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Episode #2 - Movember Kickoff Prostate Cancer 101

Steve Abbott:

Good afternoon, everyone. My name is Steve Abbott and I'm the executive director of Cincinnati Cancer Advisors. Welcome to our first-ever, but second actual Cincinnati Cancer Advisors, Medical Minute podcasts, where we'll attempt to explain complicated cancer topics in a way that makes cancer easier to understand for patients. At CCA our motto is great care begins with a great plan. And our goal with this series is to provide vital information that will help patients formulate a better plan of care along with their treating physician. And now without further ado, I'd like to introduce my co-host, Jill Hunt. Jill is not only my colleague, but she's anoncology nurse practitioner with more than 20 years of experience. The last 17 years of which have been in combination with Dr. Phil Leming, our medical director. Jill and Dr. Leming saw more than 200 patients last year, even during COVID and their consultations span almost 40 cancer types. So they see pretty much everything. Our first series of topics today will cover prostate cancer in honor of November, which promotes awareness of men's health issues such as prostate cancer, testicular cancer, mental health, and suicide prevention. Welcome, Jill.


Jill Hunt:

Thanks, Steve.


Steve Abbott:

So as I mentioned, what we're going to try to do is make things a little simpler for people to understand. And one of the things I talked to Jill about this morning is that I think something even as simple as that I don't even know if cancer patients necessarily even understand what cancer is. I mean, they know it's bad, they know that it can potentially be fatal, but do they really understand like at a cellular level what's happening, what's going on in their body. So let's just start real basic. What is cancer? What's going on? What's going wrong?


Jill Hunt :

Okay. So if we went down to the basic definition of what cancer is, an easy place to start and where I like to refer a lot of my patients for credible information would be the National Cancer Institute. How they define cancer is a disease in which some of the bodies cells grow uncontrollably and it spreads to other parts of the body. So cancer can start almost anywhere in the human body and taking into consideration that the human body is made of trillions of cells. And normally these human cells grow and they multiply through a process that's called cell division. Okay. And what that does is it forms new cells as the body needs them. So when these cells grow old or become damaged, they die and then new cells take their place. So the problem is, is sometimes that process goes a little wonky.


Steve Abbott:

Okay.


Jill Hunt :

And those abnormal and damaged cells grow and multiply when they shouldn't.


Steve Abbott:

Got it.


Jill Hunt :

So these cells can form tumors, which are lumps or clumps of tissue. And these tumors can be either cancerous or non-cancerous or benign. So the cancerous tumors, what makes them a little bit different is they can spread to different parts of the body. And that's where you get terms like metastatic from. Okay. And many cancers form solid tumors, but cancers that start in the blood like leukemia's or lymphoma, well, not lymphomas, but leukemia's or other types of blood malignancies, those typically do not form solid tumors.


Steve Abbott:

Got it. Got it. No, that's a good answer. So let me ask you at this. So particularly since we're here to talk about prostate cancer today. So prostate cancer has the reputation of being well, I think some would say very curable. Now, as we know that there's a spectrum and a continuum of what those results and outcomes can be, but why is it that prostate cancer is considered the good cancer? Why is that one a little less likely to scare people half to death?


Jill Hunt :

So traditionally prostate cancer is pretty slow growing. And when you look at actual survival numbers at the time of diagnosis, and this is something that most clinicians are looking at. They're looking at what the survival numbers are at like the five year survival rate. When you are looking at early stage prostate cancer diagnosis, these patients have a 98%, five year survival. And so what that means is at five years, 98% of patients that are diagnosed with early age disease are still alive.


Steve Abbott:

Okay.


Jill Hunt :

The other piece to this is a lot of patients, especially when they're diagnosed early, they don't even need to actually start treatment immediately though they call it like active surveillance where yes, they may have an active diagnosis, but they're in such a good spot that they can actually just sit back and monitor over time to see what their cancer is actually going to do.


Steve Abbott:

Gotcha. Gotcha. So one of the things we always talk about is one of the things at least we hope for, we tend to see patients after they've been diagnosed, but clearly we have a great interest in early detection. So what are the kind of things that given that prostate cancer is so curable if caught early, what are the kinds of things a man can do to try to catch it early?


Jill Hunt :

So the number one most important thing is making sure that they are seeing their family doctor on a yearly basis. This isn't just for prostate cancer, but obviously can pick up other things. There's health screenings that are routinely done to watch for all different types of not only cancers, but other health conditions, but as our population ages, and especially once just general population, men who don't have any other risk factors, once they hit 50, they should be having those yearly PSAs done along with their regular physical exam and other lab draws that are being done.


Steve Abbott:

Yep. No, it is so true. So there's confused. And as you know, these guidelines tend to shift a little bit here and there, depending on updated studies and things like that. The common denominator that I think drives everything is family history, particularly when it comes to prostate cancer.


Jill Hunt :

Correct.


Steve Abbott:

There probably aren't too many cancers that are so clearly defined by family history as prostate, but can you take people through kind of, what are the current guidelines? Just so if someone is watching this and kind of knows where they fall age wise, what they should be doing.


Jill Hunt :

Okay. So the current recommendations for PSAs, they should start at age 50 for men who are at average risk. And beyond that, when we start looking at people who are at higher risk, so someone that would be African American with a first degree relative, which would be a father or a brother diagnosed with prostate cancer at an early age. These men actually need to be starting their PSAs at an earlier age, around 45. To notch it up another level, men who have more than one first degree relative who have had a prostate cancer diagnosis at an early age, they actually should start their PSA at age 40.


Steve Abbott:

Yeah. And I've read, and you could tell me if this is wrong, but I've read that that even tends to be cumulative as there's more and more family history, the risk gets even greater and greater. So it's even more important for those guys.


Jill Hunt :

Correct.


Steve Abbott:

So let me ask you this. So, okay. So we're sitting here and it's like, okay. So if we stipulate and agree that getting a PSA itself is not difficult, it's a blood test. It's not expensive. It's not difficult. In order to properly diagnose, there's other procedures that are less fun than a blood test. But just to get a baseline, like on a PSA, why wouldn't a guy just go start getting him when he is 30 years old? Because you look at these guidelines and they're not encouraging anyone young to go. Why is that?


Jill Hunt :

A lot of it, and they've actually looked into studies looking at checking PSAs earlier and seeing if that actually improves the overall survival and decreases the risk of people dying of prostate cancer later in life. And there's been a lot of conflicting data and they haven't been able to truly prove that checking it earlier, like when men are in their 30s or potentially even younger, that that actually has any benefit to the overall survival related to prostate cancer. The other thing that you have to take into consideration is that prostate cancer isn't the only thing that can elevate a PSA.


Steve Abbott:

True.


Jill Hunt :

And so sometimes you can get what they call a false negative or a false positive. So false positive would be that you had a positive PSA that was elevated and people assumed that it was related to prostate cancer. So then they move on to doing a prostate biopsy. And when you're dealing with anything in the medical community, you're always looking at risk and benefit. And so doing a prostate biopsy isn't without risk. And so if you have someone who has a false positive on their PSA for an elevation that was not prostate cancer related and then that person goes through having a prostate biopsy that may not have actually been needed. You're exposing them to the risks of the anesthesia, the potential postoperative risks. And then if you do get an early diagnosis, sometimes there's a little bit of a knee jerk reaction and you can't always with 100% accuracy determine the aggressiveness,


Steve Abbott:

Yeah.


Jill Hunt :

Of the cancer. And so sometimes that early detection, sometimes you can end up with over treating in that scenario.


Steve Abbott:

Yeah. No, it's a great point. And the interesting thing about that, you mentioned other potential factors is things like either recent sexual activity or some people even cycling, certain types of exercise. There are things that younger guys tend to do that maybe older guys aren't doing.


Jill Hunt :

Correct.


Steve Abbott:

And so that could even lead to a potential false positive, as you said. So I think that's an important thing to point out. So anyway, episode two, I think we'll continue to do this. Episode three we'll continue talking about prostate cancer with some more questions that we'll go through. The goal of these is to answer questions in approximately one minute each, I think we're close. And so anyway, thanks again, Jill. And we'll talk again here shortly.


Jill Hunt :

Okay. Sounds good. Thanks.

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