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Show 1382: What You Need to Know About Prostate Cancer

Show 1382: What You Need to Know About Prostate Cancer

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Listeners ask what they need to know about prostate cancer diagnosis and treatment. Drs. Armstrong and Koontz bring us up to date.

What do you want to know about prostate cancer? This week, Joe and Terry Graedon welcome your questions about the latest screening tools and treatments for prostate cancer.

Almost 300,000 men are diagnosed with prostate cancer each year, but stigma keeps many from discussing it. As a result, they may not learn about the latest treatments, which can be very effective. Our expert guests will tell you about new approaches. You can also share your experience at 888-472-3366 between 7 and 8 am EDT.

What You Need to Know About Prostate Cancer:

The statistics are grim enough. According to the American Cancer Society, roughly 300,000 men will be diagnosed with prostate cancer this year. More than 35,000 Americans are expected to die as a result of this common cancer, which is expected to affect 1 man out of 8 over the course of a lifetime. Most men who develop prostate cancer do not die from it.

Beyond the statistics are the stories. In December 2023, Secretary of Defense Lloyd Austin was hospitalized due to complications from a prostatectomy. (That indicates surgical removal of the prostate gland to treat prostate cancer.) Many people were upset that Secretary Austin did not tell his subordinates he would be going in for surgery. Was that because there is a stigma attached to prostate cancer? Does the United States need a champion to disclose his diagnosis and treatment to remove the stigma? Former First Lady Betty Ford did that for breast cancer.

Secretary Austin is not the only high-profile individual to suffer from prostate cancer (and possibly its stigma) recently. Former director of the National Institutes of Health Dr. Francis Collins is undergoing treatment for prostate cancer. His physicians had been doing regular testing on a prostate cancer they had first detected five years ago. In the most recent test, the cancer that had seemed non-threatening and slow-growing had suddenly become quite aggressive. Dr. Collins will undergo prostatectomy himself while participating in a clinical trial of post-surgery treatment at NIH.  He points out that the MRI and PET imaging that revealed the change in his prostate cancer are not available to every man.

How Do Doctors Detect Prostate Cancer?

The prostate is a small gland that produces seminal fluid to help carry sperm. Because it is tucked away inside the body, you can’t see it and it is difficult to feel it except with a rectal exam. For screening purposes, doctors usually recommend tracking prostate specific antigen (PSA). Even a healthy prostate gland produces low levels of this compound. However, when prostate cells start to grow quickly due to a cancer, PSA levels may increase quite markedly. Recommendations on who should have PSA levels measured and when have varied widely in recent years. Our guests will describe why.

Any man with troublesome symptoms such as difficulty urinating, painful urination, or blood in urine or semen should undergo screening. But experts do not always agree on the best screening protocol for men with no symptoms. African American men and those with a family history of prostate cancer are at higher risk and will probably benefit from starting screening at an earlier age. If the PSA starts to rise, MRI of the prostate may offer important additional information.

We will hear about the role of active surveillance. When is it appropriate, and when might it be too risky? What additional tools are urologists/oncologists employing to help with this process? New diagnostic tools such as mpMRI, PSMA PET or the AI pathology tool Artera can be very helpful in determining the extent and aggressiveness of the cancer. Genomic biomarkers and genetic testing can also be used for detection and prevention.

What You Should Know About Prostate Cancer Treatment:

One of the most challenging aspects of a prostate cancer diagnosis–besides having to face your own mortality–is choosing a treatment. One of the most common treatments is prostatectomy, as we mentioned above. Many men find the idea of just taking the cancer out very appealing. On the other hand, surgery can have unpleasant side effects. Some men experience impotence; others may have urinary difficulties. Although prostatectomy may be presented as the primary or only option, that is far from the case.

Androgen Deprivation Therapy:

Another component of prostate cancer therapy is reducing the amount of testosterone circulating in the body. Protocols that combine radiation treatment with androgen deprivation therapy have been extremely successful in preventing recurrence. Radiation can also treat metastases, cancers that have spread out of the prostate gland into the rest of the body. Immunotherapy is another recent option.

We welcome your questions:

Please call to ask what you would like to know about prostate cancer. Have you been diagnosed or treated? How can you improve your chances of avoiding a recurrence? You can email us: radio@peoplespharmacy.com or call 888-472-3366 between 7:00 and 7:50 am EST on Saturday, April 20, 2024.

This Week's Guests:

Dr. Armstrong:

Andrew J. Armstrong, MD, ScM, FACP, is Professor of Medicine, Surgery, Pharmacology and Cancer Biology. He is Director of Research at the Duke Cancer Institute Center for Prostate and Urologic Cancers in the Divisions of Medical Oncology and Urology at Duke University.
The website: https://prostateurologiccenter.dukecancerinstitute.org/prostate-cancer-research

Andrew Armstrong, MD

Dr. Koontz:

Bridget F. Koontz, MD, FASTRO, is an Affiliate Teaching Professor at the East Carolina University Brody School of Medicine. She will join
AdventHealth Cancer Institute in Orlando as Director for Radiation Oncology in summer 2024.
Dr. Koontz trained at Harvard Medical School, University of North Carolina-Chapel Hill, and Duke University School of Medicine. She has served as Medical Director of the Duke Regional Radiation Oncology and the Duke Cancer Clinics of North Durham and the inaugural Director of Radiation Oncology for the Duke Center for Prostate. From 2021 to 2023, she was the US Chief Medical Officer for GenesisCare, a global oncology network and research organization.

Her interests are in promoting excellence of clinical care for patients with genitourinary malignancies and developing clinical and translational research to improve both the treatment of and recovery from cancer. She is the senior editor of the practical handbook Radiation Therapy Treatment Effects: An Evidence-Based Guide to Managing Toxicity, published in 2017. Dr. Koontz continues to investigate clinical efforts to improve the quality of life of cancer survivors through technology such as eHealth apps and activity trackers. Currently, she represents the field of radiation oncology as a member of the NCI’s Genitourinary Steering Committee for NCTN trials.

[caption id="attachment_130318" align="alignnone" width="263"]Bridget Koontz, MD, FASTRO Bridget Koontz, MD, FASTRO[/caption]

Drs. Armstrong and Koontz will describe a clinical trial utilizing abiraterone (Zytiga) and radiation they conducted at Duke University Health System. If you would like to read about it, here are links:

International Journal of Radiation Oncology, Biology, Physics, April 1, 2021.

Prostate Cancer and Prostatic Diseases, Feb. 22, 2024.

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