understand. So what those

566
00:31:40,040 --> 00:31:42,760
Speaker 4: possibly are now, as you can imagine that list of

567
00:31:42,760 --> 00:31:46,600
Speaker 4: adverse effects and be pretty long anything from things that yes, okay,

568
00:31:46,600 --> 00:31:49,600
Speaker 4: we're more likely to see this too, this was reported

569
00:31:49,960 --> 00:31:52,280
Speaker 4: and I don't know that in treating you know, three

570
00:31:52,400 --> 00:31:54,520
Speaker 4: hundred and four hundred patients, I've ever seen this happen,

571
00:31:54,920 --> 00:31:58,960
Speaker 4: and so I think you know, you obviously relay the risk,

572
00:31:59,240 --> 00:32:02,920
Speaker 4: you provide information in written form as you can, and

573
00:32:02,960 --> 00:32:05,360
Speaker 4: then obviously letting them know of any sort of important

574
00:32:05,680 --> 00:32:10,880
Speaker 4: additional potential adverse risk. So there's some very uncommon things

575
00:32:10,960 --> 00:32:13,680
Speaker 4: but can be particularly severe that you make sure patients

576
00:32:13,680 --> 00:32:14,240
Speaker 4: are aware of.

577
00:32:14,800 --> 00:32:18,360
Speaker 2: So you're constantly monitoring and adjusting.

578
00:32:18,480 --> 00:32:22,320
Speaker 4: Oh, absolutely, absolutely, So if you initiate a patient on treatment,

579
00:32:22,360 --> 00:32:25,880
Speaker 4: then ultimately you are the one who's making sure that

580
00:32:25,960 --> 00:32:28,160
Speaker 4: if there's any issues or problems that come up, that

581
00:32:28,200 --> 00:32:31,160
Speaker 4: those are being managed and as best as you can,

582
00:32:31,320 --> 00:32:33,840
Speaker 4: being cut off before they become major issues.

583
00:32:34,720 --> 00:32:39,640
Speaker 2: How much is avoiding recycling existing therapies a factor when

584
00:32:39,760 --> 00:32:42,120
Speaker 2: you are creating a treatment plan.

585
00:32:42,480 --> 00:32:45,040
Speaker 4: Yeah, so that's something we definitely look at in terms

586
00:32:45,080 --> 00:32:49,280
Speaker 4: of especially in the metastatic prostate cancer. So you're essentially

587
00:32:49,360 --> 00:32:52,160
Speaker 4: trying to get as much mileage as you can out

588
00:32:52,160 --> 00:32:55,040
Speaker 4: of every treatment option, right, and you want to be

589
00:32:55,120 --> 00:32:57,760
Speaker 4: able to go through and use it until the point

590
00:32:57,760 --> 00:33:00,720
Speaker 4: which maybe the cancer develops a sort of resist mechanism

591
00:33:00,760 --> 00:33:04,400
Speaker 4: to that. There are scenarios in which reusing therapies that

592
00:33:04,440 --> 00:33:08,160
Speaker 4: have been used before are reasonable. But the way that

593
00:33:08,320 --> 00:33:10,400
Speaker 4: I kind of look at it is more if a

594
00:33:10,440 --> 00:33:13,080
Speaker 4: patient has progressed on so and what I'm thinking about

595
00:33:13,080 --> 00:33:15,280
Speaker 4: here is one of the chemotherapy options in mind, but

596
00:33:15,360 --> 00:33:20,480
Speaker 4: also one of the oral second generation androgen receptor pathway inhibitors.

597
00:33:20,480 --> 00:33:23,960
Speaker 4: So these are two common drugs used in messin prostate cancer,

598
00:33:24,400 --> 00:33:27,640
Speaker 4: and so there is some sense of, well, if someone

599
00:33:27,680 --> 00:33:31,800
Speaker 4: progresses on say one of the ARPIS for short or

600
00:33:31,960 --> 00:33:34,760
Speaker 4: one form of the chemotherapy, then maybe you could come

601
00:33:34,800 --> 00:33:39,880
Speaker 4: back to that same chemotherapy or the ARPI. Now that

602
00:33:40,000 --> 00:33:43,040
Speaker 4: concept is there, but in the field we understand that,

603
00:33:43,280 --> 00:33:45,720
Speaker 4: especially in particular when it comes to arpis, if one

604
00:33:45,720 --> 00:33:48,120
Speaker 4: has progressed on them, coming back to a different form

605
00:33:48,120 --> 00:33:51,760
Speaker 4: of it is unlikely to produce a meaningful benefit. And

606
00:33:51,880 --> 00:33:54,520
Speaker 4: so that's where having all these other treatment options, including

607
00:33:54,520 --> 00:33:57,000
Speaker 4: the radio pharmaceuticals and clinical trials come into play.

608
00:33:57,560 --> 00:34:01,680
Speaker 2: We've talked a lot about treatment options and also the

609
00:34:01,720 --> 00:34:05,800
Speaker 2: importance of having a support person for someone who receives

610
00:34:05,880 --> 00:34:10,560
Speaker 2: a diagnosis in terms of processing the information and helping

611
00:34:10,640 --> 00:34:14,440
Speaker 2: navigate treatment. But on your end, I know with breast

612
00:34:14,480 --> 00:34:18,359
Speaker 2: cancer there is very much a team approach. Is there

613
00:34:19,040 --> 00:34:21,680
Speaker 2: a medical team approach to prostate cancer?

614
00:34:21,719 --> 00:34:23,400
Speaker 1: And ideally who would be on your team?

615
00:34:23,600 --> 00:34:23,799
Speaker 3: Yeah?

616
00:34:23,880 --> 00:34:27,920
Speaker 4: Absolutely, So there are some patient interfacing team members and

617
00:34:27,960 --> 00:34:31,560
Speaker 4: there are some who work more directly with the physicians

618
00:34:31,600 --> 00:34:34,880
Speaker 4: involved in this case and the other clinical staff involved

619
00:34:34,880 --> 00:34:38,720
Speaker 4: in this case. So in terms of patient facing members,

620
00:34:38,760 --> 00:34:43,000
Speaker 4: so there can be a urologist, a radiation oncologist, a

621
00:34:43,040 --> 00:34:47,680
Speaker 4: medical oncologist. Obviously our nurses who are a major backbone

622
00:34:47,719 --> 00:34:50,680
Speaker 4: and really do a lot of interactions and care with

623
00:34:50,719 --> 00:34:52,880
Speaker 4: our patients, so they're a big part of the patient

624
00:34:52,920 --> 00:34:56,680
Speaker 4: facing team approach. We also have members of the team

625
00:34:57,040 --> 00:35:00,600
Speaker 4: who don't necessarily have patient facing roles, but have critical

626
00:35:00,680 --> 00:35:02,840
Speaker 4: roles in the treatment of this patient. So that includes

627
00:35:02,920 --> 00:35:07,760
Speaker 4: pathologists and then radiologists as well. There's also nuclear medicine

628
00:35:07,760 --> 00:35:10,759
Speaker 4: physicians that can be involved depending on the treatment, so

629
00:35:10,800 --> 00:35:12,799
Speaker 4: it can be a pretty broad group of people working

630
00:35:12,840 --> 00:35:13,759
Speaker 4: together to take care of you.

631
00:35:14,560 --> 00:35:19,960
Speaker 2: Is there also an emotional psychological component that you find

632
00:35:20,200 --> 00:35:21,600
Speaker 2: certain patients need.

633
00:35:22,400 --> 00:35:26,680
Speaker 4: Yes, absolutely, I mean we do have psychological support and

634
00:35:26,719 --> 00:35:29,880
Speaker 4: all through our center, and there's other resources available for

635
00:35:30,000 --> 00:35:32,640
Speaker 4: patients for that, because it is critically important for patients.

636
00:35:32,680 --> 00:35:36,399
Speaker 4: It's sometimes hard to wrap your head around the diagnosis,

637
00:35:36,440 --> 00:35:38,840
Speaker 4: you know, it's hard to just get that first step in.

638
00:35:39,239 --> 00:35:41,960
Speaker 4: But also even with the treatment options or understanding what

639
00:35:42,000 --> 00:35:46,080
Speaker 4: that looks like, having the support of people who have

640
00:35:46,200 --> 00:35:51,200
Speaker 4: gone through the same situation or from a psychologist or

641
00:35:51,239 --> 00:35:55,640
Speaker 4: in some cases psychiatrists of their issues with emotional adjustment

642
00:35:55,719 --> 00:35:57,080
Speaker 4: to this can be very helpful.

643
00:35:57,400 --> 00:35:59,280
Speaker 1: Yeah, because I should think that you know.

644
00:35:59,200 --> 00:36:04,240
Speaker 2: For men it's as equally loaded and complicated and emotional

645
00:36:04,560 --> 00:36:05,560
Speaker 2: journey to process.

646
00:36:06,080 --> 00:36:06,279
Speaker 5: Yeah.

647
00:36:06,320 --> 00:36:09,880
Speaker 4: Absolutely, just cancer in general carries that right. And then

648
00:36:09,920 --> 00:36:13,320
Speaker 4: also because you know, there is a lot of thought

649
00:36:13,480 --> 00:36:18,040
Speaker 4: about the treatment we're using, does lower the men's testosterone

650
00:36:18,080 --> 00:36:22,200
Speaker 4: can affect things on a very emotional and personal level

651
00:36:22,280 --> 00:36:25,440
Speaker 4: for them, And so these are things that do require,

652
00:36:25,480 --> 00:36:29,439
Speaker 4: you know, more support than just from the medical side

653
00:36:29,480 --> 00:36:29,960
Speaker 4: of things.

654
00:36:30,800 --> 00:36:35,800
Speaker 2: How has your specialty changed you personally in terms of

655
00:36:36,440 --> 00:36:41,239
Speaker 2: your relationships with patients and just looking back, how has

656
00:36:41,280 --> 00:36:43,120
Speaker 2: it shaped you as a doctor.

657
00:36:44,040 --> 00:36:47,000
Speaker 4: So I think going into being a physician and kind

658
00:36:47,000 --> 00:36:51,080
Speaker 4: of gravitating more into medical oncology, I think personally You've

659
00:36:51,160 --> 00:36:55,960
Speaker 4: really had to exercise a much greater degree of empathy

660
00:36:56,080 --> 00:36:59,400
Speaker 4: than I probably possessed before. To be very frank, I

661
00:36:59,520 --> 00:37:02,560
Speaker 4: treat stay cancer all the time. I may be able to,

662
00:37:03,040 --> 00:37:05,319
Speaker 4: you know, sit there and I'm not worried at all

663
00:37:05,360 --> 00:37:08,880
Speaker 4: about something, but that's because of what I see and

664
00:37:08,920 --> 00:37:12,080
Speaker 4: what I do every day. And so I think personally,

665
00:37:12,200 --> 00:37:13,719
Speaker 4: you know, it's kind of made it to where you

666
00:37:13,760 --> 00:37:16,840
Speaker 4: really have to sit there and really put yourself in

667
00:37:16,880 --> 00:37:19,640
Speaker 4: the other person's shoes a lot more so and really

668
00:37:19,680 --> 00:37:21,880
Speaker 4: kind of think, Okay, if this is someone coming in

669
00:37:21,960 --> 00:37:24,840
Speaker 4: who has little to no understanding or doesn't have this training,

670
00:37:24,920 --> 00:37:27,759
Speaker 4: doesn't see this all the time, then how are they

671
00:37:27,800 --> 00:37:28,719
Speaker 4: going to feel about this?

672
00:37:28,920 --> 00:37:30,439
Speaker 3: What could be going through their head?

673
00:37:30,520 --> 00:37:33,000
Speaker 4: And I think that's probably one of the biggest things

674
00:37:33,040 --> 00:37:35,120
Speaker 4: that you know, I always try to keep in mind

675
00:37:35,160 --> 00:37:35,920
Speaker 4: with my patience.

676
00:37:36,520 --> 00:37:37,000
Speaker 1: I love that.

677
00:37:37,239 --> 00:37:42,440
Speaker 2: I love that your empathy has evolved, you know, and progressed,

678
00:37:42,600 --> 00:37:44,160
Speaker 2: as have the treatments.

679
00:37:44,520 --> 00:37:44,719
Speaker 4: You know.

680
00:37:44,719 --> 00:37:47,120
Speaker 1: What would you like listeners to take away?

681
00:37:47,880 --> 00:37:50,520
Speaker 4: So a couple of key things. One is that when

682
00:37:50,560 --> 00:37:55,520
Speaker 4: you have prostate cancer, not treating it in some cases

683
00:37:55,800 --> 00:37:59,040
Speaker 4: is a reasonable option, and that comes down to how

684
00:37:59,080 --> 00:38:01,200
Speaker 4: it may affect your life and how the disease evolves.

685
00:38:01,320 --> 00:38:04,160
Speaker 4: There's you know, hundreds of men who you know, would

686
00:38:04,239 --> 00:38:06,719
Speaker 4: undergo procedures and things when they could very well have

687
00:38:06,840 --> 00:38:09,400
Speaker 4: just been monitoring and watched for several years. So I

688
00:38:09,400 --> 00:38:13,000
Speaker 4: think that's one key thing. The other is that there

689
00:38:13,080 --> 00:38:16,759
Speaker 4: are a lot of new technologies coming into play in

690
00:38:16,840 --> 00:38:20,800
Speaker 4: prostate cancer, and we're learning the best ways to utilize those.

691
00:38:21,160 --> 00:38:24,480
Speaker 4: But I think it's important to understand that while these

692
00:38:24,480 --> 00:38:28,000
Speaker 4: are there, some of these are not appropriate for every scenario,

693
00:38:28,600 --> 00:38:31,000
Speaker 4: and so it's good for patients to read and do

694
00:38:31,040 --> 00:38:33,480
Speaker 4: their own research and learn about what's out there, but

695
00:38:33,520 --> 00:38:38,520
Speaker 4: also to understand that having every test done, or every

696
00:38:38,600 --> 00:38:42,399
Speaker 4: procedure or every treatment is not necessarily the ideal way

697
00:38:42,440 --> 00:38:46,000
Speaker 4: to go about treating something. To managing a disease, you know,

698
00:38:46,000 --> 00:38:49,200
Speaker 4: you can lead to a lot of overdiagnosis, overtreatment and

699
00:38:49,239 --> 00:38:52,160
Speaker 4: issues there. I think the other thing is is that

700
00:38:52,600 --> 00:38:55,520
Speaker 4: just because you have prostate cancer doesn't mean you don't

701
00:38:55,520 --> 00:38:58,520
Speaker 4: have options, and so I think that's you know, kind

702
00:38:58,520 --> 00:38:59,239
Speaker 4: of a key thing.

703
00:38:59,239 --> 00:39:00,439
Speaker 3: I think all the people mind.

704
00:39:00,560 --> 00:39:03,360
Speaker 4: I obviously encourage patients to do their own research, but

705
00:39:03,400 --> 00:39:05,880
Speaker 4: in doing so, you know, talk to your physician, see

706
00:39:06,400 --> 00:39:10,520
Speaker 4: what they might recommend as an appropriate resource and you know, go.

707
00:39:10,520 --> 00:39:13,640
Speaker 2: From there, and then on the flip side of that coin,

708
00:39:13,800 --> 00:39:16,400
Speaker 2: what do you want healthcare providers to take away?

709
00:39:16,880 --> 00:39:19,399
Speaker 4: So I think that it actually kind of comes down

710
00:39:19,400 --> 00:39:21,759
Speaker 4: to almost similar advice. So in terms of when we're

711
00:39:21,880 --> 00:39:25,560
Speaker 4: advising patients, we need to make sure that we're doing

712
00:39:25,640 --> 00:39:28,839
Speaker 4: a good job of informing them about the risk of

713
00:39:28,960 --> 00:39:31,640
Speaker 4: the disease that they have, about the risk of the

714
00:39:31,640 --> 00:39:35,040
Speaker 4: treatments associated with it. But we also, you know, have

715
00:39:35,160 --> 00:39:37,719
Speaker 4: to be keeping up with kind of the latest advancements

716
00:39:37,760 --> 00:39:41,279
Speaker 4: in our area so that we understand when it's appropriate

717
00:39:41,320 --> 00:39:45,040
Speaker 4: to use something or not. There can be over diagnosis

718
00:39:45,120 --> 00:39:48,399
Speaker 4: or over treatment, you know, with all the new technologies

719
00:39:48,440 --> 00:39:51,239
Speaker 4: and things are available, and so it's on us to

720
00:39:51,320 --> 00:39:54,680
Speaker 4: kind of be understanding when it's appropriate to use something

721
00:39:54,760 --> 00:39:55,000
Speaker 4: or not.

722
00:39:55,600 --> 00:39:57,200
Speaker 1: Is there anything else you'd like to add?

723
00:39:57,680 --> 00:40:00,200
Speaker 4: No, I'm just really thankful for the opportunity to be

724
00:40:00,320 --> 00:40:03,400
Speaker 4: on today and to talk with you all, and obviously

725
00:40:03,440 --> 00:40:06,400
Speaker 4: for any patients out there who are being faced with

726
00:40:06,440 --> 00:40:09,800
Speaker 4: this diagnosis. There's teams of people across the country working

727
00:40:09,840 --> 00:40:12,359
Speaker 4: on this, trying to come up with advancements and there

728
00:40:12,360 --> 00:40:12,880
Speaker 4: to support you.

729
00:40:13,520 --> 00:40:16,879
Speaker 1: Excellent answer thank you doctor for speaking with us.

730
00:40:17,160 --> 00:40:18,719
Speaker 3: No, thank you very much for having me. I really

731
00:40:18,760 --> 00:40:19,319
Speaker 3: appreciate it.

732
00:40:23,920 --> 00:40:27,120
Speaker 2: Thanks for listening to this special episode of Symptomatic. Be

733
00:40:27,200 --> 00:40:30,120
Speaker 2: on the lookout for all new episodes of Symptomatic in

734
00:40:30,160 --> 00:40:33,839
Speaker 2: the coming months, and if you haven't already, be sure

735
00:40:33,880 --> 00:40:36,360
Speaker 2: to go back and check out our two part episode

736
00:40:36,480 --> 00:40:40,640
Speaker 2: on doctor David Fagenbaum. Seemingly in the prime of his life.

737
00:40:40,800 --> 00:40:44,080
Speaker 2: David went from determined medical student to dying in the

738
00:40:44,400 --> 00:40:46,240
Speaker 2: ICU in a matter of days.

739
00:40:46,880 --> 00:40:50,240
Speaker 5: I'll never forget my doctor walking into the room and saying, David,

740
00:40:50,280 --> 00:40:55,839
Speaker 5: your liver, your kidneys, your bone marrow, your heart, and

741
00:40:55,880 --> 00:40:58,240
Speaker 5: your lungs are shutting down.

742
00:40:58,880 --> 00:41:00,959
Speaker 3: I was just treating Pa down the hall.

743
00:41:01,719 --> 00:41:04,839
Speaker 2: Follow David's race against the clock for a diagnosis as

744
00:41:04,840 --> 00:41:08,920
Speaker 2: his efforts towards finding life saving treatment for himself quickly

745
00:41:08,960 --> 00:41:13,520
Speaker 2: become the first piece of an even larger puzzle. As always,

746
00:41:13,680 --> 00:41:16,000
Speaker 2: we would love to hear from you. Send us your

747
00:41:16,040 --> 00:41:18,840
Speaker 2: thoughts on this episode or share a medical mystery of

748
00:41:18,880 --> 00:41:23,360
Speaker 2: your own at Symptomatic at iHeartMedia dot com, and please

749
00:41:23,400 --> 00:41:26,520
Speaker 2: don't forget to rate and review Symptomatic wherever you get

750
00:41:26,560 --> 00:41:29,880
Speaker 2: your podcasts. We'll see you next time. Until then be

751
00:41:30,000 --> 00:41:30,320
Speaker 2: well