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Episode #4 - Surgery and/or Radiation Failure

Steve Abbott:

Hello, everybody, and welcome back to episode four of our Medical Minute podcast, where we've been focusing on prostate cancer. We've taken some baby steps so far. As you might recall, we started out with something as simple as what is cancer. But we've kind of moved up a little bit from there, talked about early detection and what a patient's options are if indeed they find out that they do have cancer. Today, we're going to focus on what happens if surgery, radiation, or the combination thereof, "fails". And I'll put that in air quotes for a reason I'll explain in just a minute. Our producer's going to hold us to 10 minutes or less today, so we'll move quickly, four or five questions, try to keep into about a minute, a minute and a half each. So, Jill, as I just mentioned, people often say, and I said this originally that, "Oh, the surgery failed," or, "radiation failed." Does it really fail? Or is there some other reason?


Jill Hunt, CNP:

So, when looking at surgery and radiation for prostate cancer, what you have to understand is, it is a very localized treatment. It is not something that is broad. It's focal to just that area. And as amazing as our modern technology is, with the scans that we have and everything, it still cannot pick up cancer down to a single-cell level. And so, in instances where a man has had surgery or radiation or a combination of both, and he later goes on to develop metastatic disease, usually what has happened is, there's been one little cell that's gone a little haywire and got loose, and moved on into some other part of the body.


Steve Abbott:

Yep. Yep, indeed. Okay. So, let's say, for example, in our hypothetical case that, we'll act like it's hypothetical, that's what's happened. So, what do we do next?


Jill Hunt, CNP:

So, once a patient has recurrent disease, and they've been confirmed to have metastatic disease. Now we start looking at other treatment options in that setting. They're no longer going to just be observation and PSAs after the surgery or radiation. Usually, the frontline is hormone therapy. And depending on the aggressiveness of the disease, they can often use that in combination with some of the oral medications as well, or, depending on the patient, they can do just the hormone blockade itself. With prostate cancer, there are so many treatment options once it has become metastatic, that it really is tailored to the specifics of the patient.


Steve Abbott:

Got it. I mean, what exactly is hormone therapy? What's the goal with hormone therapy? What does it do?


Jill Hunt, CNP:

So, with prostate cancer, testosterone is the male hormone that feeds prostate cancer. It's kind of the driver. It's what causes and enables the cancer to grow. And so, what the hormone therapies do is they block the production of that hormone, so that you essentially starve the cancer.


Steve Abbott:

Okay. Okay. It's funny. So, I'm about, as I think you know, I'm about five years in on this. And it's funny, I'm on like a bunch of different discussion lists and things where, and I literally see guys say like, "I'm just going to go off. These side effects are killing me," and things like that. I don't know. Maybe everybody has different tolerances for different things. But, I take the approach that it's so much better than death. But I know that, just for people that might be wondering, I think pretty typical side effects are, you might feel a little tired. It's pretty commonplace, I think, to put on weight. Your appetite can be affected. But, you tell me if I'm wrong, I think one of the main things is that testosterone plays a pretty big role in metabolism as well. I don't think you metabolize things quite as well, and you get tired. You don't really feel like being as active, so it's kind of prescription for weight gain. So far, for me, that's the worst thing. But, other than that, I feel great. I feel fine. So I don't think guys should be really overly worried about that. Would you agree?


Jill Hunt, CNP:

I 100% agree. I have a few patients that were avid golfers, and they would come in complaining because their drive wasn't as far as it used to be, or your athletes who notice a difference in their strength or endurance. But again, you balance. Your prostate cancer is well controlled. You're still out on the golf course, or you're still on the basketball court. However, you're not facing death.


Steve Abbott:

Right.


Jill Hunt, CNP:

Imminently.


Steve Abbott:

Right. Exactly. Okay. So, we can switch up medications that are given sometimes in combination with hormone therapy, kind of try a bunch of different things. Hormone therapy buys a certain amount of time, and you can do that for a while. What other things, tell me real quick, why don't... Chemo's not really common early on, but it is becoming more common as an adjuvant therapy. So, can you explain what that is? And then, just what might be down the road for treatments post-hormone therapy.


Jill Hunt, CNP:

So, the term adjuvant therapy, essentially what that means is, once the cancer has been completely removed, and you have done scans, and the scans are showing that you don't have any evidence of disease in your body, what the adjuvant treatment is, is a treatment that is an insurance policy. It's guaranteeing or offering additional treatment to potentially catch any of those little cells that went rogue and could possibly be causing a problem. They usually set a duration. It's usually for four, six months, sometimes a year, depending on the case. But it just gives additional assurance for better disease control, long term.


Steve Abbott:

Gotcha.


Jill Hunt, CNP:

As far as chemotherapy and the treatment of prostate cancer, it is used, but chemotherapy comes with its own list of side effects and complications. And so, they really do try to use some of the more hormone-based therapies prior to using chemotherapy. The other piece too, and I'd referred to a variety of prostate cancer that could be described as your couch potato variety, that's more of a slow-growing cancer. And chemotherapy works better in the setting where cancer is more rapidly dividing.


Steve Abbott:

Oh, interesting.


Jill Hunt, CNP:

And so, they really do try to use it when it's appropriate.


Steve Abbott:

Okay. Yeah. That makes total sense. From what you've read, do you think there's promise for, I know initially it wasn't quite as well regarded for prostate cancer, but do you think there's promise for immunotherapy down the road?


Jill Hunt, CNP:

There's definitely some ongoing studies that are showing some promise in regards to immunotherapy, and there's other hormone-related cancers that they're seeing benefit in as well, so it's just going to be a matter of time.


Steve Abbott:

Sounds great. All right. So, our producer, Chris, you can see we're well and under the timeline. Thanks, everybody, for joining episode four. We'll be back next Wednesday at noon for episode five, where we'll kind of close out our conversation around prostate cancer and move on to another topic. So thanks, everybody, for joining.

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