Tools for Partnering in Your Prostate Cancer Care

Tools for Partnering in Your Prostate Cancer Care from Patient Empowerment Network on Vimeo.

Why is it important to partner with your doctor in your prostate cancer care? Dr. Rana McKay shares advice to help patients speak up and play an active role in their care plan.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Related Resources:

What Is Personalized Prostate Cancer Medicine?

Tools for Choosing the Right Prostate Cancer Treatment Approach


Transcript:

Katherine Banwell:

Why should patients feel confident using their voice in partnering in their care? Do you have any advice? 

Dr. Rana McKay:

It’s absolutely important for patients to share their perspective and for there to be shared decision-making at every single juncture along the way. Even around decisions to not treat. So, you know, I think it’s a lot of – there’s a lot of grays in prostate cancer and a lot of art in deciding what treatment to do and at what specific time and for any given patient given the values that that patient brings to the table, they may come back with a different decision compared to another patient. So, without the patient you know, voicing what their values are it’s impossible to make a treatment decision. 

So, it is so critically important to have that open communication with your clinician. 

Katherine Banwell:

So, in addition to that – in conjunction with that, should men diagnosed with advanced prostate cancer consider a second opinion or consulting with a specialist? 

Dr. Rana McKay:

I think it’s always a great idea to get a second opinion. You know, I think that, you know, it will only empower individuals when they seek sort of a second opinion to either confirm what their physician has already told them. And then they have reassurance that they’re on the right path or maybe provide some new novel insights that they can take into consideration and just think about how that could be applied to them. So, you know, I think that a second opinion is always really valuable.   

I will balance that by saying sometimes it can be detrimental if there’s lots of opinions, because I will say that coming to a consensus when there’s lots of different specialists that are involved, and everybody makes the soup a little bit differently – 

Katherine Banwell:

Yeah. 

Dr. Rana McKay:

Sometimes that I think that can actually hurt patients in being able to actually come to a decision because then they’re like, “I don’t know what decision to make. This person said do this. This person said do that. This person said do that.” And so that can sometimes be detrimental. But a second opinion, I do always encourage it. I do always value it. But I always want the patient to bring it back to me so I can share with them and discuss, “Okay. I understand. This is why x said X-Y-Z. This still aligns. This still doesn’t.” They need a quarterback like you know, it’s one thing to sort of get second opinions. But I think every man with prostate cancer should have a quarterback that’s driving their care and advocating for them.  

Katherine Banwell:

Yeah. How can patients find specialists near them? 

Dr. Rana McKay:

So, I will say that they are national comprehensive cancer institutes. They’re all across the country in rural areas and not. I think, you know, finding the closest NCI-designated comprehensive cancer center close to you is probably a good place to start and identifying who is seeing patients with genetic urinary malignancies or prostate cancer at that facility is a good place. I think the Prostate Cancer Foundation is an excellent advocacy group for patients with prostate cancer. They have a tremendous amount of resources to help connect patients with clinicians, and other resources in their journey with cancer.   

PSA vs Gleason Score | What’s the Difference?

PSA vs Gleason Score | What’s the Difference? from Patient Empowerment Network on Vimeo.

Prostate cancer expert, Dr. Rana McKay, explains the difference between PSA blood levels and a Gleason score and discusses how these measurements impact prostate cancer care.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Related Resources:

Managing the Side Effects of Advanced Prostate Cancer Treatment

Tools for Choosing the Right Prostate Cancer Treatment Approach


Transcript:

Katherine Banwell:

We received a patient question prior to the program. What is the difference between my PSA level and Gleason score?  

Dr. Rana McKay:

Yeah. So, very good question. So, Gleason score is something that is determined based off a pathologic assessment. So, it’s basically, you know, a biopsy is done from the prostate or the – the surgical specimen from the removal of the prostate is looked at under the microscope and a Gleason score is based off what something looks like underneath a microscope and ideally, a Gleason score is given really only for the prostate – for tissue derived from the prostate.  

So, if somebody has a bone biopsy for example or a lymph node biopsy, they’re not going to necessarily get a glycine score per se. It’s been – been validated from the prostate itself and ideally, also, an untreated prostate. So, if somebody has you know had radiation therapy and then has a biopsy, the Gleason score there is – there should not necessarily be a notation of what a Gleason score is. It’s really an untreated prostate. Now PSA is prostate-specific antigen, and it’s a protein that’s made from the prostate gland, and it’s found in circulation. PSA doesn’t hurt any – the actual, you know, molecule itself is – is innocuous. It doesn’t hurt anything. It’s just a marker of, sometimes can be a marker of burden of disease in prostate cancer, and I think sometimes we as clinicians do, you know, you know a disservice to some patients because I think we fixate – we can fixate a lot on PSA. 

But PSA is not the whole story, and it’s one factor of several factors that we take into account in determining whether someone needs treatment or whether a treatment is working or not working. 

Tools for Choosing the Right Prostate Cancer Treatment Approach

Tools for Choosing the Right Prostate Cancer Treatment Approach from Patient Empowerment Network on Vimeo.

Dr. Rana McKay discusses the factors that impact advanced prostate cancer treatment decisions. Dr. McKay reviews potential treatment side effects and explains how patients in treatment are monitored.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Related Resources:

What Is Personalized Prostate Cancer Medicine?

Tools for Partnering in Your Prostate Cancer Care


Transcript:

Katherine Banwell:

Since prostate cancer affects men differently, let’s review what factors could impact which treatment is right for their individual disease. How about we start with symptoms? 

Dr. Rana McKay:

So, yeah. I mean absolutely. I think symptoms are definitely something that plays into effect. Sometimes when patients are first diagnosed, they may not have symptoms. But, you know, boney pain, symptoms of urinary obstruction. You know, there’s specific treatments and strategies that we can deploy to help with those kinds of things. You know other factors that I think I – we take into account when we’re making decisions about which agent should any one patient receive is where are their sites of metastases? Is there disease just in the bones and lymph nodes or are there other organs involved? What’s the genomic make-up of the tumor? There are certain treatments that we would utilize if someone had a certain specific you know, genetic make-up for their tumor. You know, other things that are really important are what kind of drugs has the patient seen before or has that tumor been exposed to? Because that also helps us strategize for what to give them in the future.  

Katherine Banwell:

Do you take into consideration the patient’s comorbidities and their age and overall health? Things like that?  

Dr. Rana McKay:

Absolutely. Yeah. I think we need to absolute take that in account. I think – I think age is one thing. But I think functional status is just as – as important as the actual number itself because people are very different regarding the things that they can do at various age limits and so, that absolutely takes into account weighing the side effects of any given therapy and how that may interact with someone’s existing comorbidities and it may be something that we have to work with a team of other doctors to basically make sure that there is comprehensive, well-rounded care for any one patient.   

For example, some therapies may increase the risk of hyper-tension or increase the risk of volume overload. And so, if somebody has issues with that already we may have them see a cardiologist so we can make sure that, you know, we’re kind of addressing the totality of the patient experience. 

Katherine Banwell:

What do you mean by volume overload? 

Dr. Rana McKay:

Volume overload, I mean if they’ve got too much fluid on board. So, maybe if they have heart failure or something like that, and we have a therapy that’s going to cause them to retain fluid. And so then, we would have to work with a cardiologist to make sure that they don’t run into issues 

Katherine Banwell:

Mm-hmm. Once a man is undergoing treatment for advanced prostate cancer, how are they monitored to see if it’s actually working? 

Dr. Rana McKay:

So, a lot of ways. So, one is by just, you know, visiting with the patient. Making sure that their symptoms are in check. Making sure that they’re not developing new aches or pains that are worrisome. It’s by checking their labs in addition to their organ and bone marrow function. We would check their PSA. And PSA isn’t the whole story. But it is one factor that contributes to us determining whether treatment may or may not be working. It’s also doing intermittent scannings. So, you know, CT scans of the organs, of the lymph nodes. Bone scan and now we actually have PSMA based imaging, which can be integrated to help assess where the disease is and not yet being utilized to assess whether something is working, because we haven’t really defined the criteria there. But, it can be utilized as well.  

Managing the Side Effects of Advanced Prostate Cancer Treatment

Managing the Side Effects of Advanced Prostate Cancer Treatment from Patient Empowerment Network on Vimeo.

Prostate cancer expert Dr. Rana McKay reviews potential prostate cancer treatment side effects and discusses strategies for managing these issues.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Related Resources:

What Is Personalized Prostate Cancer Medicine?

When Should Advanced Prostate Cancer Patients Consider a Clinical Trial?

Tools for Choosing the Right Prostate Cancer Treatment Approach


Transcript:

Katherine Banwell:

Dr. McKay, for these treatment classes, what can patients expect as far as side effects? 

Dr. Rana McKay:

Absolutely. So, I think side effects – discussing side effects is a really important part of the discussion for selecting any one given therapy and in general, I think when we talk about the hormonal therapies one of the side effects that people can get is largely fatigue.  

But a lot of the symptoms are related to low testosterone. And so, that may mean muscle loss, bone loss, you know, hot flashes, fatigue, decrease libido. So, you those are things to consider with hormonal therapies. With the chemotherapies, I think the big ones we worry about are fatigue, risk of infection, blood counts dropping a little bit, people getting tired, numbness and tingling in the hands and feet can occur, some swelling in the legs are common side effects for chemotherapy agents. With regards to the immunotherapy with the vaccine therapy, it actually tends to be a fairly well tolerated treatment. Maybe some fatigue, rarely some dizziness or some lip – lip sensitivity, numbness with the – the process of kind of collecting the cells. But it actually tends to be fairly well tolerated.  

The targeted therapies can cause fatigue. They can cause the blood counts to drop and can impact bone marrow function. There can be sometimes GI side effects. Nausea, rash, and then the immune therapy, the pembrolizumab (Keytruda), that is FDA-approved sometimes that can cause immune related adverse events which is kind of over activation of the immune system developing you know, what I’d call it as the itises. Colitis or pneumonitis which is inflammation of various organs and symptoms related to wherever that may be.