Understanding the Role of a Digital Rectal Exam in Prostate Cancer Care

Understanding the Role of a Digital Rectal Exam in Prostate Cancer Care from Patient Empowerment Network on Vimeo.

Prostate cancer screening can involve different tests, but which ones are essential? Dr. Yaw Nyame with the University of Washington explains a common misconception about a prostate cancer test and and the effectiveness of PSA blood tests.

See More from [ACT]IVATED Prostate Cancer

Related Resources:

Prostate Cancer Screening and Outcomes _ Impact of Racial Disparities

Prostate Cancer Screening and Outcomes | Impact of Racial Disparities

What Can Signal Hormone-Sensitive Advanced Prostate Cancer

What Can Signal Hormone-Sensitive Advanced Prostate Cancer?

Advanced Prostate Cancer Clinical Trials _ Why Black and Latinx Participation Is Vital

Advanced Prostate Cancer Clinical Trials | Why Black and Latinx Participation Is Vital

Transcript:

Lisa:

Dr. Nyame, could you explain what a digital rectal exam is and its role in the prostate cancer screening, and is the screening invasive and can men prepare for it?

Dr. Yaw Nyame:

So I am so glad that this question is here because I think for far too long, there has been this misinformation that prostate cancer screening that is effective requires a digital rectal examination. And we have a lot of data that demonstrates to us that for screening to finding cancers early, that the digital rectal examination is not necessary and it’s not effective. Effective screening requires a blood test. And that is the PSA blood test. Now, if your blood test is abnormal, we absolutely require the rectal examination for what is called staging, and that’s to understand whether you have an advanced cancer or not. That digital rectal examination means that a provider uses a lubricated gloved finger to feel the prostate through the rectum that is an invasive test, but I would say absolutely do not let the thought of the finger exam as many of the men call it, be an impediment to being screened, because really what you need to catch your cancer early is a blood test.

A blood test that most people of African ancestry should be considering in their 40s. My activation tip when it comes to prostate cancer screening is to be informed on what the best current practices are and to understand that simply getting a blood test that you can add on to your standard routine physical examination and visit with your primary care doctor starting at age 40, could significantly increase your chances of having your cancer detected early when it is curable.

Cure rates of localized prostate cancer, so cancer that is only in your prostate is somewhere between 97 to 99 percent when we catch it early, and so this blood test can save lives, we have a lot of information that demonstrates that. And I think by being aware of the benefit of screening and the harms. Okay, false positive tests, infections, some of the other things that can come downstream, you can be well informed to make a decision that suits you, and you can have these conversations with your doctor to understand whether testing is appropriate for you and when and how to pursue testing to be screened for prostate cancer.

Sherea Cary:

My activation tip for care partners it’s important that the caregiver know what the blood test, what the range should be, so that when the results are back the care partner will understand whether you or the patient need to be concerned. It’s important to have the blood test done, the PSA test, it’s important to know what it detects as a care partner, and it’s also important to know what is the range of what is normal or what is something that needs to be examined further. Knowledge is the key as a care partner.

Lisa Hatfield:

Right, thank you both Dr. Nyame and Sherea, who is a care partner. Thank you for that. Those activation tips. 

[ACT]IVATED Prostate Cancer Post-Program Survey

Prostate Cancer Screening and Outcomes | Impact of Racial Disparities

Prostate Cancer Screening and Outcomes | Impact of Racial Disparities from Patient Empowerment Network on Vimeo.

What do prostate cancer screening and outcomes data show about racial disparities? Expert Dr. Yaw Nyame with the University of Washington shares research data about screening and treatment outcomes for Black populations and the importance of early detection.

See More from [ACT]IVATED Prostate Cancer

Related Resources:

Understanding the Role of a Digital Rectal Exam in Prostate Cancer Care

Understanding the Role of a Digital Rectal Exam in Prostate Cancer Care

What Can Signal Hormone-Sensitive Advanced Prostate Cancer

What Can Signal Hormone-Sensitive Advanced Prostate Cancer?

Advanced Prostate Cancer Clinical Trials _ Why Black and Latinx Participation Is Vital

Advanced Prostate Cancer Clinical Trials | Why Black and Latinx Participation Is Vital

Transcript:

Lisa:

So, Dr. Nyame, are there racial or ethnic differences in the incidence, screening outcomes, and/or treatment of prostate cancer. And can you talk about those a bit.

Dr. Yaw Nyame:

About prostate cancer demonstrates the widest racial disparity of any cancer in the United States. Black men are more likely to be diagnosed with prostate cancer, about 60 percent to 80 percent more likely, and they are more than twice as likely to die from prostate cancer compared to the average U.S. population.

When it comes to data on screening and treatment, there’s mixed data available of differing quality, but what I would say is that Black individuals, Black prostate cancer patients seem to be less likely to receive definitive treatments or treatments that can offer cure, and they’re less likely to have screening performed and perform a PSA testing, and I think a lot of the outcomes that we see reflect that lower use of early detection, finding cancers early through PSA testing, which is a blood test and lower utilization of treatment for when people are diagnosed with curable cancers is a really complex topic that I could talk about for a really, really long time, but suffice it to say that Black populations have among the worst outcomes of any cancer, when we look within prostate cancer and we know that other populations that have social disadvantages also can have worse prostate cancer outcomes as a result of the social determinants of health and other structural determinants of equity. When it comes to racial disparities and prostate cancer my activation tip is to be knowledgeable and aware.

Be knowledgeable and aware of what’s happening in your community with regards to prostate cancer and what’s happening in your family, because family histories are really important, not just to prostate cancer, but all cancers that may run in the family, because I think the first step is understanding what your individual risk is. And then that allows you to then make plans and educate yourself around things like, well, I do PSA screening to try and get my cancer detected early, if I’m at high risk, should I get treatment if I am diagnosed? And all the other things that come downstream. So really the awareness is absolutely critical, and I think having conversations that don’t seem like routine family dinner conversations, like, did grandpa have prostate cancer? Those are things that we need to normalize.

[ACT]IVATED Prostate Cancer Post-Program Survey

Thriving With Prostate Cancer | Tools for Navigating Care and Treatment

Thriving With Prostate Cancer | Tools for Navigating Care and Treatment from Patient Empowerment Network on Vimeo.

How can you thrive with prostate cancer? Dr. Tanya Dorff discusses prostate cancer treatment and developing research, side effect and symptom management, and shares advice and resources for coping with emotional issues.

Dr. Tanya Dorff is Associate Professor in the Department of Medical Oncology & Therapeutics Research at City of Hope. Learn more about Dr. Dorff here.

See More from Thrive Prostate Cancer

Download Resource Guide

Related Resources:

Tools for Partnering in Your Prostate Cancer Care

Tools for Partnering in Your Prostate Cancer Care 

Understanding Advanced Prostate Cancer Treatment Approaches

Understanding Advanced Prostate Cancer Treatment Approaches 

What Is Advanced Prostate Cancer?

What Is Advanced Prostate Cancer? 

Transcript:

Katherine:

Hello and welcome. I’m Katherine Banwell, your host for today’s program. Today’s webinar is part of our Thrive series, and we’re going to discuss tools to help you navigate life with prostate cancer. Before we meet our guest, let’s review a few important details. The reminder email you’ve received about this program contains a link to a program resource guide. If you haven’t already, click that link to access information to follow along during the webinar.

At the end of this program, you’ll receive a link to a survey. Please take a moment to provide feedback about your experience today in order to help us plan future webinars. And finally, before we get into the discussion, please remember that this program is not a substitute for seeking medical advice. Please refer to your healthcare team about what might be best for you.

Well, let’s meet our guest today. Joining me is Dr. Tanya Dorff. Dr. Dorff, welcome. Would you please introduce yourself?

Dr. Dorff:

Thank you. Hi, I’m Tanya Dorff. I’m a medical oncologist and section chief of the genitourinary cancer program at City of Hope, which is near Los Angeles, California.

Katherine:

Excellent. Thank you so much for taking the time to join us today.

Dr. Dorff:

My pleasure.

Katherine:

Like all of the webinars in our Thrive series, we start with the same question. In your experience, what do you think it means to thrive with prostate cancer?

Dr. Dorff:

Well, that’s a big question. As a medical oncologist, my job is to try to strike a balance between cancer control and quality of life, and I guess that’s how I would put thriving with prostate cancer. It’s not always just about what is the PSA doing, but it’s also about, ‘How are you getting around your day-to-day life activities, and are you able to do the things you enjoy?’ So, treatments can be very effective. They can also have significant side effects, and we spend a lot of time day in and day out trying to help men strike a good balance.

Katherine:

Thank you for that, Dr. Dorff. Let’s move on to how prostate cancer is treated. This webinar is mainly focused on advanced prostate cancer. But before we get into treatments for more advanced disease, let’s do a quick overview of early-stage prostate cancer options. First, some prostate cancer patients are often put in active surveillance. What does that mean?

Dr. Dorff:

Active surveillance is different than what some people think it is. So, some people think it means we’re not going to treat the cancer, that we’re just going to let it take its natural course. It’s actually quite active, as the name implies. We’re really trying to get to know a person’s cancer and understand whether it is a cancer that will ultimately need to be treated, in which case we will intervene with definitive treatment, whether that be radiation or surgery, but the goal is to find those patients whose cancer is not very aggressive and may never need to be treated so that they can avoid the possible risks that come from definitive local therapy.

Katherine:

So it’s more like a watch-and-wait situation?

Dr. Dorff:

But it’s…I, again, view it as a little bit different than that. Watch and wait is “let’s just let it do what it’s going to do.” Active surveillance is what I call a getting-to-know-you period. Let’s understand whether these clinical features that have signaled that your cancer may be low-risk, may not need treatment – let’s see if that really plays out, let’s make sure we haven’t missed anything, and if your cancer needs treatment, we’re going to treat it.

Katherine:

Okay, that’s good to know, thank you. When it is time to start treatment, what types of approaches are available for early-stage prostate cancer patients?

Dr. Dorff:

Localized prostate cancer or early-stage prostate cancer can be cured with either surgery or radiation, and we actually view these to be equally effective options. Sometimes people have the misconception that if they’re getting radiation to treat their localized prostate cancer, they’re being relegated to a noncurative or a less effective option. It’s actually not the case. We don’t have truly good, randomized, head-to-head studies.

You can find retrospective studies, people looking back at 2,000 patients treated at this institution or that institution, and you can find a study that pretty much says whatever you want it to. You can find some that say surgery’s better, some that say radiation’s better, but in sum, we sort of view them as being equally effective options. And so, they just have different side effect profiles, and so, we often counsel patients who are considering which local treatment to receive to look at what their current urinary function is, what their goals are for their long-term function, both urinary and sexual, and use that as a guide, as well as their age, their other health conditions, and those kinds of factors. 

Katherine:

Let’s turn now to how advanced prostate cancer is treated. First, what does it mean to have advanced disease?

Dr. Dorff:

Advanced prostate cancer signals cancer that’s come back after curative intention or has presented de novo in a way that means we don’t currently have a tool to cure it. That’s at least how I view advanced prostate cancer. You could take a broader definition and consider some high-risk localized patients who need multimodal therapy, but to me, it’s really signaling a shift from something we’re aiming to cure versus something we’re aiming to manage, so that can manifest just as a PSA that’s rising, what we call biochemical recurrence, or it can manifest as visible metastatic disease.

Katherine:

What does “locally advanced” mean?

Dr. Dorff:

So, “locally advanced” means that it hasn’t metastasized, but it might be involving the local structures, like the seminal vesicles or the bladder or some of the regional lymph nodes, the pelvic lymph nodes.

Katherine:

How is advanced prostate cancer treated?

Dr. Dorff:

The cornerstone of treatment for advanced prostate cancer has really been hormone therapy. I think there’s a lot of negative stuff out there on the internet about hormone therapy that I think does a disservice to patients because hormone therapy is truly very, very effective and, for many men, can be quite livable.

I have patients who live more than a decade on hormone therapy, and they’re running their businesses and they’re raising their grandkids, they’re traveling, they’re running 10Ks, they’re doing all the things that they might want to be doing. That’s not to say there aren’t side effects, but hormone therapy is an effective cornerstone, and I really hope people won’t dismiss it offhand because of the negative things they’ve heard or read about it.

Katherine:

What about other treatment classes?

Dr. Dorff:

Most of our other treatments are really layered on top of hormone therapy. We may get to a point – 10 years from now, I don’t know, sometime in the future – when we don’t start with the hormone therapy, so a lot of patients come in asking about the new radiopharmaceutical, the Lutetium-177-PSMA that got approved last year, or about whether chemotherapy can be used. They can be, but they’re really layered on top of hormone therapy, so the hormone therapy is the first treatment, it’s the most effective right now, and then it’s continued as we swap out – we add a novel hormonal agent like abiraterone (Zytiga), or enzalutamide (Xtandi), or one of the others.

When that is no longer effective, we swap that out, we might use chemotherapy or the radiopharmaceutical. There’s also an immunotherapy that’s been around for more than a decade called sipuleucel-T, and now there’s the targeted therapies – the PARP inhibitors – as well for select patients.

Katherine:

Where do clinical trials fit into treatment?

Dr. Dorff:

That’s a great question. I’m so glad you asked. Clinical trials some people mistakenly believe are your last choice, like you’ve gone through every single treatment we have, and then you go to a clinical trial. That’s not the case. Some of the biggest advances in prostate cancer have been when we’ve taken drugs that work in a more advanced resistance setting, like a second- or third-line, and when we move them right up front, first-line, we dramatically amplify their benefit. We dramatically improve survival.

So, if we don’t think about a clinical trial in the first line, we’re going to miss the opportunity to not only develop those new treatment paradigms, but actually participate in them ahead of when they become the new standard of care down the road.

Another misconception that people have often about clinical trials is that they are always randomized, there’s always a flipping of the coin in assignment of different treatments, and that they may include a placebo. So, most of our clinical trials at this point do not include placebo. Because we have so many effective treatment options, we’re more and more frequently comparing either two drugs against one, so everyone’s getting at least one effective drug, or we’re not comparing at all, but everyone’s getting some new treatment or some combination of treatments when we’re working out dosing in that scenario, like a Phase II.

So, clinical trials are really an option at any stage of prostate cancer, even at diagnosis for localized disease all the way through, and truly, I hope people would consider looking at those as options because that’s where some of the most innovative treatment options are going to become available to them.

Katherine:

Yeah. What sorts of questions should patients ask their doctors about clinical trials?

Dr. Dorff:

There are a few really basic things to ask about any clinical trial that you’re being presented as an option. One is is there a randomization? Is there a treatment assignment where some people get one treatment and some people get another treatment? Another one is is there a placebo? I think if we just get those questions up front, right away, then people may be more open to hearing what’s happening in the rest of the trial.

Our informed consent documents are reviewed by ethical consultants and are really meant to inform about risks more than benefits, so the other thing to really ask the provider is what’s the goal of the trial, because that’s often not clearly communicated in an informed consent. Why did the people who designed this trial think it was a good idea? Is there science behind it, is there clinical data behind it, and do you think this is something that, in the future, could end up being the new way that prostate cancer is treated?

What is it about me that you think makes me a good candidate for this trial? What’s been your experience? – even though it’s more anecdotal, but it’s often nice to hear from a physician “I have patients on this trial, they’re having these types of side effects, they’re having these types of benefits, and we can’t know what will happen for you, but at least I have a sense of how things are going on this trial.”

Katherine:

Yeah, those are great questions. What about cost? Is that a question that patients should ask about?

Dr. Dorff:

Patients often do ask about that. Costs are really complex in this medical care landscape that we have in the United States. Clinical trials – I think there’s a lot of misunderstanding about costs. Some people think that everything is paid for by the clinical trial, which is not true.

There is a system by which we assign things that will be paid for by the clinical trial – anything that’s novel and only being done as part of the trial versus things that would be done anyway if you were not in the trial and if you were just receiving regular care, such as your PSA test, your clinic visit, your CAT scan potential, or your bone scan.

So, there are some costs that are not covered, and in that case, if a patient has an insurance plan where they have copays for a clinic visit or for a CAT scan, those aspects that are not felt to be unique to the clinical trial and are getting billed to standard insurance – that means they’re still going to have those copays, but anything that is unique, if there’s an extra set of scans, if there are extra clinic visits, those get billed to the study, and the patient should have no extra cost on that basis.

Insurance companies should view clinical trials very favorably, because they’re often getting some clinical care paid for. They’re getting extra treatment at no cost, so anything that’s new on the treatment plan in the clinical trial is free to the insurance company on the patient, it’s paid for by the study, so it’s a good deal, generally speaking, and more importantly, there’s legislation that really seeks to ensure that regardless of your insurance, you should have access to clinical trials because they are felt to be often the best way to have your cancer treated.

Katherine:

Yeah. Dr. Dorff, are there emerging therapies that are showing promise?

Dr. Dorff:

There are a lot of emerging therapies. People all over the country and all over the world are working to find new and better ways to treat prostate cancer. So, the breakthrough radiopharmaceutical last year of the Leutetium-177-PSMA is the first, but not the last, I believe, in that field. There are other antigens we can target rather than PSMA, there are other particles we can use rather then Lutetium-177, and so, there are currently clinical trials looking at different constructs.

Take a winning strategy, and then tweak it a little bit to see if you can make it even better, right? Similarly, the PARP inhibitors, which are FDA-approved for prostate cancer, are being studied in different types of clinical trials to try to expand the number of patients who can benefit from them and amplify the benefit – so, moving them earlier, increasing the types of patients who are appropriate.

And there are additional targeted therapies, like the PI3-kinase AKT inhibitors, the CDK-46 inhibitors, that are being looked at in combination with our standard hormonal drugs that I think could end up being big advances depending how the results play out. There’s a novel class of drugs, the antigen receptor degraders, which also look tremendously promising in clinical trials and are in Phase III testing in some cases, and then, some additional ones are a little earlier in testing.

And then, there’s immunotherapy, which is at the heart of my research at City of Hope. Immunotherapy offers the promise of using your own immune system to control the cancer or eradicate the cancer, so we’re looking at different strategies, from oncolytic viruses, to bi-specific T-cell-engaging antibodies, to CAR-T cell therapies in hopes that we will find something that can really induce a big, deep, durable, long-lasting remission for patients.

Katherine:

That’s really promising. What about treating symptoms of the disease itself, like bone pain?

Dr. Dorff:

Bone metastases are the predominant pattern of spread, and so, what really drives the story for a lot of our prostate cancer patients during their journey with cancer has to do with bone complications – not always pain, but unfortunately, there can be pain pretty frequently.

So, we start by trying to protect the bones early on. We know that when we use our hormonal therapies, osteoporosis can develop, so we want to avoid that. I’ve had patients where their cancer was well-controlled, but they had an osteoporosis fracture that they were miserable from, so it starts at the beginning, at protecting the bones, checking a bone density scan and/or using a bone-supportive agent like zoledronic acid (Zometa) or denosumab (Xgeva), and then, in the metastatic setting, as the disease progresses, we intensify that use of bone-supportive agents.

We sometimes end up using radiation therapy, which is primarily external-beam traditional kind of radiation, but there is also the radiopharmaceutical Radium-223 (Xofigo), which delivers the radiation kind of more internally through the bloodstream to areas of the bone that are active from the prostate cancer, and sometimes we end up needing something even like surgery, but the bones are a major part of the story.

Katherine:

Yeah. What about sexual dysfunction? Are there approaches that can help?

Dr. Dorff:

So, this is generally an area that’s managed more by urology. There definitely are things that urologists do to help patients who have lost sexual function due to prostate cancer treatments. They can involve medicines, they can involve slightly more invasive things like a suppository or an intracavernosal injection. There are also more mechanical ways, like a pump device or a penile implant, but generally, anything beyond the first level, which is Viagra, will be handled more by a urologist than a medical oncologist.

Katherine:

What is palliative care, and how can it help men with prostate cancer?

Dr. Dorff:

Palliative care is something that we think about more towards the end of life, where we’re focusing on cancer symptoms more than treating cancer. However, some studies have shown – very prominent studies – that early palliative care in some malignancies is associated actually with better survival, meaning that paying attention to the patient’s symptoms is actually a really important part of keeping them well and keeping them alive as we treat the cancer.

So, more and more, we’re starting to integrate palliative care earlier in the disease.

I think that can sometimes signal a little alarm for patients – “Oh, I’m being referred to palliative care, that means my doctor doesn’t really think they can treat my cancer anymore” – and it’s gonna take some education to really help people transform their thinking about palliative care as a strategy that’s not for the end, but something that really should be part of our treatment all along.

So, our palliative care team, or what we call supportive medicine at City of Hope, uses treatments to manage pain. They have a broader spectrum, they’re more focused on all the different modalities to treat pain, so an oncologist or urologist can treat pain, but when we refer to palliative or supportive medicine, you get just that extra expertise, especially if people are having a lot of side effects from pain medicines, but our supportive medicine doctors aren’t only pain management doctors.

They help with other symptoms, like nausea or constipation, to some extent urinary symptoms for my prostate cancer patients, although we rely heavily on urology for that, and also just the existential, or spiritual, or emotional components.

Our supportive medicine team typically includes not only an MD, an advanced practice provider like an NP, but also someone from psychology, someone from social work, because dealing with cancer is really stressful and challenging, and in an ideal world, palliative care is not only taking care of the symptoms of the cancer that are physical, but also helping the whole being, the whole family unit that’s going through this experience have less emotional distress as well.

Katherine:

Yeah. Well, that leads us perfectly into the next section, which is about emotional support. Beyond treatment, another large part of thriving with prostate cancer is dealing with the emotions that come along with the diagnosis, like fear and anxiety. Whether it’s the stress of being in active surveillance or worrying about progression, many patients need help coping emotionally. Why do you feel it’s so important for patients to share these emotions with their doctor or their healthcare team?

Dr. Dorff:

I think it’s a conversation that’s not held enough between patients and their physicians, and if we don’t remember to ask our patients, we will just focus on the medical because that’s our main wheelhouse, that’s what we’re best at. So, if a patient brings forth that they’re having some emotions related to the cancer, it is helpful to us in remembering – we ought to do everything 100 percent all of the time, but let’s face it, we’re physicians with time pressures and certain areas of comfort and expertise. So, if a patient brings it up, that is super helpful because then we know someone’s needing assistance, which probably every patient is, whether they tell us or not, but that triggers us to then offer appropriate referrals.

And also, it tells us they’re open to it. If we have to ask every patient, “Are you having any emotional distress?”, even if someone answers yes and then we make a referral, they may not have actually been ready for it or open to it. So, having the patient come forth and raise that, I think, is really helpful and important.

Katherine:

Many prostate cancer community members are interested in learning more about their cancer and are hungry for information. For men who are newly diagnosed, are there educational resources that you recommend?

Dr. Dorff:

There are several good patient-focused or patient-facing educational resources for cancers generally. So, the American Society of Clinical Oncology, or ASCO, runs a patient-facing website called Cancer.net.

They also produce a lot of educational materials. So, for instance, we have some handouts in our clinic rooms produced by ASCO that really just help patients understand, okay, when you’re having diarrhea related to cancer treatment, here are some strategies. So, there’s lots of good information from them. There’s also a group specific for prostate cancer called Prostate Cancer Foundation.

So, they are an organization that works a lot in funding new research in prostate cancer, but they also put out some really helpful publications, again, that are aimed at prostate cancer patients, and really kind of covering the whole spectrum of disease, as well as more holistic aspects which are really important, things like diet and exercise and how that plays into overall wellbeing and health during prostate cancer treatment. So, we keep some of those little booklets in our rooms as well to hand out to patients, but they’re probably available by request online as well on one of the Prostate Cancer Foundation websites.

Katherine:

Yeah. What about resources for prostate cancer patients who are already really knowledgeable about their disease and want to stay up to date on the latest research and treatment? What’s available for them?

Dr. Dorff:

There are some conferences that seek to educate patients on a little higher level. It can be challenging because not every prostate cancer patient is at the same place, but they can look for some of those conferences. Frankly, they can follow Twitter or some of the other social media.

Sometimes prostate cancer support groups also will bring in speakers who try to provide updates about emerging treatments, or where the research is going, or where the field is going. So, most big cancer centers are gonna have a support group.

Obviously, it’s very variable, and sometimes they may focus more on the psychosocial aspects, but I do think a lot of them will include people like me, who are just trying to connect with the cancer patients on various levels about the latest and greatest.

Katherine:

We received some audience questions prior to today’s webinar, and I’d like to go through some of them with you. Bob asks, “Does androgen deprivation therapy cause cognitive issues?”

Dr. Dorff:

So, androgen deprivation therapy is another way of saying hormone therapy. We’re lowering testosterone, which is an androgen, and the question about cognitive issues is a good one. If you look in the literature, it’s not been well documented, and part of that is because our patients tend to have age and other comorbidities that can lead to changes in cognition happening at the same time as they’re being treated for prostate cancer, but also because the tools just haven’t been very good.

The tests where we measure how your brain is working have traditionally not been very good. There are some better tools that have been developed, and we’re hoping to be able to – with some ongoing studies – better define are there cognitive changes? If so, how severe are they, how common are they, are they more common with one drug versus another? Very basic questions.

I will say in my own practice, after 15 years of treating prostate cancer, I do believe that some patients experience cognitive changes during ADT. They can be mild, like taking longer to remember someone’s name or walking into a room and forgetting why you’re there, which, frankly, happens to all of us when we’re not having our best days, but obviously, I do see that a little bit more with prostate cancer patients who are receiving hormonal therapy.

For some of my really high-functioning patients, it can be helpful to use a drug that treats attention because some of the cognitive dysfunction actually ends up being an issue with attention. So, we use drugs like methylphenidate (Ritalin) or dextroamphetamine mixed salts (Adderall) to support patients who need to be really focused, and I’ve had many patients tell me that that has made a huge difference for them, so it’s not going to solve the overall changes that may happen in the brain on the basis of the hormonal deprivation, which we know happens from animal models, but it can help in the short term so that men can continue to function at a high cognitive level, despite ADT, when needed.

Katherine:

Yeah. George wants to know, “Are there any advances in imaging that patients should know about?”

Dr. Dorff:

Yes. So, the PSMA PET scans – so, these are a nuclear medicine imaging that looks for prostate cancer using a protein called PSMA, and there are several of them, there’s the F-18-based one called Pylarify, and then there are the Gallium-68 versions, Illuccix and Locametz, so those have been revolutionary. They can see prostate cancer in much smaller quantities, so we use them a lot for rising PSA after prostate surgery or radiation to see where is his small amount of cancer, and hopefully, we can treat it better by seeing it earlier.

They are also now being used to select patients for potential benefit from a treatment like Lutetium-177-PSMA, which obviously won’t work if the cancer doesn’t have that protein, so the imaging helps see who’s got the protein, who can benefit from the treatment. So, that’s the biggest imaging advance. There are some others, like using MRI fused to ultrasound for prostate biopsy at diagnosis. There’s also another kind of PET scan called a fluciclovine PET scan, which we still sometimes use because not 100 percent of prostate cancers have PSMAs, so sometimes we need something a little bit different.

Katherine:

Antonio had this question. “I heard that statins – cholesterol-lowering drugs – could help fight prostate cancer. Is that true?”

Dr. Dorff:

There’s been a lot of interest in the statins because in addition to having those positive effects against cholesterol, which are helpful when hormonal therapy that we use for prostate cancer disrupts our lipids, they have these anti-inflammatory properties that are being looked at in a number of different research avenues.

And then, there has also been a new, evolving understanding that they interfere with some hormone-binding compounds in the body, and so, could augment the effect of androgen deprivation therapy.

So, there has been interest in prospective studies because the literature we have right now is really retrospective, so we can’t really tell a patient which statin drug or what dose and for how long would be associated with a positive benefit, and we don’t really yet know how to use them proactively during someone’s treatment, but I will say if you’re starting on hormone therapy or ADT, having your lipids checked and getting on a statin if your lipids are not in a good range is really important anyway to just protect your cardiovascular health, and then, maybe we’ll find out that it does actually help your prostate cancer treatment be more successful as well, but I would say those data still need to be fleshed out a bit more.

Katherine:

Thank you for those answers, Dr. Dorff. I appreciate it. And please continue to send your questions to question@powerfulpatients.org, and we’ll work to get them answered on future programs. As we close out our conversation, Dr. Dorff, I wanted to get your thoughts on where we stand with research progress. Can patients truly thrive with advanced prostate cancer?

Dr. Dorff:

Absolutely. I would say in the 15 years I’ve been treating prostate cancer, I’ve really seen a transformation from a disease with a short lifespan and a lot of symptoms to a disease where people can actually thrive, living more than a decade even with advanced or metastatic prostate cancer, because the treatments have gotten so much better, and I think also potentially due to the increased awareness on the part of physicians about helping people stay healthy during their longer-term treatment. So, definitely, my patients today live longer and better than my patients did when I started treating prostate cancer.

Katherine:

Well, it seems like there’s a lot of progress and hope, then, for prostate cancer patients.

Dr. Dorff:

Absolutely.

Katherine:

Thank you so much for joining us today, Dr. Dorff. I really appreciate it.

Dr. Dorff:

Thank you. I hope people found it helpful.

Katherine:

And thank you to all of our partners. If you would like to watch this webinar again, there will be a replay available soon. You’ll receive an email when it’s ready. And don’t forget to take the survey immediately following this webinar. It will help us as we plan future programs. To learn more about prostate cancer and to access tools to help you become a proactive patient, visit powerfulpatients.org. I’m Katherine Banwell. Thanks for being with us today.

How Can Prostate Cancer Patients Access Clinical Trials?

How Can Prostate Cancer Patients Access Clinical Trials? from Patient Empowerment Network on Vimeo.

Dr. Andrew Armstrong shares trusted resources for accessing information about prostate cancer clinical trials and reviews common barriers to participation.

Dr. Andrew J. Armstrong is a medical oncologist and director of clinical research at the Duke Cancer Institute’s Center for Prostate and Urologic Cancers. For more information on Dr. Armstrong here.

See More From Prostate Clinical Trials 201

Related Resources

Should Prostate Cancer Patients Consider a Treatment in Clinical Trials

Should Prostate Cancer Patients Consider a Treatment in Clinical Trials?

Why Should Prostate Cancer Patients Be Empowered

Why Should Prostate Cancer Patients Be Empowered?

Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial

Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial


Transcript:

Katherine Banwell:

Yes, yes. How can patients find out about a trial that might be right for them? 

Dr. Armstrong:

There’s several sources. One is through their doctor. You know, their doctor can be their navigator. They will be connected either within a cancer center or be connected to a cancer center that’s in their region. So, getting a referral to a cancer center can be that open door to hearing what trials a big cancer center might offer. 

If patients are willing to travel longer distances, there are websites like clinicaltrials.gov where patients can search and find a trial, find a coordinator, find a principal investigator or doctor, contact them, and then either drive or fly to that site to access that trial. Not every patient has that means. 

But that’s certainly a resource that many patients and their family members can use to seek out those trials. And I certainly have patients that have found me in that way. 

But it’s probably more common for patients to come to you through a referral from their doctor because many sites in the community don’t have access to those clinical trials, but they know who does.  

Katherine Banwell:

What are some common barriers to accessing clinical trials? 

Dr. Armstrong:

The most important one is probably transportation. Some trials are close by, and some trials are very far away, and resources can be a major barrier. The cost of transportation, of having to be near a trial site, can be a major barrier. We wish we had all of the trials everywhere, but that’s not possible. Some trials are available at Duke, but are not available for example in Baltimore or Boston or California, and vice versa.  

Each academic institution may have their own trials. There are going to be some big trials that are available everywhere. These are like global Phase III studies. And really just talking to the physician, maybe getting a second opinion about which trial may be right for you in a certain circumstance is really part of the shared decision-making process. 

So, travel, socioeconomic status, cost concerns, those are barriers. But most clinical trials will pay for the experimental drugs. They will not charge you more money to participate in the study. And most insurance companies will pay for your participation in that trial, so that should not be a major barrier, but transportation can be. So, sometimes patients will find trials near a loved one or a family member so they can stay with them during the trial participation. 

What Is Precision Medicine for Prostate Cancer?

What Is Precision Medicine for Prostate Cancer? from Patient Empowerment Network on Vimeo.

 Prostate cancer has the option of precision medicine in the treatment toolbox. Dr. Heather Cheng from Seattle Cancer Care Alliance defines precision medicine and explains how it is used to help provide optimal prostate cancer care.

See More from Prostate Cancer TelemEDucation

Related Programs:

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

How Can We Improve Remote Access for Prostate Cancer Patients?

How Can We Improve Remote Access for Prostate Cancer Patients? 

Why Is Specialized Care Important in Prostate Cancer?

Why Is Specialized Care Important in Prostate Cancer? 


Transcript:

Sherea Cary:

So, what is precision medicine? And what…and what is precision medicine when we think about prostate cancer?

Dr. Heather Cheng:

Yes, it’s a great question and something I get really excited about. So, precision medicine, I guess in a nutshell would be finding out more about somebody’s personal prostate cancer and being more precise about our treatment decisions, meaning using that information to avoid overtreating or using drugs or treatment that don’t work and choosing treatments that we have a much higher level of confidence will be effective. Now, that’s the potential, sometimes we’re more successful than other time, but in prostate cancer, we have a few exciting examples that are, I think that are new, that I think just get me really excited because, for example, some cancer…some people, cancers have certain mutations or markers in them, that if they’re there, which is not in all people with prostate cancer, but if they’re there, then we have a different treatment tool box for those patients, so we have new extra, extra drugs or extra treatment opportunities, and that’s the sort of precision aspect or tailoring or we’re making the treatment it better for the patient and their cancer, and that’s really exciting, so it’s not one-size-fits-all, but kind of more tailored to the patient and their particular cancer.

New Developments in Prostate Cancer Care

New Developments in Prostate Cancer Care from Patient Empowerment Network on Vimeo.

Prostate cancer care has seen some recent developments. Dr. Heather Cheng from Seattle Cancer Care Alliance shares updates that are likely to be shared at the American Society of Clinical Oncology (ASCO) conference and a recent treatment approval.

See More from Prostate Cancer TelemEDucation

Related Programs:

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Understanding New Targeted Therapies for Prostate Cancer

Understanding New Targeted Therapies for Prostate Cancer

What Is the PROMISE Study for Prostate Cancer Patients?

What Is the PROMISE Study for Prostate Cancer Patients?


Transcript:

Sherea Cary:

Are there any exciting developments being presented at the upcoming ASCO conference that you can share with us?

Dr. Heather Cheng:

Yeah, I think one of the most recent, really exciting…there are many, it’s hard to pick just one. As a medical oncologist, I’m probably paying more attention to the Phase III clinical trials in the more advanced disease, meaning for patients who have metastatic cancer, cancer of the process started in the prostate that spread to other parts of the body. There are trials that show that the combination of effective drugs that we currently use in the latest stages of prostate cancer, metastatic prostate cancer, we are moving them earlier in the disease spectrum, meaning we are not waiting until the end when people are really sick. We’re trying to use them earlier, and we’re trying to use them in combination with each other to improve the outcomes of men with advanced prostate cancer, so men with prostate cancer that has spread outside the prostate can actually now live longer than they ever have ever before, which is really, really exciting. We do need to be thinking about side effects, but some of the newest strategies are, for example, trying to understand how we can use immunotherapy more effectively, so many people may be aware that immunotherapies are manipulating the immune system, is really effective in some types of cancers, and they have different side effects than chemotherapy, most of the time, they have fewer side effects that they occasionally can have pretty serious side effects, but as a general strategy, it’s very exciting in oncology to say, Can we encourage your own immune system, your defense system, your built-in defense system, to be more effective in addressing cancer without as many of the side effects. If we could do that, we would really be in a much better place, and for prostate cancer, it hasn’t historically been as effective, but many of the strategies now are trying to understand how can we manipulate the system and maybe give different combinations so that that works just as well as it does for some of the other cancers.

So, that’s number one, number two is thinking about this idea of precision oncology or tailoring the treatment to the person’s cancer are based on the genetics of their cancer and genetics of the patient, and we already have some examples now of how that’s really exciting and effective, and I think then the third strategy the third approach that I’m really excited about is these drugs that are what we call targeted radiation therapies, or there’s the drug called lutetium  [Editor’s note: Pluvicto is now approved] that is likely to be approved soon, where there is a radiation molecule that is linked or tagged to basically a homing device. So, it’s an antibody, which is something that is made by the body’s immune system, but basically hones in on any cell in the body that expresses this tag called prostate-specific membrane antigen, so you’re taking a smart delivery of radiation just to those cells, not to the other cells. So, it’s hopefully not going to have as many side effects, but it’s going to be really effective, so those are the kind of maybe in a high level over some of the things I am really excited about, and always there’s more progress and more to talk about, so hopefully, I can tell you about it again.

Sherea Cary:

Thank you. I find the information that you are providing about smart medicine very informing, and I think it can be used to help promote education in the community when we want to talk about prevention because when we talk about cancer, this…there’s this overwhelming feeling about it, and there’s sometimes a feeling of no hope, but when we put out more information about there’s ways that treatment can be targeted and where we can do prevention, if we find out early, treatments can be different and you can continue on with your life, I think that that makes a huge difference. And the more information that is provided about smart technologies for medical treatment is going to make a difference in the area of educating patients and caregivers about prevention and the importance of prevention.

Dr. Heather Cheng:

Absolutely, I think actually the most exciting thing about what I do is not necessarily the targeted precision treatments that I mentioned, what I get most excited and passionate about it is the fact that if those mutations are genetic, then what can we do for the brothers, for the sons, for the nephews, that can change things so that they don’t have to have those late-stage medications that we find the cancer early, we cure the cancer, so that it’s a non-issue. And I think that’s possible. We have to start somewhere, but I think we can definitely see benefit at the advanced disease setting, but I’m most excited and hopeful for the earlier… The sort of people who might be at risk where we can do something.  Just as you said, screening prevention…knowledge can be power. Knowledge doesn’t need to be a burden.  

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer?

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer? from Patient Empowerment Network on Vimeo.

Prostate cancer screening can now be accessed via some mobile methods. Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about mobile-optimized tools and access – and how mobile access is working toward health equity.

See More from Prostate Cancer TelemEDucation

Related Programs:

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Understanding New Targeted Therapies for Prostate Cancer

Understanding New Targeted Therapies for Prostate Cancer

Can Prostate Cancer Patients Rely on Telemedicine Without Risk?


Transcript:

Sherea Cary:

Can you speak to any mobile-optimized tools making a difference in prostate cancer?

Dr. Heather Cheng:

So, I don’t know specifically about…well, I can speak about some efforts I know about, but I think the mobile options are really a great idea. And I think the way I would think about it is, there are maybe…and I know this is the case, for example, mammograms. But I know that there can be traveling clinics where they may offer, for example, the prostate-specific antigen blood tests, which can be used as a screening to determine if somebody might have prostate cancer, and that might be something that somebody otherwise is really busy and doesn’t necessarily have access to. Usually, it’s something that is done by the primary care provider but can be done through mobile access, and I think some of the procedures could be done like blood tests for prostate cancer, I think to get an actual diagnosis to really be confident that there is prostate cancer, not something that’s just causing the PSA, that blood test could be high. Sometimes people can have a high PSA without cancer, and so it’s important to actually get a biopsy to help be more confident and know for sure that there’s cancer. That’s usually done in a clinic, but the screening, meaning the sort of trying to figure out if somebody’s at higher risk or not can be done in a mobile van, and I think there are a number of many excellent programs around the country, not enough, probably, but whose mission it is to try to improve access to cancer screening.

Why Is Specialized Care Important in Prostate Cancer?

Why Is Specialized Care Important in Prostate Cancer? from Patient Empowerment Network on Vimeo.

Prostate cancer specialized care can be utilized in different ways. Dr. Heather Cheng from Seattle Cancer Care Alliance explains the various ways specialized care can be used to help provide the best care in prostate cancer diagnosis and treatment.

See More from Prostate Cancer TelemEDucation

Related Programs:

Prostate Cancer Genetic Testing and Family Testing Guidelines

Prostate Cancer Genetic Testing and Family Testing Guidelines 

Prostate Cancer Treatment Tools and Advancements

Prostate Cancer Treatment Tools and Advancements

New Developments in Prostate Cancer Care

New Developments in Prostate Cancer Care


Transcript:

Sherea Cary:

Can you speak to the importance of connecting to specialized care in prostate cancer?

Dr. Heather Cheng:

Yes, I think it is really important when people are thinking about a diagnosis of prostate cancer, which is a difficult thing under the best of circumstances, but it’s so important to get the best information, the most current information. And if you’re thinking about prostate cancer surgery, if you’re thinking about prostate cancer radiation, if you’re thinking about medical therapies, you want to make sure that you have the most up-to-date knowledge and you’re in the best hands, and sometimes that’s going to a cancer center or a center that does see a lot of patients like you, who have cared for a lot of patients who have been in a situation like yours and have a lot more experience and have knowledge about the most current treatments and have experience. And so I think it’s important when you’re getting a diagnosis to get that information, and to at least have knowledge about all of your options and get the best knowledge, and I think that’s where patient education and then also getting second opinions can be really helpful, and telemedicine is allowing that to be easier, but really getting all the information before you make a decision and feeling that you’re well-informed is really going to go a long way in improving your outcomes and getting kind of the best treatment that you deserve, right? Patients really deserve that.

What Is the PROMISE Study for Prostate Cancer Patients?

What Is the PROMISE Study for Prostate Cancer Patients? from Patient Empowerment Network on Vimeo.

Prostate cancer patients may have access to participate in prostate cancer studies. Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about the PROMISE Study that she’s involved with and what the study examined in prostate cancer genetics.

See More from Prostate Cancer TelemEDucation

Related Programs:

How Is Genetic Information Used for Prostate Cancer Treatment_

How Is Genetic Information Used for Prostate Cancer Treatment?

Prostate Cancer Treatment Tools and Advancements

Prostate Cancer Treatment Tools and Advancements

Why Is Specialized Care Important in Prostate Cancer?

Why Is Specialized Care Important in Prostate Cancer? 


Transcript:

Dr. Heather Cheng:

The PROMISE Study is a study that I’m conducting in partnership with my colleague, Dr. Paller at the Johns Hopkins and other collaborators throughout the United States, and it’s a study to help men with prostate cancer understand their genetics. We know that there are many people who have prostate cancer who have genetic risks of prostate cancer, maybe they inherited a risk factor, but they don’t know about it, and this is important to know because now we have targeted or precision treatment options on additional toolboxes, treatments exciting treatments for those patients, but they may not be aware of it if they don’t know about their genetics. And so one is, it’s increasing the knowledge, and then also it may have important implications for the relative, so sometimes those genetic factors are shared and that information can also be life-saving. So the study is really easy, actually, patients who are interested or people that are interested who had a diagnosis of prostate cancer, go to the website, which is www.prostate cancer promise.org, and then they can read about the study and they can enroll on the web or by the Internet, and then they are mailed a saliva test or kit, and then they spit into the kit and then mail it back, and then they get a medical-grade genetic testing report back that test 30 genes that are associated with cancer risk. 

So some of those are prostate cancer, but then men who have certain mutations that we’re particularly interested in will be invited for long-term more…more long-term follow-up in all patients who participate can get a newsletter where we sort of inform them about the newest, latest, greatest things and prostate cancer. And so I think it’s really exciting because it’s increasing the ability and access of patients to genetic testing, but then also leveraging our web-based information platforms, just like this one, is to advance education and make sure we’re getting all of that excitement and opportunities out to patients even if they live far away from some of the biggest cancer centers, we want to make sure all patients have access to that knowledge.

Can Prostate Cancer Patients Rely on Telemedicine Without Risk?

Can Prostate Cancer Patients Rely on Telemedicine Without Risk? from Patient Empowerment Network on Vimeo.

Prostate cancer patients may have concerns about risks posed with telemedicine care. Dr. Heather Cheng from Seattle Cancer Care Alliance discusses telemedicine risks and benefits and specific situations when in-person visits help provide optimal patient care.

See More from Prostate Cancer TelemEDucation

Related Programs:

What Are PSA and PSMA?

What Are PSA and PSMA?

Telemonitoring and How It Benefits Prostate Cancer Patients

Telemonitoring and How It Benefits Prostate Cancer Patients 

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer?


Transcript:

Sherea Cary:

Is relying on telemedicine when managing prostate cancer without risk?

Dr. Heather Cheng:

No, I think with anything, there’s always some risk, I think the risks that I see as much as there are possibilities and benefits is that it can be difficult sometimes to get all the information about a patient from two dimensions. There’s a lot to be said for seeing somebody in a room in 3D, and really getting a sense of their overall help, being able to examine them, so sometimes there are things we can’t replace in terms of listening to somebody’s heart and lungs then maybe doing other examination and procedures to really understand where the patient is things like biopsies, things like treatment, seems like blood draw may still need to be part of the patient’s care in order to give the best recommendations, so even though I think there’s a huge amount of possibility for benefit of telemedicine, there are some things that cannot be replaced, and that’s the danger that if patients don’t come, if I never see somebody in 3D in clinic, then I’m losing some valuable information about that patient, and so there are times when we still like to see people maybe it’s not as frequently, so it’s more convenient, but there are times when we definitely still need to meet with people face-to-face, do procedures or medications or just lay eyes on them in real life.

So, I think that’s a danger. If that’s not present at all, then we’re going to miss important things in people’s healthcare.

Telemonitoring and How It Benefits Prostate Cancer Patients

Telemonitoring and How It Benefits Prostate Cancer Patients from Patient Empowerment Network on Vimeo.

Prostate cancer can benefit from the use of telemonitoring as part of care.  Dr. Heather Cheng from Seattle Cancer Care Alliance explains telemonitoring and situations when telemonitoring can be beneficial for prostate cancer care. 

See More from Prostate Cancer TelemEDucation

Related Programs:

Prostate Cancer Genetic Testing and Family Testing Guidelines

Prostate Cancer Genetic Testing and Family Testing Guidelines 

Can Prostate Cancer Patients Rely on Telemedicine Without Risk?

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer?


Transcript:

Sherea Cary:

What is telemonitoring? And does it benefit prostate cancer patients?

Dr. Heather Cheng:

Yeah, telemonitoring. I think probably for prostate cancer it would best be described as monitoring symptoms, side effects, and may also include following the PSA blood and other blood tests that can be drawn at the convenience of the patient, so they may be for example, a patient could go to the lab, have their blood drawn on the weekend when they’re not working, and then have those results be available for their visit, or sometimes they don’t even need to have a visit and they can do a lot of the communications by the patient web portal, so we increasingly have that as an option where the nurses are able to…the whole team can work together to us help the patient in between, so maybe it’s not in real time, but it’s a little bit like email or Twitter where there can be communication about a patient’s healthcare and maybe a side effect optimization like somebody’s having side effects and we adjust the medication or we add another medication to make it more easy to manage, so that’s definitely something that I think is more possible in the current era of telemedicine and telemonitoring.

How Can We Improve Remote Access for Prostate Cancer Patients?

How Can We Improve Remote Access for Prostate Cancer Patients? from Patient Empowerment Network on Vimeo.

How can prostate cancer remote access and care be improved for patients? Dr. Heather Cheng from Seattle Cancer Care Alliance shares how optimal remote care can be ensured and explains some situations when in-person care can provide better care. 

See More from Prostate Cancer TelemEDucation

Related Programs:

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Prostate Cancer Treatment Tools and Advancements

Prostate Cancer Treatment Tools and Advancements

Why Is Specialized Care Important in Prostate Cancer?

Why Is Specialized Care Important in Prostate Cancer? 


Transcript:

Sherea Cary:

It sounds like to me that telemedicine is similar to the work from home, and it seems like we’re all getting benefits from the ability to be able to do some things in a remote fashion. Are there any steps being taken to improve remote access for prostate cancer patients?

Dr. Heather Cheng:

Yeah, I think…I don’t know that the efforts that we have are specific to prostate cancer patients, but I sure hope that prostate cancer patients, like all of our patients across medicine can continue to benefit from these new technologies, and I think we are getting better…we’re not perfect, of course, there’s always room for improvement, but we’re getting better at trying to partner with our patients to figure out how to do this in a way that is as optimal as possible, and sometimes I think there is great value still to seeing people face to face and examining them, and sometimes that can’t really be replaced, but maybe that’s not all the time for all the visits, and so as long as patients are comfortable using the platform, using the telemedicine, using the software and the phone, those things, some patients aren’t. So, I think we need to really make sure that the patients who are not comfortable or who need a little extra help with the technology get the help they need so that they are not left behind. Because I do worry a little bit about people who may be not as comfortable with using video conference or ZOOM or things that many of us are getting more familiar with, but not all patients are, so we need to just make sure we’re thinking about those of those who may not be quite as comfortable or maybe whose Internet access is not as stable, things like that.

Prostate Cancer Treatment Tools and Advancements

Prostate Cancer Treatment Tools and Advancements from Patient Empowerment Network on Vimeo.

What’s the latest in prostate cancer treatment tools and advancements? Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about areas of prostate cancer research that have experienced recent advancements.

See More from Prostate Cancer TelemEDucation

Related Programs:

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

How Can We Improve Remote Access for Prostate Cancer Patients?

How Can We Improve Remote Access for Prostate Cancer Patients?

What Is the PROMISE Study for Prostate Cancer Patients?

What Is the PROMISE Study for Prostate Cancer Patients?


Transcript:

Dr. Heather Cheng:

I think it’s a really exciting time. I think there are a lot of advancements throughout prostate cancer. I think one area of importance is early detection, but we also have newer imaging platforms, meaning the way, and we can discover where the prostate cancer is, is advancing through new types of PET scans that we didn’t previously have. And then my own kind of research which is near and dear to my heart is talking about genetics and what we have learned about the genetics of the risk of prostate cancer, but also how the genetics of the cancer itself, which sometimes is inherited, and sometimes isn’t can help us plan for better treatments for patients.

Understanding New Targeted Therapies for Prostate Cancer

Understanding New Targeted Therapies for Prostate Cancer from Patient Empowerment Network on Vimeo.

Which prostate cancer therapies are experts excited about? Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about recent treatment advancements and how the therapies are utilized to help provide optimal prostate cancer care.

See More from Prostate Cancer TelemEDucation

Related Programs:

What Are PSA and PSMA?

What Are PSA and PSMA?

Telemonitoring and How It Benefits Prostate Cancer Patients

Telemonitoring and How It Benefits Prostate Cancer Patients 

New Developments in Prostate Cancer Care

New Developments in Prostate Cancer Care 


Transcript:

Sherea Cary:

So, Dr. Cheng, share with us some of the new treatments that you and your colleagues are excited about? 

Dr. Heather Cheng:

Thank you. So I am a medical oncologist, I specialize in genetics, most of my patients have more advanced prostate cancer, meaning they have had surgery to remove their prostate, but then their cancer continued to grow or that they have radiation and their cancer continued to grow, and we are…then looking at treatments that are medical, and by that I mean they are given through a pill, or they’re given and through an injection and they travel throughout the body and treat the cancer…wherever the cancer is.

And I think what I get very excited about is that we have new targeted therapies, and by that I mean some of my patients to have certain mutations in their cancers or DNA changes in their cancer, have access to newer treatments like a pill, for example, called in a family called PARP inhibitor, that are really especially effective against cancers that have that type of mutation. So can’t we learn about this whether it’s a good fit or whether that person’s cancer might especially be well treated by that drug by doing DNA sequencing of the cancer or DNA sequencing of that person’s DNA, inherited DNA. So, both of those can give us clues about this kind of special treatment toolboxes that I get very excited about, and so I think that’s the frontier in oncology, but also in prostate cancer as well.

Prostate Cancer Genetic Testing and Family Testing Guidelines

Prostate Cancer Genetic Testing and Family Testing Guidelines from Patient Empowerment Network on Vimeo.

What do patients need to know about prostate cancer genetic testing? Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about genetic testing, testing guidelines for those with a family history of prostate cancer, genetic counseling, and when it’s important to share family medical history.

See More from Prostate Cancer TelemEDucation

Related Programs:

Prostate Cancer Genetic Testing and Family Testing Guidelines

How Is Genetic Information Used for Prostate Cancer Treatment?

Understanding New Targeted Therapies for Prostate Cancer

Understanding New Targeted Therapies for Prostate Cancer 

Are Mobile-Optimized Tools Making an Impact in Prostate Cancer?


Transcript:

Sherea Cary:

Is it easy to get the genetic testing, and if you have a first-degree relative, if you had a father who had prostate cancer and your son, is it easy for them to get the testing, and do you recommend it?

Dr. Heather Cheng:

Yeah, I think that’s a question that I think it’s becoming easier, it is something that I think it’s important for people to understand what it can and cannot do, so if there is a strong family history of prostate cancer, for example, it is best to start with the person in the family who has cancer, if we were talking about genetic testing, if that’s possible. If it’s possible, testing that person, because if they have that marker, then we’re more confident that that’s important for the family, it’s sort of…if that person doesn’t have it, then it’s much less likely that the children or the relatives who don’t have cancer will have it. So I guess thinking about the person who has cancer and then also sharing with the family, sharing what the doctor is a family history of cancer.

But I guess one of the things that’s really interesting and I would guess, I would say challenging but exciting in the field, is that historically, we’ve had a reliance, or we’ve needed to do genetic testing through genetic counselors. And genetic counselors are professionally trained individuals who can answer questions about genetics, and sometimes patients or persons, people have a lot of questions, maybe they are not sure they want to do it, and so if they’re not sure that it’s important to get them the information so they can understand what the testing is about and then feel good about proceeding with testing. I think there’s a lot of value to knowing about somebody’s genetics, but there can be questions and concerns, and so we want to make sure every person has the chance to do that.

We have studies, and more and more, I think there is availability of genetic testing and people can do genetic testing through blood test or a saliva test, and the other thing that’s really important to understand is that there’s kind of two major classes of genetic testing, I would say, one is what I would call recreational for fun, and those are tests like 23andMe or Ancestry.com, where you’re trying to maybe you pay some amount of money and you want to know where in the world your relatives are from. That’s more for fun, it’s not really useful for medical purposes, if you’re thinking about genetic testing for how to manage your medical care, you might want to talk to your doctor about it, but there’s a different set of tests that are really medical-grade, and they shouldn’t be confused with each other because they have really different purposes. One is more recreational and one is, we need the quality to be much higher because we’re gonna use this information for your care, and we want to make sure is the sort of standards are a lot higher, and so for example, I have a study with my colleague, Dr. Paller at Johns Hopkins, where we were offering then we’ve met any type of prostate cancer, so any history of prostate cancer, and they don’t necessarily have to have a family history of cancer, but we would ask them about that, and if they’re interested in participating, then they get mailed, they can enroll at prostate cancer promise dot org, and then they are mailed us a Levite, and that test is a medical grade test that’s not one of the recreational tests, that one is, it is covered free of cost, so there’s no cost to the patient, and then there’s also an email and informational hotline if there’s more questions and somebody wants to, you know, learn more about it before they proceed. So that’s one way that we’re trying to expand the access of genetic testing to patients and their families.

Sherea Cary:

I have one more question. When we talk about family history, does that mean we have to have one or two generations or just one generation, how many generations qualify for a family history?

Dr. Heather Cheng:

Yeah, that’s a great question. I think a couple of important points. So, family history is really the available information that you have, and sometimes people have a lot of information about multiple generations, and sometimes they don’t, and I think whatever you have is important, and if you don’t have all of it…that’s okay, but the important things to think about are, do you know about any family history of prostate cancer, but…that should be on both sides of the family. Sometimes people will think, “Oh, if it’s only on my father’s side, should I only think about it on my father’s side because it’s prostate cancer” which is a male cancer. But actually, it’s really important to ask about both sides, because maybe your mom’s dad had prostate cancer, or maybe your mom’s brother had prostate cancer, that’s also really important to know about, and then some of the other cancers are also really important, such as is their breast cancer and the family, and is it on the mom’s side or the dad’s side? And if it’s known, kinda how old was the person when they had that cancer, where they’re in their 50s or where are they’re in their 80s.

So those kinds of things, if it’s known and many people don’t know all of these details, then that’s okay, but if you do know it, then it’s important to share it. And I think sometimes there are relatives who are a little less comfortable talking about their health. But if you think if there’s a culture of saying, “This information might help my kids or my grandkids to share that with their doctors and then think about their own cancer screening more proactively,” then maybe that will be an incentive to sort of open up those dialogues, I know sometimes it’s hard to talk about cancer diagnosis, but it can be life-saving.