How Can Prostate Cancer Screening Access Be Increased?

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How Can Prostate Cancer Screening Access Be Increased? from Patient Empowerment Network on Vimeo.

How can access to prostate cancer screening be improved? Expert Dr. Ronald Chen from KU Medical Center discusses the importance of prostate cancer screening, methods that experts are using to increase awareness, and patient advice for optimizing health outcomes.

[ACTI]IVATION TIP

“…if you’re diagnosed with advanced prostate cancer, always consider if a second opinion is right for you, a second opinion with a specialist who may have access to the latest treatments, technologies and clinical trials, and having that information before you to make a treatment decision can provide you with information, so you can make the best decision and have the best outcome for your cancer.”

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Expert Perspective | Aggressive Prostate Cancer Research and Health Equity

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

 Advanced Prostate Cancer Clinical Trials | Access and NRG-GU008 Trial

Advanced Prostate Cancer Clinical Trials | Access and NRG-GU008 Trial

Transcript:

Lisa Hatfield:

Are there any innovative approaches or technologies that you and your team are exploring to improve prostate cancer detection, treatment, or support services, especially for communities with limited access to healthcare resources?

Dr. Ronald Chen:

I think that access to screening is so important because screening, to be able to catch a cancer as early as possible allows the highest chance for cure and the best outcome for the patient. So what my team has been doing to try to increase access to screening is two-fold.

One is, we need to increase the awareness that screening is important. And unfortunately, in prostate cancer, there’s actually some controversy about whether prostate cancer screening is good or bad for the patient. There’s been some, I think, unfortunate national guidelines that recommend against screening and a lot of debate about whether screening is good or bad. I think it’s been unfortunate. It actually has led to some physicians and patients to really be doubtful about prostate cancer screening. I think we need to do a lot of education to actually reverse that misperception. And so one aspect is to educate, to make sure people do understand that prostate cancer screening, early detection is important.

So part of what my team is doing, not only really screening, but also all of prostate cancer and actually other cancers as well, is that my cancer center is doing a regular podcast. And so, what my cancer center director, Dr. Roy Jensen, on a weekly basis will interview a cancer expert and have a conversation about some cancer topic. It could be screening, it could be how to live a healthy lifestyle as a cancer patient, it could be about survivorship, it could be about a new technology to diagnose or treat cancer, a topic, a different topic every time recorded as a podcast with experts at my center and other places, and that podcast is freely available to anybody who wants to learn about different topics.

And I think that’s really great because I think knowledge gives patients power to make the right decisions. And so, our podcast, and actually we have some videos as well freely available through Facebook and other media channels, is one way to help us tackle this issue, and increase knowledge.

I think the other aspect of increasing screening is to have more opportunities for screening. And so, what my cancer center has been doing is we actually host three cancer screening events around our state, around Kansas, around Western Missouri, which is close to where we are, and we would just host screening events. It’s prostate cancer, it’s skin cancer, it’s lung cancer, it’s a colorectal cancer. The more we’re able to offer these free community events where people can come and just get cancer screened, the more access we provide and the more early detection we have for patients. I think those are pretty innovative strategies, free education, podcasts, and videos that anybody can access, hosting community events for screening. Sometimes we have it at local churches, sometimes we just have local hospitals to bring this to where people are. I think it’s pretty innovative, I think we make an impact there.

I think another really important thing is telehealth. I think patients from almost anywhere in the country, even if they live in rural areas, can have access to cancer experts and can have access to clinical trials because of telehealth. Telehealth, which is basically a consultation with a cancer specialist, either through phone or through video like Zoom, has really increased the access patients have anywhere to expert opinion, so they can make the right decision for their treatment and potentially have access to clinical trials. I think that’s really made a huge difference for patients as well.

And so, my activation tip for this question is, if you’re diagnosed with advanced prostate cancer, always consider if a second opinion is right for you, a second opinion with a specialist who may have access to the latest treatments, technologies, and clinical trials, and having that information before you to make a treatment decision can provide you with information, so you can make the best decision and have the best outcome for your cancer.

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Are There Worldwide Links to Aggressive Prostate Cancer?

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Are There Worldwide Links to Aggressive Prostate Cancer? from Patient Empowerment Network on Vimeo.

Does aggressive prostate cancer occur more often in specific population groups? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses some regions with high prostate cancer incidence outside the U.S., the impact of inflammatory cytokines, and how screening recommendations may change.

See More from [ACT]IVATED Prostate Cancer

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How Can Advanced Prostate Cancer Care Barriers Be Overcome?

How Can Advanced Prostate Cancer Care Barriers Be Overcome?

 How Can Prostate Cancer Disparity Gaps Be Overcome?

How Can Prostate Cancer Disparity Gaps Be Overcome?

How Can Advanced Prostate Cancer Disparities Be Reduced?

Transcript:

Lisa Hatfield:

So, Dr. Powell, worldwide are there factors that drive aggressive prostate cancer?

Dr. Isaac Powell:

Yes, let me address that. In 2015 it was reported that in Ghana, the incidence of prostate cancer was higher than in the United States. It’s also been found in the Caribbean, Jamaica specifically in Haiti, that the incidence in prostate cancer is greater than among African Americans in this country. So that takes us to the question of what is it about Africa that’s responsible for this aggressive cancer. And so I’ve been looking into that issue and finding that it’s not all Sub-Saharan Africa, it’s the West Africa. It’s consistent with the slave trade and what is it about West Africa and also Central Africa that is causing this. And I also found that in East Africa, the incidences of prostate cancer as well as breast cancer is less than West Africa. So what now we’re talking about the environment. What is it about the environment of West Africa versus East Africa. And the environment is in West Africa considered a rainforest and in East Africa is considered a different environment. 

The diseases are different. In West Africa, you have such disease as a malaria and yellow fever, acute inflammatory diseases, West Africa, I mean East Africa, you don’t have that you have other things. So it’s the environment of West Africa, the rainforest specifically that causes those particular diseases. Now the genetics is, in those poor inflammatory cytokines that we’ve discussed that causes prostate cancer and, in fact, other benign diseases to be more progressive, protect against these acute infections. So this is…the immune system is very complex. In some cases it protects, in some cases it drives the cancers. This is what is…therefore, cancer is what is called an autoimmune disease. And so what the protection does, it selects the population in West Africa. The population that’s selected, because people don’t die from malaria because of these high expressions of poor inflammatory cytokines but, they do then die from chronic diseases such as cancer because those same genes drive the cancers.

 Now, the worldwide scientific organizations have shown a map of West Africa and Central Africa where malaria is very high. That same map shows that prostate cancer is more aggressive in that same area where malaria causes diseases. So the environment has a significant impact on the genome. The environment specifically impacts what I mentioned earlier, the oxidative stress, which is activated by reactive oxygen species. The reactive oxygen species is what is called an unpaired electron which makes it inactive and want…and therefore interacts with various environmental factors. These environmental factors also will activate through RNA methylation. Those two factors are the part of the genome that interacts with the environment, and those two factors interact with pro-inflammatory cytokines. So there is a triangle there that interacts or interplays during cancer and other diseases, and that’s where the environment impacts on the genome causing more cancers in particular populations.

Now, in terms of European Americans, there’s a difference between the Northern European genome gene pools and Southern European gene pools and prostate cancer. And Northern Europe prostate cancer is more aggressive compared to Southern Europe. So it’s not just among people of color. In fact, the color makes very little difference in whether you have an aggressive cancer, particularly in Sub-Saharan West Africa as well as in European. So I just wanted to make that point. And not many people are talking about this, because this is what is called population genetics. Epigenetic, transgenerational, hereditary genetics, those genes are transferred through populations over generations. So that’s what I’ve been learning more recently and there needs to be more discussion about population genetics. We know about familial hereditary, but this is different. This is population hereditary genetics.

Lisa Hatfield:

That is so interesting. So do you think over time there will be recommendations for…I think it depends too on funding for it, but for screening in certain areas of the world for prostate cancer or for any type of cancer where they have found this to be the case?

Dr. Isaac Powell:

Absolutely. That’s going to be a little while, but that I think should happen, yes.

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Do Prostate Cancer Genetics Differ in African Americans?

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Do Prostate Cancer Genetics Differ in African Americans? from Patient Empowerment Network on Vimeo.

Do the genetics of prostate cancer vary in African Americans? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses what research has shown about gene expression and what occurs in the body in African Americans versus European Americans.

[ACT]IVATION TIP

“…patients need to take charge by asking questions about the therapy. Again, ‘is it going to cure me, and is the chemotherapy going to cure, immunotherapy going to cure? If not, how long do we think that I will live?’ That’s a good question, that I’d like to know if I were a patient.”

See More from [ACT]IVATED Prostate Cancer

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How Can Advanced Prostate Cancer Disparities Be Reduced?

 How Can Prostate Cancer Disparity Gaps Be Overcome?

How Can Prostate Cancer Disparity Gaps Be Overcome?

 Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

Transcript:

Lisa Hatfield:

So, Dr. Powell, I just read a bit about your really impressive research, particularly with regard to the biology and genetics of prostate cancer. Can you provide an overview of your research focus on how prostate cancer impacts African Americans in comparison to other ethnic groups?

Dr. Isaac Powell:

Yes, I would certainly love to do that. In 2010, we found that the cancer grows faster among African Americans compared to European Americans. And those are the terms we use now, as opposed to Black and white. In science, we use those terms. And so at that point, I thought that this may be driven by the genetics and biology. So in 2013, we used what now has been considered the artificial intelligence.

We use bioinformatics, which is computational biology, and gene interactive and network analysis to evaluate the cancer tissue. And so at that point, we identified, and we asked the question, are there genetic differences between African Americans and European Americans? And what they found were driver genes, driver genes being the genes that drive the cancer, that make the cancers carry out a function, a mechanistic function, as opposed to passenger genes that are just associated with the cancer, just as in a car, the driver is the one that controls the car, the passenger sits there. These passenger genes, yes, they’re associated with aggressive cancer, but they have minimal or no function. The driver genes are the ones that are controlling the cancer, the function mechanism of the cancer progression. And so we identified in our analysis 21 genes that were different between African Americans compared to European Americans, different in terms of the expression of the disease, not different genes, but different expression of the genes.

What we found is that African Americans have a greater expression of inflammatory genes and transcript genes. And I’ll be more specific about that in a moment. Whereas European Americans had a higher expression of lipid metabolism genes. Those are genes that are associated with fatty acids as well as unsaturated fatty acids, specifically omega-6 as opposed to omega-3. But there is a connection between these two gene interactions at one particular molecule called tumor necrosis factor. And this gene then interacts with both the lipid metabolism genes as well as other inflammatory cytokines. And the genes that we found that were more specific in among the inflammatory genes were the pro-inflammatory cytokines, and those were IL-6 tumor necrosis factor, IL-8, and IL-1B as well as CXCR4.

These are what are called pro-inflammatory cytokines and chemokines. And they carry out functions that cause the cancers to invade. First of all, the cancer initial is cancer cells are stuck together. We call them adherent. They have to come apart before they can spread and go elsewhere. Well, these genes cause that it’s called epithelial mesenchymal transition. And once that happens, they’re capable of being transferred to distant sites such as the bone. And they also cause increased blood flow to the cancer. They also cause the oxidative stress that is driven by a molecule called reactive oxygen species.

And we’ll come back to that particular molecule because that’s important. Once it causes the oxidative stress, this causes DNA damaged repair genes to develop as well as mismatch genes. This mismatch means there are gene molecules that are stuck together, and there is an order. This order is upset by this particular oxidative stress, and those are mutated once they are repaired, and they impact on the mitochondria, which is a molecule in the cell nucleus that controls the chemistry of the cell.

And then this activates cancer stem cells, which is really important. And this is where we are going now with the cancer research. So TNF, the tumor necrosis factor IL-6 and IL-8, and the IL means interleukins. That’s what that stands for. They activate that pathway, the oxidative stress pathway. They also individually activate other pathways that lead to cancer stem cells. And I mentioned cancer stem cells because that’s the reason why chemotherapy and immunotherapy and all the drugs that we’ve used don’t work because the cancer stem cells undergo mutations and these mutations change the character of the cell. 

And that’s why the cancer cells resist that after a certain period of time, now these drugs will work and prolong survival, but they do not cure them because of the cancer stem cells. And so the cancer stem cells, in summary, are driven initially by the pro-inflammatory cytokines. So my research currently is to, well, how do we inhibit these pro-inflammatory cytokines? And that’s where we are now trying to develop a drug. We’re at the stage of mouse at this time, mouse biology and testing the drug in mice, not ready yet for human testing. So that’s where my research is headed, and I believe that that is going to work if the drug works.

Lisa Hatfield:

So just a follow-up question to that is, as a if I were a patient of yours or a family member, I might ask, so with your findings, do you think that this could lead to a cure, for example, for advanced prostate cancer?

Dr. Isaac Powell:

Yeah. I hate to use the word cure. The word I use is that we, our goal is to eliminate death from prostate cancer. That’s the term I prefer, because when we talk about cure, we have to know what causes it in order to really be certain as we are curing it. Because I don’t know whether what we’re doing is going to eliminate death, but that’s our goal. So I don’t like to use the word cure, because that’s the magic word and everybody gets excited. So I don’t want to get people excited too soon. So that’s where I am with my research.

Lisa Hatfield:

Well thank you so much for that. And do you have an activation tip for patients for this question, Dr. Powell?

Dr. Isaac Powell:

Yes. I think that, again, patients need to take charge by asking questions about the therapy. Again, is it going to cure me, and is the chemotherapy going to cure, immunotherapy going to cure? If not, how long do we think that I will live? That’s a good question, that I’d like to know if I were a patient. In fact, I’ve had prostate cancer and bladder cancer, so mine was early, so we didn’t get into those kinds of questions. But I like to know whether is this going to be something soon or later? Nobody can tell you when you may pass away from any cancer. I never give a patient any time. If they ask me, “Well, am I going to live six months or three years?” I don’t know. Because everybody’s different. Everybody responds differently to these particular treatments. So, but ask the questions as specific as possible that you’d like to know about the treatments, because there are several treatments, and there may be many answers.

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Understanding Recommended PSA Screening Age and Frequency In Prostate Cancer

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Understanding Recommended PSA Screening Age and Frequency In Prostate Cancer from Patient Empowerment Network on Vimeo.

What do prostate cancer screening guidelines recommend for PSA screening age and frequency? Expert Dr. Yaw Nyame with the University of Washington explains different guidelines and patient groups who should receive PSA screening sooner or more frequently than the general population.

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 Emerging Promising Advanced Prostate Cancer Treatments

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What Impact Does Advanced Prostate Cancer Have on Lifestyle?

Transcript:

Lisa Hatfield:

And, Dr. Nyame, can you comment on the recommended age of first PSA screening and then the subsequent screenings, the frequency of subsequent screenings.

Dr. Yaw Nyame:

Yeah, so there are a lot of different guidelines out there, unfortunately that don’t all agree, the most current ones from the American Neurologic Association and the American Cancer Society are rooted in the best available evidence and both recommend that high-risk populations which include people of African ancestry, individuals who have strong family histories of prostate cancer, so strong usually means first degree relative, grandfather, father, brother, and it’s important to remember that there’s crossover, so it’s not just prostate cancer, but if breast cancer runs in the family or colon cancer runs in the family, or cancers in general, that can put you in a high-risk category that those individuals should consider screening starting at age 40. The frequency is debatable. We have a study that says that every year for a really high-risk population and PSA test every year, the guidelines will say every two years at the most.

And then it’s important to stop screening around age 69 to 70, especially if your PSA numbers have been really stable, because we can’t over-detect cancers, meaning finding cancers that are going to affect your natural life and that risk goes up if we continue to test unnecessarily as men age, and so somewhere in their early to mid-70s, you definitely want to stop testing.

The most important thing is what is an abnormal PSA, and that varies by your age, so if you have a PSA of 1 when you’re 40, that’s alarming, and that would prompt me to say, “Hey, let’s test every year, and if it gets above 2.5 in the next 5 to 10 years, we’re going to do a biopsy.” You’ve got a PSA of 1, at age 70 that’d be below PSA for your age. And so we use these numbers three or four, but it’s a spectrum. What I would say is, don’t let your PSA get above 10 before you do something regardless of your age, so if you see a pattern of increase certainly as you’re getting above three, four, five and especially if you’re a younger person, you definitely want to make sure you get connected to a urologist.

[ACT]IVATED Prostate Cancer Post-Program Survey

Advanced Prostate Cancer Diagnosis and Survival | Black and Latinx Disparities

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Advanced Prostate Cancer Diagnosis and Survival | Black and Latinx Disparities from Patient Empowerment Network on Vimeo.

For advanced prostate cancer diagnosis and survival, what are some disparities that Black and Latinx patients can help overcome? Expert Dr. Yaw Nyame with the University of Washington discusses ways that Black and Latinx communities can help shift the power dynamic for patients to help drive prostate cancer research efforts.

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Prostate Cancer Clinical Trials | Is Mistrust a Barrier

 Emerging Promising Advanced Prostate Cancer Treatments

Emerging Promising Advanced Prostate Cancer Treatments

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What Impact Does Advanced Prostate Cancer Have on Lifestyle?

Transcript:

Lisa Hatfield:

So a shout-out to Dr. Nyame for an outstanding article that you wrote. I’m going to read a quote from that. Worldwide Men of African Ancestry Demonstrate Worse Outcomes in Prostate Cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and healthcare risks. So, Dr. Nyame, considering the disparities and taboos on prostate cancer, how can Black and Latinx men including their care partners play a role in eliminating these racial disparities surrounding prostate cancer diagnosis and survival rates?

Dr. Yaw Nyame:

I think because of the nature of what drives these disparities, there is no doubt that cancer is a biologic phenomenon, and so there is no reason to ignore biology, but a lot of inequity in the majority of inequity is rooted in structural and social inequities that really inform health, and when I look at our traditional mechanisms for providing healthcare, there is such a power differential, whether it’s in how we provide clinical care or how we do research, and so we as a research team here at the University of Washington, fundamentally believe that we have to reverse those roles that we have to hand the power back to community, so that they’re an equal partner at the table when we do the work that we do. And so we do a lot of work that is centered around engaging community and patients and partnering with community and patients, and I think that’s one way to ensure that we develop research and interventions that create equity.

My activation tip in this particular space is for Black and Latinx communities to think of ways to be partners in research and to really embrace the fact that it is their right to be at the table when we make decisions about how research is conducted, what the results of our research means and how we share those results so that they have impact in our communities, and so there are a variety of ways to be partners in research, sometimes it’s literally being part of the research team, like we do on showing up to meetings every week, and being engaged in the work in all forms, just asking to participate in the trial, being a member and a participant in the trial and making sure that your experience counts in the way we think about advancing the field of prostate cancer and making it better for everybody.

Sherea Cary:

My activation tip in this area for care partners would be encouraging communication, encouraging the patient to share with others, other men, what their experience has been. It seems to me that when you’re in community with other people and you have something in common then the person who is experiencing cancer or an illness, feel a connection, if they know that someone that they know has had it and survived it and seems to be doing well, that’s encouraging to them, and then we also want that person to pay it forward.

So what I remember about my dad is that after he had his cancer diagnosis, he would share with other men who were facing, who were having testing done and then who had been diagnosed, he talked to them about what happened with them, and they had their own sense of community.

[ACT]IVATED Prostate Cancer Post-Program Survey

What Can Signal Hormone-Sensitive Advanced Prostate Cancer?

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What Can Signal Hormone-Sensitive Advanced Prostate Cancer? from Patient Empowerment Network on Vimeo.

Advanced prostate cancer patients may experience common symptoms, but what are they? Expert Dr. Yaw Nyame with the University of Washington explains the range of symptoms that metastatic patients may experience and common treatments for advanced prostate cancer.

See More from [ACT]IVATED Prostate Cancer

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Prostate Cancer Screening and Outcomes _ Impact of Racial Disparities

Prostate Cancer Screening and Outcomes | Impact of Racial Disparities

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

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

 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 Hatfield:

What is advanced hormone-sensitive prostate cancer, and are there specific symptoms or warning signs to be aware of?

Dr. Yaw Nyame:

When we have prostate cancer that has spread beyond the prostate. We define that as advanced or sometimes we call it metastatic prostate cancer. And early on in that process, we can control and often kill many of those prostate cancer cells by taking away testosterone. Testosterone ends up being like the fuel that allows these cancers to grow. And so when we say a prostate cancer is hormone-sensitive, what we mean is it’s sensitive to testosterone, and by shutting off testosterone, we can effectively manage and or kill those prostate cancer cells.

Over time, when we shut off that testosterone, prostate cancers will learn how to produce internally their own testosterone or develop resistance or find ways to still survive in the absence of testosterone, and when that happens, we call that pheromone-resistant or sometimes you will hear the term castrate-resistant prostate cancer.

Advanced prostate cancers are going to be in a category of cancers where people may have symptoms, those symptoms aren’t always specific, they can range from difficulty urinating, having blood in the urine, having fractures of bones that have been invaded with cancer, weight loss, loss of appetite, and so that is sort of a broad spectrum of symptoms that someone could potentially experience with an advanced prostate cancer, but not all folks are going to have those particular symptoms, because oftentimes when you have severe prostate cancer-related symptoms, those are in pretty advanced stages, meaning you have a pretty high amount of cancer that is outside of the prostate.

My activation tip, when it comes to hormone-sensitive prostate cancer that is advanced, is to be informed about the latest therapies that we offer in this space, because it is constantly changing 15 years ago. The mainstay of treatment was just hormone blockade, and we put people on medications that took their testosterone away or offered them surgeries to take away testosterone from the testicles. We then added on these novel testosterone or androgen-blocking medications like abiraterone (Zytiga) or enzalutamide (Xtandi), which people will hear about when they look up the space of what their diagnosis, then we added on chemotherapy in the form of docetaxel (Taxotere), and now we’re doing combinations where we add the hormone blockade and medicine like abiraterone and chemotherapy, what we call triplet therapy as now first-line therapy.

And so this space is changing so much that when you have this diagnosis, you need to take a pause and do your homework so that you are prepared to have a conversation with your medical oncologist about whether you need doublet therapy, one of the two medications or triplet therapy, or if you even need to consider the addition of something like radiation to the prostate. All of these are standard of care, and it’s no longer just a one medication pipeline for treatment is really an individualized and complex therapy.

[ACT]IVATED Prostate Cancer Post-Program Survey

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

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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.

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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

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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

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

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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.

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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?

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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.

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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.

Can Prostate Cancer Patients Rely on Telemedicine Without Risk?

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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.

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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

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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. 

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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?

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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. 

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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.

Should Prostate Cancer Patients and Families Keep Using Telemedicine?

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Should Prostate Cancer Patients and Families Keep Using Telemedicine? from Patient Empowerment Network on Vimeo.

 Prostate cancer patients can still utilize telemedicine after COVID-19 restrictions have lessened. Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about situations when telemedicine visits can be helpful for patients.

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Transcript:

Sherea Cary:

Dr. Cheng, now that telemedicine has broader applications, should prostate cancer patients and families keep telemedicine in their toolbox post-COVID?

Dr. Heather Cheng:

Yes, I actually think it’s one of the…telemedicine, in general, is one of the silver linings of COVID, I think from a member of the medical community, we had to learn…actually, I was already doing some telemedicine, limited telemedicine before COVID hit. But I do think for patients who have access to an Internet or a smartphone and are able to do their visits, it is really decreasing the burden on them in terms of how much time they have to take off work to go to their medical appointments, I think there are times when patients still have to go into clinic, for example, to get treatment, but a lot of times, at least for prostate cancer patients, they can have their PSA that prostate-specific antigen blood test, checked in a lab close to their home, and then you know, at a time that’s convenient to them. And then I can do a telehealth with them later, so that they don’t have to take as much time off work. And so, I think in some cases it’s really, really made it easier for patients, although there are still times when we do need to see them in person, it’s just really nice to have that as an option.

So, I really do think that’s a really good thing, and I hope that the medical community and patients can continue to benefit from that. The other time when it’s helpful is for second opinions and consultation, so this is also really important for patients to know about it, is the first time they’re making a big decision about their treatment and they’re not 100 percent sure maybe they want to get us that an opinion, just to make sure that other doctors agree and that they get another chance to hear the treatment options explained in a different way. And I see a lot of patients for second opinions just to kind of get more confidence, maybe they’ll still decide to get treatment with their local oncologist, because it’s easier closer to home and less disruptive than to come to see us in Seattle. But it still gives them more confidence that they’re going down the right treatment path, so I think telemedicine also makes that a lot easier for patients as well.

How Does Aggressive Prostate Cancer Impact Various Populations?

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How Does Aggressive Prostate Cancer Impact Various Populations? from Patient Empowerment Network on Vimeo.

How is prostate cancer impact different for some populations? Watch as expert Dr. Yaw Nyame shares how prostate cancer incidence and death rates vary for some groups, potential risk factors, screening recommendations, and actions that can be taken to improve health outcomes.

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Ask the Prostate Cancer Expert: How Is Prostate Cancer Diagnosis and Treatment Evolving?

Transcript:

Sherea Cary: 

What differences do you see in terms of aggressiveness for cancers in different…various populations? 

Dr. Nyame: 

This is an area of research that for me, is trying to understand why certain populations have more aggressive or worse outcomes when it comes to prostate cancer. 

The most obvious example of this here in the United States is for Black men. Black men are more likely to be diagnosed with prostate cancer each year, so about 70 percent more likely to be diagnosed, and they are twice as likely to die from prostate cancer as men of other races in the United States. If you look at what the natural history of prostate cancer and Black men looks like, meaning if you were to chart from diagnosis through the course of the disease, does it look different for Black men? The answer is yes, it appears of Black men get prostate cancer when they’re younger, and there’s data to suggest that perhaps Black men get more aggressive prostate cancer because they’re more likely to progress from the localized or treatable disease to stage IV aggressive disease that can’t be treated. We don’t understand what the drivers of that are for a long time, the medical community has suggested that it’s all biology, and by that may be an inherited biology, but we know that health disparities really carry a significant social contribution. And, in fact, I like to say that social and environmental factors inform biology too. And so, if we see something biologic that explains these trends, it doesn’t mean that that’s the way they were born, it might mean that you put someone in a community that lives near a highway with high pollution or does not have access to clean water or lives in a state of high stress or over security. We don’t know what the biologic manifestations of those types of experiences are, but that perhaps is the reason why we see our communities of color, especially our Black men, are experiencing a higher burden of prostate cancer. 

Sherea Cary: 

So, is there a push to have African American men tested earlier with the PSA test, since it appears that they may get prostate cancer earlier?  

Dr. Nyame: 

The U.S. Preventative Services Task Force, which makes a recommendation to the medical community about prostate cancer screening states that they cannot make a specific recommendation about screening in Black men and other high-risk populations like men with a strong family history of prostate cancer, because those men were not included in the clinical trials that have looked at the efficacy of PSA testing for screening. 

Unfortunately, Black men make up 3 percent or less of participants in the two screening trials that have informed whether there’s a benefit to PSA testing, which there has been shown to be a 20 percent decrease in dying from prostate cancer if you get screened. We recently took data from the screening trials and superimposed them on real-world data from our surveillance apparatus for cancer in the United States, and what we found was that if you did lower the age of screening in Black men from age 55 to 45, that you did decrease the risk of dying from prostate cancer significantly. It is our hope that this type of research will encourage the U.S. Preventative Services Task Force and other medical societies to reconsider their screening recommendation for Black men, ultimately, whatever, if there is a recommendation made to screen at younger ages, I think we need to be conscientious and evaluate what the impact is on the ground, so that if there is a time where we need to reverse a recommendation like that because it’s potentially harmful, that we consider that. But I feel strongly sitting here today that we do need to advocate for earlier screening and Black men.