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What Do Prostate Cancer Patients Need to Know About COVID-19?

What Do Prostate Cancer Patients Need to Know About COVID-19? from Patient Empowerment Network on Vimeo

Due to COVID-19, many patients with prostate cancer must follow new guidelines to receive care. Dr. Alicia Morgans, a hematology and oncology specialist, explains precautions patients should take and the role telemedicine plays in prostate cancer care.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

Prostate Cancer Research News

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

Men with prostate cancer, like every patient with cancer, do need to take precautions because of COVID, but the degree of caution that they need to take really depends on a couple of factors. One is probably that individual’s age, with older people being more susceptible to having severe complications related to COVID, especially if they have other medical conditions like COPD or lung disease or heart disease with a history of things like heart attack or stents in the heart. Things like diabetes can even increase the risk of having complications, according to some studies, for people with cancer. So, these are things to think about. Comorbid illness and certainly advancing age.

The other thing that I always think about is what kind of therapy are you getting as a man with prostate cancer? Are you getting something that really is only affecting hormones, like lowering testosterone levels or blocking testosterone signaling? That’s the male hormone. Hormonal treatments don’t suppress a person’s immune system. So, they don’t change the way that an individual’s immune system can attack the COVID virus and protect them from that illness. And those kinds of treatments are not as dangerous to use in a pandemic like we’re experiencing now, because they don’t affect a person’s ability – their innate and normal ability – to fight off the disease.

Things like chemotherapy, on the other hand, do suppress the immune system. They make it difficult for the immune system to fight things like that SARS virus, SARS-CoV-2, that causes COVID-19, because it suppresses the immune system such that a patient can’t mount the normal response that he would have against that virus if it came into his body.

When we don’t have an immune system, we can be more susceptible to things like that SARS-CoV-2 virus that causes COVID-19, but we can be susceptible to things that we would find in our normal environment and sometimes even to infections from bacteria that live in our body all the time. So, things like chemotherapy can be challenging whenever you take them. They can be incredibly effective against cancer. And so, it’s always this trade-off.

And if it’s recommended to you, you can get it safely, but taking extra precautions with, of course, washing hands, wearing masks, but also, probably, really still socially distancing even though some of the restrictions in most of the United States have lessened. If you’re on chemotherapy, I would still recommend social distancing and staying out of public places, because you do not necessarily have the immune system that you would normally have to protect yourself from the virus.

Telemedicine has been great for men with prostate cancer when they don’t necessarily need to come in to be seen. This can be really helpful, especially between visits where people are getting injections that they get to lower testosterone as androgen deprivation therapy. If that injection is due every three months or four months, but your doctor wants to check in on you every six weeks or eight weeks, having a telemedicine visit at that interim visit can be really useful so you don’t have to come all the way into the clinic to see the provider.

They can even be useful if you do need to get the injection or you do need to get lab work, because you can get those procedures and then go home and still be safe not sitting in a waiting room, not sitting in a doctor room. And the doctor can usually call and have that telemedicine visit.

For men who have been treated and are simply having their PSA followed because they’ve had a prostate surgery or have had radiation to the prostate and are believed to be cured, as long as they can get that lab work done, the telemedicine visit gives them the opportunity to get the guidance of their doctor who has looked at their lab work, without actually going in to see that doctor in person and potentially put themselves at risk of getting an infection in the in the clinic or the hospital setting.

So, telemedicine is a way for us to really protect our patients and stay engaged while we’re not seeing them in person. But it is still important to do the telemedicine and not just say I’m not going to do anything. And it will be important at some points for many men with prostate cancer to come in at least to do lab work or to get their injections if that’s part of their treatment plan to make sure that they are still being monitored despite the pandemic.

Prostate Cancer Research News

Prostate Cancer Research News from Patient Empowerment Network on Vimeo

Are there developments in prostate cancer research that patients should know about? Dr. Alicia Morgans discusses highlights from the 2020 American Society of Clinical Oncology (ASCO) meeting.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

What Do Prostate Cancer Patients Need to Know About COVID-19?

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

Just recently in June, ASCO, which is our American Society of Clinical Oncology, meeting was held here in Chicago, and it was a virtual meeting. It was actually very exciting for people who take care of prostate cancer and for men who have prostate cancer in several advances. Some of those advances were around imaging and new strategies that we’re going to have, I think, in the relatively near future using PSMA-targeted imaging for men who have prostate cancer that is high-risk before they go through things like surgery or radiation, or for men who have a rising PSA after they’ve had their initial treatment for prostate cancer.

We also learned the survival data that was associated with three agents that we now have to treat non-metastatic castration-resistant prostate cancer. And this is prostate cancer where we have had a group of men who have already had treatment of their prostate, but now have a rising PSA blood level despite having imaging that doesn’t really show any areas of cancer on the scans. And there are three drugs that we have to use for men with this particular stage of prostate cancer, or state of prostate cancer, and we learned that those drugs not only prolong the time until men develop metastatic disease or disease that we can see on those scans, but they also help men live longer.

And this tells us that if we move those therapies earlier on in the stage of treating prostate cancer, we can actually, probably bend the curve of that man’s survival for the rest of his life. Intervening early, at our earliest opportunity, in this particular situation may be so helpful for men over the rest of their journey, no matter what their next treatments might be.

And finally, we learned information about a drug called lutetium, which is not yet approved for the treatment of prostate cancer, but was tested in a clinical trial for men with more advanced prostate cancer and called metastatic castration-resistant prostate cancer. And we learned that this drug can be both tolerable and potentially as effective, or perhaps more effective, than the chemotherapy that we have traditionally used in this state. So, lutetium is a drug that we expect will eventually be approved for the treatment of prostate cancer, pending some clinical trial data that we are still waiting for. And that was real exciting, to learn about the upcoming advances with this particular drug.      

Why You Should Consider a Prostate Cancer Clinical Trial

Why You Should Consider a Prostate Cancer Clinical Trial from Patient Empowerment Network on Vimeo

Dr. Alicia Morgans, a hematology and oncology specialist, explains the importance of prostate cancer patients of different geographic locations participating in clinical trials and the role trials plays in clinical care.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

Prostate Cancer Research News

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

From my perspective, I think any time in a prostate cancer journey is a great time to think about a clinical trial if that trial is available where you live or is available at a place where you would be willing to travel. We have so much to learn about prostate cancer, about how to continue to provide options to patients, and about how to support men as they go through their treatment. And the only way we can learn those things is if men participate in clinical trials. So importantly, also, we need to have men of diverse backgrounds of diverse races from geographic diversity.

Because if we only study certain people from the city of Chicago, for example, where I live, we’ll really only know what we know about those men. And we won’t necessarily know if we can apply our findings to men who live in Atlanta and are Black. It’s going to be the kind of thing where we have the data, but we don’t necessarily know if it’s going to be the right data for you.

So, the more men of color, the more men from different geographic locations that we can encourage to participate in clinical trials, the more we learn for every patient and the more we are able to take care of the specific and unique needs of you as an individual, which is really a critical part of what we do and why we do what we do. So, participating in clinical trials, no matter who you are, if you’re able, and if you’re willing, is really a great service to you to get, hopefully, better outcomes for you, but also a great service to your community of men with prostate cancer.  

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

Prostate Cancer Treatment Decisions: Which Path is Best for YOU? from Patient Empowerment Network on Vimeo.

Which prostate cancer treatment path is best for you? Dr. Alicia Morgans discusses how multiple factors, including disease progression and patient goals, determine which treatment path is best to help improve a patient’s outcome and overall quality of life. 

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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What Do Prostate Cancer Patients Need to Know About COVID-19?

Prostate Cancer Research News

How Does Prostate Cancer Staging Affect Treatment Approaches?

 


Transcript:

Dr. Alicia Morgans:

The main factors I think about when approaching a treatment plan for a patient is to understand is this treatment for cure. Are we able to cure this patient? Is that our goal? Or are we in a situation where we know that the cancer is going to be incurable, but we can prolong that individual’s life and improve the quality of life that he has?

That is a major breakdown or separation point in how we approach treatment. Once we figure that out, we can try to sort through among all the choices. If we’re going to use curative treatment to the prostate itself, what do we think is best for you as an individual man? And what do we think is possible from a medical perspective? Whether that’s radiation or surgery or even just watching and waiting with an active surveillance plan, there may be choices.

And similarly, with metastatic prostate cancer or advanced prostate cancer that’s incurable or not able to be cured, what are the medical treatments that we can use? And what are the choices that you as a man with prostate cancer want to make to really maximize your benefit – thinking through what’s important to you? What barriers do you have? And how do you want to go through your treatment sequence?

We’re actually really fortunate in prostate cancer care to have many choices, whether it’s in treating localized curable prostate cancer or in treating metastatic prostate cancer that we’re really trying to treat to prolong life and improve quality of life. In each setting, in most cases, there are multiple choices to make along the journey. Sometimes these choices would exclude other choices in the future, but sometimes they don’t. Sometimes you can choose A or B, because in a few months, you’re going to have the opposite option available to you. So, exactly what your choices are going to be are going to be important for you to speak with your doctor about.

But having those choices really empowers men to get engaged in each of these treatment decisions to explain this is my preference for that side effect or this particular toxicity, and I’m going to choose this treatment, because it works best for me because I can get to work or because it doesn’t lead to incontinence or because it doesn’t cause me to lose my hair or whatever the reason is. Men’s preferences can be so importantly incorporated into the treatment decision, because we have all the choices we have in treating prostate cancer.

How Does Prostate Cancer Staging Affect Treatment Approaches?

How Does Prostate Cancer Staging Affect Treatment Approaches? from Patient Empowerment Network on Vimeo

Every stage of prostate cancer stage requires different treatment approaches. Dr. Alicia Morgans explains prostate cancer staging and how it impacts treat options.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Prostate Cancer Research News

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

Staging in prostate cancer is a way for people to understand how to best approach the treatment of the disease. To say this a different way, low stages – things like Stage I, II, and usually Stage III – can be treated with local therapies to the prostate itself with a goal of trying to cure the prostate cancer. And some patients who have Stage I disease may not even need active treatment, but could be followed on active surveillance as a way to monitor the cancer and prevent side-effects by simply monitoring until it would actually need treatment. Higher stage, like Stage IV, means that the cancer has spread outside of the prostate.

And it’s still prostate cancer. It just is cancer cells from the prostate that now live in the bones, or live in distant lymph nodes, or live in another organ or place in the body. Those cancer cells are still treated the exact same way we treat prostate cancer in terms of the medical therapies – the injections, the pills, the chemo agents potentially – that we would use to treat those cancer cells, whether they’re in the bones or in the prostate. But when they have spread outside of prostate, that typically means that there’s no longer an opportunity for us to cure that cancer. And we wouldn’t necessarily use things like surgery or radiation to the prostate if the cancer had spread.

I say “wouldn’t necessarily,” because that is certainly an area that’s evolving. And now even men with metastatic prostate cancer or Stage IV prostate cancer can be treated with radiation, in particular, to the prostate, and we know that can be beneficial. So, staging helps us understand how far the cancer has spread or not spread.

And it helps us understand if we can treat that patient with local treatments to the prostate to try to cure them, or if we need to use medical therapies as a major backbone of treatment rather than things like radiation or surgery to treat them for prolonging their life and improving quality of life but knowing that we can’t cure their disease.

Are You Prepared for Your Prostate Cancer Appointment? Expert Tips.

Are You Prepared for Your Prostate Cancer Appointment? Expert Tips. from Patient Empowerment Network on Vimeo.

Could you be better prepared for your prostate cancer appointment? Prostate cancer specialist, Dr. Alicia Morgans explains what pre-appointment tasks and helpful tools can help ensure patients get the most out of their appointments.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Seeking Optimal Prostate Cancer Care? The Importance of Partnering With A Specialist

How Does Prostate Cancer Staging Affect Treatment Approaches?

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

There’s not really a question that I think is missed in most appointments when I talk to men with prostate cancer, but there are many men who have a burning question, whatever it may be, and they forget to ask it when we’re in that clinical encounter.

And the advice I would have is it’s really important if you think of it as a question that’s really important to you or even just a fleeting thought, to consider keeping a notebook where you can write it down to remember what that question is. Because if you bring the notebook, even that fleeting thought that you may never think of again is something that you’ve got written down, and you can open that notebook, and you can say, “Hey, I thought this may be a silly question, but what do you think?” And I’m sure that your doctor will answer it.

Questions about “How long do I have?” or “What can I expect?” or “How is this going to end?” or “Where is this going to go?” – these are sometimes questions that are really hard to answer. But even those questions, if that’s what you’re thinking about all the time, are going to be important to at least discuss with your doctor, whether you get a concrete answer or not. That may be an ongoing conversation that you have. But if you trust your doctor, you’ll be able to ask whatever it is that you need and not feel like it’s a silly question, because there really isn’t a silly question.

My best recommendation for patients to think about as they’re preparing for their physician visit is to get an advocate; get somebody to come in with you. And if that individual can’t come in with you, perhaps that individual can be on a cell phone or on FaceTime or engaged in that visit in some way, either in person or virtually.

And to take notes or to ask for things to be printed out that explain what you discussed at your visit, because it is very challenging to take in everything that is discussed in those physician visits and memorize everything when there’s really so much going on in many cases. So, having another set of eyes and ears and having a notebook piece of paper or a printout that really catalogs what was discussed can be really, really helpful in preparing for a visit.

And the other thing is to maybe always end with “Is there anything that I didn’t ask that I should?” or “Is there anything else that I need to know?” And sometimes that will prompt the doctor to say, “Yeah, I got through this whole thing, but I meant to mention this, and I forgot.” So, always leaving that door open in case there’s anything else the doctor needs to mention, and sometimes they just need a little prompt at the end. But I think the advocate’s probably the most important part.

Seeking Optimal Prostate Cancer Care? The Importance of Partnering With A Specialist

Seeking Optimal Prostate Cancer Care? The Importance of Partnering With A Specialist from Patient Empowerment Network on Vimeo.

As prostate cancer treatment options continue to expand, it’s important to partner with a physician who is up-to-date on the latest developments. Dr. Alicia Morgans explains why patients should consider seeking a specialist and obtaining a second opinion.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

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Three Key Steps to Take Following a Prostate Cancer Diagnosis

Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

Over the last few years, prostate cancer treatment has been incredibly complicated. And I think I and many in the prostate cancer community would absolutely recommend that men with prostate cancer seek out a prostate cancer specialist to make sure that he has access to someone to get advice and medical recommendations that are going to be the most up-to-date.

It’s incredible to me that in the last few years there have actually been multiple new medications that have been approved, even some as recently as about a month and a half ago. And this landscape that we have to try to take care of men and help them live longer and feel better is constantly changing and hopefully broadening as we find more ways to take care of men with prostate cancer.

And the people that know that best are going to be specialists. And they include medical oncologists, urologists, and radiation oncologists, as well as some palliative care doctors who can really help with being specialists in pain control, constipation, appetite issues, energy issues. So, having a team of specialists is really critical. And it doesn’t necessarily mean that you need to see that specialist for every single appointment that you have for treating your prostate cancer, because many men in the United States who have prostate cancer don’t live very close to a large center where there might be a prostate cancer specialist.

Many men that I take care of actually live several hours away and come to see me once every six months or once a year or if they need advice because something has changed about their cancer. And that is completely okay, and actually, really, I think, a nice way to balance the convenience of having care close to home while still making sure that you have access to someone who is actively engaged in participating in the work to advance therapeutics and other ways of caring for prostate cancer.

Sometimes it can feel like you’re hurting feelings or potentially even offending your doctor if you say that you want to see someone else to get a second opinion or just to get another bit of advice about your cancer. But I think, and I think most doctors think, that at the end of the day part of dealing with cancer is making sure that you have the right treatment for the disease.

But part of taking care of people with cancer and dealing with cancer if you are the patient is making sure that your mind is at peace, that you have tried everything, and looked in every corner to find what you need to get the help that you really do deserve. And I think as we care for men with prostate cancer, we physicians know that we may have the answers for most but not all men, or we may not necessarily have an area of specialty in the particular issue that that man needs help with.

And so, we’re always open – I think I am. And I’m sure most doctors are, too – encouraging people, in fact, to seek second opinions if that’s what they need to either feel like they have access to the treatments that they need or to put their minds at ease. Because it really is the combination of physical care and emotional and mental care that is necessary to heal yourself while you are taking care of yourself with prostate cancer.

How Can You Access Personalized Prostate Cancer Treatment?

How Can You Access Personalized Prostate Cancer Treatment? from Patient Empowerment Network on Vimeo.

How could genetic testing results affect your prostate cancer treatment plan? In this INSIST! Prostate Cancer webinar, Dr. Sumit Subudhi will discuss key prostate cancer tests, the latest targeted therapies and tools to help you advocate for a personalized treatment approach and insist on better care.

Dr. Sumit Subudhi is a Medical Oncologist at The University of Texas MD Anderson Cancer Center.

Related Resources

 

Three Key Steps to Take Following a Prostate Cancer Diagnosis

 


Transcript:

Katherine:                  

Welcome to Insist Prostate Cancer, a program focused on empowering patients to insist on better care. Today we’ll discuss the latest advances in prostate cancer, including the role of genetic testing and how this may affect treatment options.

I’m Katherine Banwell, your host for today’s program. And joining me is Dr. Sumit Subudhi. Welcome, Dr. Subudhi. Would you please introduce yourself?

Dr. Subudhi:        

Hi, I’m Sumit Subudhi. I’m a medical oncologist at MD Anderson Cancer Center, and I specifically focus on prostate cancer.

Katherine:    

Excellent, thank you. Before we start, a reminder that this program is not a substitute for seeking medical advice. Please refer to your own healthcare team. Well, Dr. Subudhi, I’d like you to begin with a brief explanation of the stages of prostate cancer.

Dr. Subudhi:               

Yeah, that’s a great question. So, we use stages, and there’s four – Stage I, II, III, and IV. And we use it to help us determine what treatments the patients need for their prostate cancer. In general, Stage I is localized prostate cancer, and it’s localized only to the prostate. And when we do a digital rectal exam, we cannot feel or palpate the prostate.

And the treatment for Stage I prostate cancer is either active surveillance, where you’re not trying to cure the cancer, you’re just actively watching it, and you’re using a PSA imaging studies, prostate biopsies, and digital rectal exams at regular intervals to follow the patients. But other patients with Stage I prostate cancer can actually get definitive treatment for curative intent with radiation therapy or surgery. Stage 2 prostate cancer is also localized, but on physical exam, we can actually palpate or feel the prostate cancer. And this also can receive definitive treatment for the prostate to cure it, and that, also, you can use radiation therapy and surgery.

Stage III is what I consider locally advance. This is where the prostate cancer is now starting to leave the prostate. And it still can be cured by radiation and surgery, but most likely needs a multidisciplinary approach, where you might need both or maybe even in addition of a systemic therapy. Stage IV is the last stage that I’ll talk about, and it has distant metastases. And here we’re not looking for a curative approach; we’re actually looking for palliation, which means that we’re trying to treat the prostate cancer as a chronic disease.

Katherine:                  

I understand that there are many types of prostate cancer that have been identified. How can patients advocate for a precise diagnosis?

Dr. Subudhi:    

Yes, you’re absolutely right. There are many types. So, we have historically used histological classification. And when I say histological, that means when we look at the cancer under the microscope, we can look at the different structures within the prostate cancer and classify them.

And there are multiple types such as adenocarcinoma, neuroendocrine, small-cell, mucinous, etc. But more recently, with the advances in genetic and molecular testing, we now can look at the genes inside the prostate cancer, and that has also helped us better classify the cancer. Now many of these types of approaches are best done at major cancer centers, where they have experienced pathologists who actually evaluate both histologically and molecularly the cancer.

So, I recommend to my patients, or family and friends, that have been diagnosed with prostate cancer that they don’t necessarily have to go to the major cancer centers. They can have their local doctor send the tissue from the biopsy to the advanced cancer centers to get a second opinion.

Katherine:    

But this would be an initial visit to a doctor. Is that right?

Dr. Subudhi:    

Good question. So, I’m presuming that the patient is actually being seen at a local center where they have a local doctor, and so they don’t have to come, for example, to MD Anderson Cancer Center to see me. They could actually have their tissue sent to our pathologists and get it reviewed, and they can still be at home. And especially in this era of COVID, that’s important.

Katherine:      

What is the role of genetic testing in prostate cancer?

Dr. Subudhi:     

That’s a great question, because this is something that wasn’t really available when I was training and understanding prostate cancer. But over the last few years, this has actually hit the mainstream, and it’s very important. And I see it having three roles. The first role is whether or not you can receive a certain type of targeted therapy or systemic therapy known as PARP inhibitors. So, if your genetic test is positive for certain markers – that I think we’ll cover later – then it can help give you more treatment options. The second is that generate testing can give you also risk of other cancers besides prostate cancer. For example, if you have the BRCA mutation, you’re 15% to 20% more likely to get breast cancer in men.

The third is that because the genetic testing is looking for inheritable mutations in your genes, that means you can pass it along to your kids. And this could have a tremendous impact on the screening strategies your children want to use in the future.

Katherine: 

Would you mind going into that a little bit?

Dr. Subudhi:  

Yeah.

Katherine:  

For instance, my ex-husband had early prostate cancer. My 22-year-old son is worried now about also getting prostate cancer. His grandfather had prostate cancer.

Dr. Subudhi:               

Yeah, great question. So, it’s not just about prostate cancer. So, prostate cancer, genetically, is linked to other cancers, as well.

So, in your case, you’re turning by your son. But if you have daughters or any female members in the family, consideration needs to be given to breast and ovarian cancer. And for both men and women, we also have to think about melanoma and pancreatic cancer. So, it’s not just prostate cancer that we’re thinking about when you have these genetic risks. And that’s very important, because each of these different cancers can have different screening modalities.

Katherine:                  

Oh. Well, how is the testing administered then?

Dr. Subudhi:               

The testing is actually a blood test, so very simple.

Katherine:                  

Have there been any major advances in testing?

Dr. Subudhi:               

Yeah, so when we’re talking about the inheritable testing, that’s just a simple blood test. And the reason why it can be done simply through the blood is because every cell in your body has it. So, when they collect the blood, they can just take any cell from there and do genetic analysis. And if that gene is mutated or missing, it will be captured.

Now, there’s another type of testing where they test your tumor tissue itself – so, your cancer tissue – whether you got it by biopsy or surgically removed. And so, that’s a different type of testing. That’s looking for what we call somatic mutations. These are not inherited mutations. These are mutations that are specific for your prostate cancer. Again, in contrast, the inheritable mutations are in every cell in your body – not just your prostate cancer cells, but every cell in your body. And the somatic, it’s just in your prostate tissue itself.

And so, sometimes with prostate cancer, it’s difficult to get the tissue. And what’s happened more recently – and to answer your question – is that the advances have been in what we call liquid biopsies, where they are able to use your blood and get the DNA from the tumors and actually genetically test the cancers that way. And so, that’s where the future is going.

Katherine:      

Oh, that’s amazing. Are there specific tests that patients should ask their doctor for following the diagnosis?

Dr. Subudhi:   

Yeah. So, if inpatients with high risk or metastatic prostate cancer, they should definitely be considering tests to see if they have mutations in what we call the DNA damage repair pathway or homologous recombination DNA pathway. And I know they’re fancy terms. What these genes are, they’re genes that help the body repair their DNA, and DNA is very important. And so, when there’s defects in the DNA repair pathway, then mutations occur. And these mutations can actually help the cancer grow.

Now what’s happening is that what they’re looking for in these genetic tests – whether it’s the inheritable test or the somatic mutation test that’s looking just within the tumor itself – they’re looking to see if there’s any DNA damage machinery that’s defective. And if it is, then you’re more likely to benefit from PARP inhibitors, which are oral drugs that specifically target the DNA repair pathway.

Katherine:    

All right. Dr. Subudhi, what is the link between inherited mutations and prostate cancer?

Dr. Subudhi:               

Yeah, so in approximately 10% to 15% of patients with prostate cancer, they have an inheritable cause for their cancer. And so, this predisposes them to not just having prostate cancer, but potentially to other cancers, but also their family members.

Katherine:                  

Would you give us an overview of common mutations in prostate cancer?

Dr. Subudhi:               

Yeah. So, in regards to the inheritable causes, the BRCA mutations – BRCA2 and BRCA1 – are very common. In fact, BRCA2 is more common than prostate cancer than BRCA1. In addition, there’s CHEK2 and ATM which are common inheritable mutations. And the other ones are the mismatch repair genes. Again, all these play an important role in repairing DNA. So, if you’re mutated in these genes, then your ability to repair DNA has been significantly diminished, and you’re more likely to gain more mutations.

Katherine:                  

How do these mutations affect disease progression?

Dr. Subudhi:               

Yeah. So, what they can do is they can lead to mutations that make the cancer grow more. And there’s two ways to do it. You can have a mutation in what we call an oncogene, a gene that when it’s active, it’s going to just promote the cancer.

And then we have other genes called tumor suppressor genes. Their normal function is to prevent the cancer from growing. But if the tumor suppressor gene gets mutated so it’s no longer functional, then the cancer can then take off, because it’s no longer suppressed. So, those are how these genes can actually affect the prostate cancer.

Katherine:                  

What about treatment options, what’s available?

Dr. Subudhi:    

Yeah. So, if you have either an inheritable mutation in these genes or a somatic mutation, then there’s a chance that the PARP inhibitors could actually work for you. And the PARP inhibitors, they actually target cancers where there’s a defect in the DNA repair pathway.

Now, there’s one thing that I want to point out that a lot of people sort of are missing, and it’s not a subtle point. Not all inheritable mutations are made the same – or even somatic mutations. Meaning, what we’re learning is the PARP inhibitors seem to be more active with the “Braca,” or BRCA, mutations and the ATM mutations. Whereas, they’re less active with other types of DNA repair mutations. So, the point is not all mutations are made the same.

Katherine:                  

Let’s turn to targeted therapies. How exactly do they work?

Dr. Subudhi:      

Yeah. So, this is a form of personalized medicine. So, what you’re doing is you’re looking at the patient’s cancer, either their inheritable cause of genetic causes or the somatic. And then you’re saying, oh, wait, they have a genetic defect in a DNA machine. So, let’s use the PARP inhibitor, which also targets the DNA machinery.

And these are the cancer cells that are most likely to be susceptible to PARP inhibition. And actually, the cancer cells will die from it. Whereas if a patient has a normal DNA machinery, the PARP inhibitors will actually not have any effect on the cancer.

Katherine:                  

Oh, I see. Just as a follow-up, how are these targeted therapies administered?

Dr. Subudhi:               

They’re given, actually, orally twice a day. The two drugs are rucaparib and Olaparib that have been FDA approved for this indication.

Katherine:                  

How do these newer treatments differ from traditional chemotherapy?

Dr. Subudhi: 

That’s a great question. So, with chemotherapies, at least in prostate cancer, they’re given intravenously every three weeks. And the goal of the chemotherapies, they are actually designed to kill any actively dividing cell in the body.

And the problem is it’s not just cancer cells that are actively dividing in our body. For example, with the chemotherapy such as docetaxel or cabazitaxel, that’s used in prostate cancer – their brand names are Taxotere and Jevtana – these chemotherapies will also affect hair loss. Why? Because hair grows really fast. And in fact, I need a haircut every three to four weeks, which my wife has been helping me with.

So, the chemotherapies are targeting all actively dividing cells, and that’s why you also get nausea vomiting, because the cells of our GI tract are also affected by that. So, chemotherapies are not personalized. They’re there to kill actively dividing cells. Luckily prostate cancer divides a lot more quickly than any other cell in our body, and that’s why they’re susceptible to chemotherapy.

Katherine:   

And as far as the targeted therapies, Dr. Subudhi, are there side effects with those?

Dr. Subudhi:     

Yeah, there are. One of the most predominant side effect is actually anemia. And so, that’s when the red blood cells in our body are lower than usual. And so, that’s one of the major side effects for PARP inhibitors. But in addition, you can have nausea, vomiting, and diarrhea as other side effects with the PARP inhibitors.

Katherine:  

What are you excited about in prostate cancer research right now?

Dr. Subudhi:  

So, to me, it’s the combination of treatments. So, not just treating with one PARP inhibitor or just one hormonal therapy, it’s combining these approaches, and especially with immunotherapies, so that we can potentially cure what’s considered incurable cancer. To me, that’s the most exciting.

Katherine:   

What would you say to patients who are nervous about participating in a clinical trial?

Dr. Subudhi:    

Yeah. This is a common question that I deal with in clinic, because we tend to have a lot of trials at MD Anderson. And the first thing, for me, is to understand why they’re nervous, because there’s different reasons why people are nervous.

Some people have heard of placebo trials, where the experimental drug that they’re hoping to get is only given to a portion of the patients and not all. And so, patients are worried what if they get on the placebo arm. And so, what I tell patients in that case is that please note that you’re going to be monitored very closely – more than usual, and so I’ll be seeing you in clinic more often. And if there’s any signs of progression, I will take you off the study. But I also always have a back-up plan. So, I tell them this is the next drug I’m going to give you if you progress, so don’t worry, I’ve got a plan for you. So, that’s one thing.

The other thing that people get concerned about are experimental drugs – just the fact that they are experimental. And I have to remind them that all these standard therapies that we have for prostate cancer were all experimental at one point. And it was the courage of the other patients that went through clinical trials that helped bring it as standard of care. And then sometimes some people have issues with travel, and those are more logistical issues. And especially now with the COVID era, we have to think about that. And so, we’re also trying to find and use networks to see if there’s other trials that are more amenable for patients so they don’t have to travel far.

Katherine:     

How can patients find out about clinical trials that may be right for them?

Dr. Subudhi:               

Yeah. So, one way is using clinicaltrials.gov. And that’s a website that allows you to search for specific trials either by drug name or by disease type – so, for example, prostate cancer. So, that’s one resource. And the others are cancer societies like the American Cancer Society or ASCO or Prostate Cancer Foundation. They also have links to clinical trials that are exciting.  

Katherine:                  

Do you recommend having patients see a specialist?

Dr. Subudhi:               

Absolutely. I think that if you have a metastatic disease, you need to have a medical oncologist on board that can still work with your urologist, who’s more surgically trained.

Katherine:                  

Right. Well, we’ve talked about COVID a couple of times, and I’d be remiss if we didn’t touch upon it now. What should prostate cancer patients be considering at this time, especially those with advanced disease?

Dr. Subudhi:               

Yeah, so what I don’t want are people to say, oh, I can wait a little bit longer to contact my physician, whether it’s primary care or a prostate cancer doctor, because of COVID. I think it’s very important that the medical team is up to date on a patient’s symptoms and what’s going on medically, whether it’s related to prostate cancer or not. And so, that’s one of the messages we’ve been trying to pass on to our patients.

And with every single patient, we try our best to see if we can provide medical care as well as expertise without having physically see them through telehealth, whether it’s through video or whether it’s just through a simple phone call. So, we’re trying to look at that with each individual patient. Now, sometimes when there’s treatment decisions that have to be made – especially like do we start chemotherapy? – it’s harder to do that over the phone. But sometimes what I’ll do for my patients that are in areas where COVID is really worrisome, I’ll work with the local medical oncologist and talk to them and basically see if we can develop a plan together so that the patient can be served best.

Katherine:                  

Is there a time when telemedicine is more appropriate than others?

Dr. Subudhi:               

I think that has to be a case-by-case basis. And that’s how we do it in clinic.

Every week, a week before hand, I go through my entire clinic list – I go through each patient’s case – and I say, okay, this is a patient that would be better served with telemedicine, this is a case that I really need to see the patient to get a better sense of what to do next.

Katherine:                  

If a patient has to go into clinic, what safety measures are in place for them?

Dr. Subudhi:               

Yeah, so I can only speak for our hospital and how we’re doing it. But there’s actually like a thermal scan where when you walk in the building, they actually measure your temperature without you even knowing it. But they delete it, so it’s not something that’s kept. And this is still kept private, so you don’t have to worry about public disclosure of your temperature. And so, they’re monitoring both the staff and the patients – their temperatures. The staff themselves have to go through screening questions that they have to answer every time, and they’re actually handed a mask that’s required to be used at all times.

As far as patients go, they are also getting their temperature measured. But in addition, they are asking questions about their exposures, whether it’s family members that are asymptomatic, or not symptomatic. And in addition, the new patients will get a COVID test done prior to seeing the medical team. And for the follow-up patients, they’re not required to get a COVID test unless there’s concerns of symptoms.

Katherine:                  

Unless they’ve been exposed to somebody?

Dr. Subudhi:               

Correct, that’s right. Thanks for pointing that out. In addition, all patients are asked to wear their masks at all times, especially if they’re going to be within 6 feet of a healthcare provider or a patient or anyone else. And so, these are the measures that we’re taking to keep our patients safe.

Katherine:                  

Oh, good. Dr. Subudhi, what advice do you have for patients who may be hesitant to speak up an advocate for themselves when it comes to their own care and treatment?

Dr. Subudhi:               

Yeah, I’d say that it’s interesting because we all do this ourselves. And when it comes to our car – let’s say a car breaks down, or if we’re trying to buy furniture – we’ll get three, four different opinions. But for ourselves, for our own body, we don’t do that. And when you watch – we were talking earlier about Major League Baseball – and these players, when they get injured, they get the three best specialists in the world to evaluate them. And they’re seeing the best of the best.

And so, we owe it to ourselves and the patients owe it to themselves to actually get second opinions. I encourage it. I encourage my patients to get second opinions, even if I’m the first doctor they see, because I want them to feel comfortable with their decision.

And it’s important to understand that just because you’re seeing a doctor doesn’t mean that it’s a one-size-fits-all. You will get different opinions from different doctors, and you have to go with the one that makes you feel most comfortable.

Katherine:    

We have a question from the audience, Dr. Subudhi. Amy is saying she’s the daughter of a prostate cancer patient. And she’s curious to know how she goes about getting genetic testing, and if her children should be tested, as well.

Dr. Subudhi:               

Yeah. So, one of the things is that family history is very important in determining who should get genetically tested. So, if you’re a prostate cancer patient and you have metastatic disease, you should get genetically tested. And the reason for that is because we have a new set of drugs, the PARP inhibitors. But if you’re a family member that’s wanting to know whether you have a loved one has inheritable cancer that you may end up inheriting, that requires more understanding of the family history.

For example, did the grandfather have prostate cancer? Did the uncle have prostate cancer? And as I mentioned earlier, it’s not just prostate cancer. Is there a family member with breast cancer or ovarian cancer? These things play out in the decision-making of who should be genetically tested.

Katherine:                  

Absolutely. As a researcher in the field doctor, Dr. Subudhi, what would you like to leave patients with? Are you hopeful?

Dr. Subudhi:               

Yeah, I’m very hopeful. It’s a really interesting time, because with the technological advances and scientific advances – Traditionally, prostate cancer has always been treated just with hormonal therapies from the 1930s all the way to early 2000. Then in 2004, chemotherapy became the next thing. And then after chemotherapy, we’ve now got a dendritic cell vaccine; we’ve also got a radiopharmaceutical agent. And so, what the point is now we have a lot more different FDA-approved agents. And now, experimentally, the PARP inhibitors have now become a standard of care for those patients with mutations in the BRCA1, BRCA2, or ATM.

And then, in addition, we have many other types of technologies, such as BiTE and CAR T cells, that are coming out that are showing in early studies to be exciting. And so, I feel like that these therapies in combination may actually lead us to cure the cancer.

Katherine:                  

ASCO happened in June. Was there any news that patients should know about?

Dr. Subudhi:   

Yeah, so the PARP inhibitors got a lot of press during ASCO, as they should, because this is a new class of drugs that is the first personalized version of medicine that we have in prostate cancer. Now, personalized medicine has been around for a long time in cancers such as breast and lung cancer. But for first time, we actually have it in prostate cancer.

Katherine:

Dr. Subudhi, I want to thank you so much for joining us today.

Dr. Subudhi:

Thank you for your time. I really appreciate it.

Katherine:

And thank you to all of our partners. To learn more about prostate cancer and to access tools to help you become a more proactive patient, visit powerfulpatients.org. I’m Katherine Banwell.

Communicating About Cancer: A Brief Guide to Telling People Who Care

Getting a cancer diagnosis can easily be the most terrifying, heart-wrenching experiences one has in their lifetime. Everything from different treatment options (if you’re lucky), to financing, and maintaining quality of life suddenly are in full force front and center. It can be hard to know who to turn to if you’re not directed to a support group (of which there are many), and especially how to tell loved ones and co-workers. The choice is yours, of course, in whom you wish to tell and when – there is no right or wrong answer. (However, I and many others have found that having a caregiver to help manage appointments, billing, etc. can help).

Should you choose to tell others, here are some tips that I have read and/or heard from other cancer patients/survivors as well as some I have found personally helpful:

Kids:

  • It depends on the age – using simpler terms with younger kids (8 and under) may be more helpful, while older kids and teens can understand more detail. For example, saying that you’re sick and you’re getting the best care from a team of doctors who really want to help you get better
  • According to the American Cancer Society, children need to know the basics, including:
    • The name of the cancer
    • The specific body part(s) of where it is
    • How it’ll be treated
    • How their own lives will be affected
  • Think of a list of questions ahead of time that you think they may ask and jot down answers, such as how the cancer happened (that it’s not anyone’s fault), if it’s contagious, and/or if it’ll be fatal
  • Make sure that they know you are open to talking about it at any time. You can also perform check-ins with each other to monitor feelings

Family and friends:

  • Select a group of people, including immediate family and close friends
  • Divulge information only you feel comfortable sharing. Maybe it’s the basics, as mentioned above, or more detailed information
  • Prepare for different reactions, including sadness, anger, frustration, depression, anxiety, compassion, and support
  • Also prepare for people to not feel comfortable and feel as if they’re helpless. A cancer diagnosis is a heavy weight to bear, and not everyone will feel like the have the capacity to help as much as they want to
  • As the patient, tell them how you’re looking for support (ex. what are your needs during this time, including physical, emotional, mental). Guiding members of your support system to get your needs met may help them feel more at ease and able to help

Work:

  • Telling a supervisor/manager may be one of the hardest tasks for fear of discrimination
    • However, the Americans with Disabilities Act (ADA), which covers employers with 15 ore more employees, prohibits discrimination based on:
      • Actual disability
      • A perceived history of disability
      • A misperception of current disability
      • History of disability
    • The ADA also:
      • Protects eligible cancer survivors from discrimination in the workplace
      • Requires eligible employers to make “reasonable accommodations” to allow employees to function properly on the job
      • Ensure that employers must treat all employees equally
    • The Family and Medical Leave Act (FMLA) also gives you the right to take time off due to illness without losing your job
      • However, an employee must have worked for his or her employer for at least 12 months, including at least 1,250 hours during the most recent 12 months in order to qualify. The law applies to workers at all government agencies and schools nationwide as well as those at private companies with 50 or more employees within a 75-mile radius
    • The Federal Rehabilitation Act prohibits employers from discriminating against employees because they have cancer
      • However, this act applies only to employees of the federal government, as well as private and public employers who receive public funds

Sources:

Three Key Steps to Take Following a Prostate Cancer Diagnosis

Three Key Steps to Take Following a Prostate Cancer Diagnosis from Patient Empowerment Network on Vimeo.

The actions that a patient takes following their prostate cancer diagnosis could have an impact on their care and treatment options. Expert Dr. Alicia Morgans recommends these three key steps post-diagnosis.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

Related Resources

 

Seeking Optimal Prostate Cancer Care? The Importance of Partnering With A Specialist

Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

From my perspective, three key steps that a man with prostate cancer would take as he’s getting that first diagnosis would start with getting an advocate – getting someone who can be the extra eyes and ears that you need when you go to a visit or read something that doesn’t quite make sense.

I think this is especially important for doctor visits, where so much information may be put in your lap that it can be really hard for the individual who has prostate cancer to take everything in. And sometimes, having someone who can either take notes or can just be there to listen and to recall things can be really helpful.

The second thing would be to make sure you find a doctor who you can trust. And this sounds really simple, but sometimes can take trying a couple different doctors to really find the one who you feel that you can connect with and who you feel will be able to listen to the questions that you have. Because your questions are valid, and I’m sure that there is a doctor out there who can help answer those questions no matter what they are.

 From my perspective, the third thing that individuals should really make sure that they have is a source of information that they feel they can trust. For many men, this is an online source. But it’s real important to recognize that there is a lot of false information, and there’s a lot of information that’s really not necessarily from your perspective as a man with prostate cancer, but perhaps from someone else’s perspective – still truth, but not necessarily your truth.

So, some of the best sources of information can be from advocacy groups or from medical organizations. Because these are usually going to be vetted by physicians or by groups of patients who really try to present both broad perspectives as well as correct information that will be trustworthy as you move through the journey of prostate cancer.

Spotting False Claims: Tips for Identifying Prostate Cancer Misinformation

Spotting False Claims: Tips for Identifying Prostate Cancer Misinformation from Patient Empowerment Network on Vimeo.

While there are many helpful online resources to guide patients in a positive direction, false claims and advertisements about prostate cancer can add confusion. Dr. Alicia Morgans provides insight into how to identify misinformation.

Dr. Alicia Morgans is an Assistant Professor of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

See more from The Pro-Active Prostate Cancer Patient Toolkit

Related Resources

Three Key Steps to Take Following a Prostate Cancer Diagnosis <new link>
Are You Prepared for Your Prostate Cancer Appointment? Expert Tips <new link>
Prostate Cancer Treatment Decisions: Which Path is Best for YOU? <new link>
 

 

Are You Prepared for Your Prostate Cancer Appointment? Expert Tips

Three Key Steps to Take Following a Prostate Cancer Diagnosis

Prostate Cancer Treatment Decisions: Which Path is Best for YOU?

 


Transcript:

Dr. Alicia Morgans:

Some clues that may demonstrate that something is going to be riddled maybe with false claims or false promises would be if there are advertisements for medications that can cure prostate cancer on the computer.

Those medications are probably not real. And if they are, then they should be things that your doctor probably knows about. And so, I would certainly talk to your doctor about any supplements, any special nutrition or shakes or different things that make those claims. Because unfortunately, at this point, we in the medical community do not know of any herbs or spices that could cure prostate cancer. Certainly, there are things that people can take that may be useful and as long as they don’t interfere with the medicines that we’re using, or interact with them in a dangerous way, most doctors are completely okay with people taking them.

But anything that’s charging a lot of money and making really incredible claims is probably, unfortunately, just preying on people who are clearly vulnerable. And you need to be very careful that you’re not giving money away to things that are not real.

Empowered! Podcast: Meet Andrea Conners

Today, we’re extremely proud to introduce our first-ever Empowered! podcast. Empowered! will bring you conversations around topics that are important to patients and care partners.

For our first episode, we meet Andrea Conners. Andrea is Patient Empowerment Network’s Executive Director. Andrea shares a little bit about herself, about PEN, and her inspiration in getting involved.

 


Why Getting a 2nd and 3rd Opinion Made a Difference In Her Cancer Treatment, With Sasha Denisova

This podcast was originally publish on WE Have Cancer by  on May 7, 2019 here.


Sasha Denisova – WE Have Cancer

Seeking out a 2nd and 3rd opinion in her cancer treatment resulted in a dramatic improvement in Sasha Denisova’s quality of life.

Sasha first appeared on this podcast in Episode 83 where she shared the struggle she faced getting doctors to take her colorectal cancer symptoms seriously.

During our latest conversation she discussed why she made the decision to forego treatment at the Mayo Clinic in Minnesota to seek treatment at Memorial Sloan Kettering in New York City. We also discussed:

  • How she got the courage to challenge the initial treatment recommendations made by her doctor and why it’s important for everyone to advocate for their best care.
  • The importance 0f seeking out opinions from the top rated cancer facilities in the U.S.
  • How she eased herself back into working out in the gym and why working with a guided fitness instructor was important.
  • Why exercise is vital to her well-being and how most cancer patients can find an exercise routine that works for them.

Take Control Of Your Care When You’re Seriously Sick via NPR

This podcast was originally publish on NPR by John Henning Schumann, Mara Gordon, and Chloee Weiner on September 7, 2019 here.


Finding out you have a serious medical condition can leave you reeling. These strategies from medical and lay experts will help you be in control as you navigate our complex health care system and get the best possible care.

Here’s what to remember:

1. Your primary care doctor is the captain of your health care team.

With any serious diagnosis, there will usually be more specialists to see. Having a primary care doctor you trust helps coordinate the information flow and keep track of the big picture. Your primary is on her toes for possible medication interactions. Regular preventive measures shouldn’t be overlooked, either.

2. Don’t be afraid to get a second opinion.

If you’re offered treatment such as chemotherapy or surgery that can be life-altering, it’s crucial to get more than one opinion, ideally from a doctor working for a different institution. Oncologists and surgeons expect patients to seek second opinions — many provide them as a major part of their practice. If your doctor resents you seeking more opinions, that’s a red flag.

3. Get organized, stay organized, and find someone to help you if you can’t do it yourself.

Make a list of what you hope to accomplish at the doctor’s office. If for some reason you aren’t able to take notes, bring someone along who can act as an advocate and make sure your concerns aren’t overlooked. Ask for copies of your medical chart and test results so that you are part of the conversation — you have a legal right to see your records.

4. If you need a procedure, go to someone who does it all the time.

It’s true for medical care as it is in life: The more a doctor does a procedure, the better at it she’ll be. This means fewer complications and better outcomes. It’s OK to ask your doctor how many times she’s done a procedure; a high volume means competence when things go as planned, and calmness for unforeseen complications.

5. Use the Internet, but use it wisely.

Contrary to what you may think, your doctor wants you to be well-informed and engaged with your health. There’s more medical information available online than ever before, but a lot of it is garbage. Stick with trusted sources like the National Library of MedicinePubMed.gov, or learn about and use the U.S. Preventive Services Task Force.

6. Figure out what matters to you, and fight for it

Our default setting for health care is that more testing is always good. But that’s often not the case, as tests have side effects and can cause undue anxiety because of false positives or incidental findings. Have a frank conversation with your doctor about your values and what you want (and don’t want!) and you’ll be an empowered patient with a doctor as your advocate, not your adversary.

Learning How to Simplify Cancer With Joe Bakhmoutski

This podcast was originally publish on WE Have Cancer by Lee Silverstein on June 18, 2019 here.

Joe Bakhmoutski – WE Have Cancer

Joe Bakhmoutski was diagnosed with Testicular cancer in 2016.He founded Simplify Cancer  to provide support and advice to those touched by cancer. During our conversation we discussed:

  • Why he created Simplify Cancer
  • How he came to be diagnosed with Testicular cancer
  • How people perceive various cancers and how some are deemed “embarrassing”
  • What patients can do to prepare for their first oncologist appointment and the free tool he offers on his website to assist with this.
  • The book he’s writing to help men dealing with cancer.

Links Mentioned in the Show

Simplify Cancer – http://simplifycancer.com/