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Episode #3 - Prostate Cancer 102

Steve:

Hey, everybody. Welcome back to the CCA Medical Minute. This is episode number 3 and where we left off last week, which is what we call prostate 101 was a pretty basic list of questions. And we'll take it up a little bit of a notch this week. Our audience for these things are patients, not doctors. So we're going to try to explain the answers to these questions fairly quickly. And occasionally Jill will use words like wonky to describe erratic cell division. So we're going to be keeping it real. So Jill, when we left off last week, we were talking about the value of PSA, PSA being a number it's highly sensitive and it's very predictive for prostate cancer, but it's not the be-all end all for prostate cancer. So, let's say, for example, I come back with a high PSA. What other kinds of things is my doctor going to do to determine whether I actually have prostate cancer or I just have some mother things that are driving that number?


Jill:

So there are multiple things that can elevate a PSA level. Just some of the basic things that you would look at age, people that are a little bit older men that are older, have a little bit higher level prostate size infections like prostatitis or urinary tract infection, conditions like BPH, benign prostatic hyperplasia, also prostate simulation. So, ejaculation, excessive exercising like cycling, and then there are certain medications that can elevate a PSA. So if a patient comes in and they have an elevated PSA, the first step would be to recheck the PSA, and then they would have a physical exam, including a DRE or a digital rectal exam. And then if those things are still abnormal, then the next step would be for the patient would have a prostate biopsy.


Steve:

Okay. I still don't like talking about these DREs, but anyway, it is what it is. So let's say, unfortunately, there are other non-cancer-related things you mentioned that weren't the case in my case. And so I went and I had a rectal exam and they found a lump and then I had a tissue biopsy and they found cancer. So what can I do now? What treatments are available to me?


Jill:

So men who are diagnosed with early stage prostate cancer, depending on kind of the tumor biology or how aggressive their prostate cancer is deemed to be at the time of diagnosis, do they have more aggressive prostate cancer that they're anticipating is going to have a chance of spreading or do they have a couch potato prostate cancer. And so for those patients that are diagnosed with early stage, we're kind of looking at that, what is their risk of recurrence? So those who have your couch potato variety prostate cancer, really do have the option to do just watchful waiting and active surveillance. They're usually seen pretty regularly by their urologists. They have those physical exams as well as frequent PSAs. And they don't have to do any treatment while they're waiting to see what the characteristics of their prostate cancer are. Most men go on and don't ever have to have treatment until much later. For those who have a little bit more of an aggressive biology, they're often offered surgery or radiation.


Steve:

Okay. From what you hear, is there one that's better than the other?


Jill:

In regards to surgery versus radiation, there isn't one that is better than the other in taking into consideration overall survival, but each has their risk and benefit. And ultimately what you're looking at is what is the best option for the individual patient.


Steve:

Okay. So let's say I make my treatment choice and I decide to get surgery. So am I done?


Jill:

As much as I would love to tell you that you're done and you can go on your merry way and don't ever have to see any of us ever again, unfortunately, even patients who are diagnosed with early stage disease who have surgery or radiation about 20 to 30% of them will have a recurrence of their disease within 10 years. Although that seems like a high number. If you think about it in another way, 70 to 80% of men diagnosed with early stage prostate cancer will be cured of their disease. But because we don't know who the 20 to 30% are, everybody gets stuck seeing their urologists pretty regularly, always checking those PSAs and making sure that they're staying on the straight and narrow.


Steve:

Okay. So 20 to 30%, unfortunately we'll have a recurrence, but a hundred percent of those guys need to keep an eye on things. So there's a couple of new tools out. That'll help them do that. So if you pay much attention, you've probably run into this or heard about it. Talk to me real quick about what's called a PSMA PET scan and then when we're done with that, let's talk about liquid biopsies and how those might be useful?


Jill:

So PSMA scan is actually one of the newest tools in the box. It was just FDA approved earlier this year for men who have prostate cancer that has been previously treated and now they're starting to see an elevation in their PSA. PSMA stands for prostate-specific membrane antigen. And so PSMA is actually found in more concentrated quantities on the prostate cells. And so they're finding that they're able to diagnose recurrence of disease at a much earlier phase. The test is linked to a PET scanner. So it's the same nuclear medicine testing. Patients get a nuclear medicine injection, and it helps to identify those prostate cells that are the prostate cancer cells. And so essentially when they're reading the PSMA scan, they're looking for hotspots or areas that are lighting up because of the injection and identifying those concentrations of cells. They're able to do this in a much earlier phase. And so for patients who have early progression of their disease, it allows quicker treatment for their disease.


Steve:

That's great news, actually really, really great news. And the liquid biopsies, are they kind of a substitution for tissue biopsies or they are a little bit different?


Jill:

It is not a substitution. The science is definitely evolving and we've actually seen in other tumor types like lung cancer that, if you're looking to be able to find targetable mutations for treatment options, that you can find those with a liquid biopsy, when a tissue biopsy isn't an option for the patient. And so they're studying more and more and more other solid tumor types. And what they're finding is that they're able to identify when patients are on treatment, if they're responding to treatment, because they'll see those numbers go down. If they're having progression of their disease, they'll start to see that the numbers are going up and specifically they can pick up those mutations that are in the DNA of the actual tumor that are circulating through the bloodstream and hopefully to identify some potential treatment options.


Steve:

Okay. All right. Well, there you have it. So episode 2 was prostate cancer 101, we did 102 today and next week we'll graduate to the 200 series. Get more to an intermediate level, I guess, but either way, we'll keep it as simple as we can keep it, but join us next week. Next Wednesday at noon. Thanks again, Jill.


Jill:

Thank you.

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