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Episode #16 - Biopsy Results

Steve:

Hello everyone, welcome back to episode 16 of our Medical Minute podcast. You know, Jill, we've been on this big subscription push lately. We're doing well, and we've got some brand equity built up, I think at least in our Medical Minute name, but it's starting to look like we probably need to change the name to the Steve Show, based on the way it's going here.


Jill:

Well, if Sherry has it her way, she'll want to call it the Sherry Show.


Steve:

Probably true. That doesn't roll off the tongue quite as easily.


Jill:

As well as the Steve Show?


Steve:

Yeah, I think that's better. So we're back. We're both sporting our new cancer pins. They all matter is the thing because we got our rainbow pins on, so we're making a little bit of a fashion statement there. You know, my friend Sean Miller in Cleveland subscribed. He's my friend and nemesis. He sent me an email yesterday, the youngsters won't really get this, but he said, "I think the podcasts are really great." And he said, "By the way, George Burns called, and he wants his glasses back." So, just to stick it to Sean, I'm going to continue to wear these glasses.


Jill:

I think that's a great idea.


Steve:

All right. Sounds good.


Jill:

You have much better hair than George Burns did.


Steve:

Hopefully, I'll continue to have good hair.


Jill:

Absolutely.


Steve:

We'll talk about that later. As we've kind of gone through this journey, it's been born of unpleasant circumstances, but it's been a nice opportunity to actually bring to life some of the things we've talked about in concept. We started out with PSA results that were rising, and then we covered the Guardant360 and the value of that and what that told us, and then we talked about my PSMA PET scan, which I got done, and then we got those results back.


Jill:

In the beautiful city of Ann Arbor, Michigan.


Steve:

Absolutely. Now be careful, there are a lot of people in Ann Arbor, and they get a little angry sometimes, depending on the football game.


Steve:

So we got those results back, and we talked about those. Where we left off was the PSMA PET scan found some stuff that I certainly wasn't very happy about, but it is what it is. We're back here today to talk about the biopsy that I had done last week, and I try to say this because I stumbled the supraclavicular node. As it turns out because I could hear the chatter when I was on the table, there actually turned out to be three of those that were quite large, the largest of which I think was about almost an inch across. Two centimeters is about close to an inch, right?


Jill:

Yes.


Steve:

About eight-tenths of an inch, something like that. Now we have those results and bear in mind that we always try to make difficult things simple.


Jill:

Yes.


Steve:

Can you walk us through what those biopsy results say?


Jill:

Yes. So very similar to the PSMA results and CAT scan results or any medical report that you would receive, they have what's called an impression. I like to refer to that as the CliffNotes version, and standardly on pathology, they have additional comments. The additional comments section, realistically, I almost think it's for all of the people that hang out in the lab, mostly the pathologists. Because standardly, in the comments section, it talks about the stains that were done and what stain results were positive. For the typical layman, it just really doesn't offer you any information other than what the heck is an NKX3 positive cell is. What is that?


Steve:

I looked that one up, and I didn't get very far.


Jill:

If you ever do have a pathology report and you're trying to read all of it and have an understanding, just know that for the different cancer diagnoses, there are certain stains that the pathologist will do that tells them pretty much without a shadow of a doubt, that what they're dealing with is that specific cancer. Because they would've already known that you had prostate cancer, they would've started with stains that were specific to that prostate cancer. In the comments section, that's what it talks about. It talks about the stains that they did, and because they were positive, they were very sure of what they were seeing.


Jill:

With all of that long explanation, the final diagnosis on the left supraclavicular lymph node biopsy was that it was indeed metastatic prostatic adenocarcinoma. A long way to say that your prostate cancer spread up to that lymph node there in the neck. It did not indicate that the cell type or that anything had changed, that it had taken a more aggressive spin, which obviously could have been a concern. It's just telling us that the prostate cancer that you have is headed north and hung up in your lymph node in your neck and is causing a problem there. Obviously, what that tells us clinically, is that we've now moved outside of the regional metastatic disease, and we've moved you to a distant site. That changes up the approach. We're no longer taking a local-focused regional approach.


Steve:

If you kind of thinks back, the Guardant360 will find shed DNA in the bloodstream.


Jill:

Correct.


Steve:

The PSMA PET scan would kind of see where the cancer cells are kind of lighting up.


Jill:

Mm-hmm (affirmative).


Steve:

Some of my tissue was sent to a company called Caris Life Sciences.


Jill:

Correct.


Steve:

Can you tell everybody what the Caris analysis will tell us?


Jill:

Caris falls under the umbrella of next-generation sequencing, or molecular profiling. It actually takes the specific cancer tissue and runs all of those tests looking for the same mutations and alterations that the Guardant360 was looking for, but instead of looking at it in the blood, it's looking specifically at the tissue. It again adds another piece to the puzzle. What we're looking for is, are there any mutations that we're picking up again that might not have been picked up on the Guardant that could potentially offer some additional treatment options? It just helps again to be another data point as we're moving forward on deciding what the next best step for treatment is.


Steve:

We talked about this last week, so we're at the point where, and this is going to circle back to a previous episode where you gave one of your good analogies. I need a quarterback.


Jill:

You need a new quarterback. You need to add another player to your team.


Steve:

And that's going to be the medical oncologist.


Jill:

That will be the medical oncologist, and standardly with prostate cancer, and I'm sure that you can attest to this. When you're an early diagnosis, most of the time, you just have a urologist who is following you. However, you were lucky and super blessed in the fact that your radiation oncologist happened to be Dr. Bill Barrett, who isn't just your doctor. He becomes part of your family. He's a friend. He definitely added another layer of watch-over for you. You had not only your urologist but also Dr. Barrett, your radiation oncologist. When you get to the point where you're outside of what those two specialties can offer regarding treatment, that's when you kind of need to bring in the next level of player in regards to a medical oncologist or your quarterback.


Steve:

To bring us kind of current on where we're at while we wait for the tissue analysis from Caris Life Sciences, and for me to actually meet with my medical oncologist for the first time, all of this stuff that we've been talking about, all this precision medicine results, where it's kind of brought us, is that we found something early, wasn't as a result of symptoms, so that helps. Right?


Jill:

Correct.


Steve:

We may get some guide guidance out of the Caris analysis that may tell us what things might be more effective what treatments might be more effective or successful.


Jill:

Correct.


Steve:

And I guess by contrast, what probably wouldn't be more successful. To wrap it up, this is where I see it. And here it comes, movie reference. Wait for it.


Jill:

I'm anxiously waiting.


Steve:

So you're saying I've got a chance.


Jill:

Very nice.


Steve:

I thought that up right then; I literally made that up.


Jill:

Was that spur of the moment? Impromptu.


Steve:

That was not on this sheet.


Jill:

Very nice.


Steve:

Next week, we'll have to figure out a way that we can continue to talk about me. After next week hopefully, we'll have the Caris report. If not, we'll find something. Maybe we'll put Chris behind the mic next week or something. I don't know, we'll see.


Jill:

There you go.


Steve:

We'll go ahead and wrap it up. We've been on a mad push for subscribers because we like what we're doing here. We think it's good. We're closing in on 300 subscribers. We'll figure something out, but we're going to find a way to reward subscriber number 500. Subscriber number 100 was Steve Wolf. He's a big supporter of ours, and so he'll get some kind of swag bag. Five hundred will get some sort of swag bag as well, but we got to get to 500, and that'll put us halfway to our goal of 1000 subscribers. If you like what we're doing, subscribe, if you don't like what we're doing, subscribe, and we'll be back here next Wednesday at noon to talk a little bit more about-


Jill:

You.


Steve:

Yeah, about me. Why not? All right. Thanks, everybody. We'll see you next week.

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