For most men diagnosed with prostate cancer, there are many treatment options.
How do you decide which one is best for you?.
In recent years there have been many advances in prostate cancer treatment technology, such as robotic surgery, targeted GPS guided radiation, and major advances in chemotherapy, hormone therapy and immunotherapy.
Understanding the benefits and risks of each treatment can help men navigate through the process of selecting proper treatment.
Selected Podcast
Advances in Prostate Cancer Treatments
Featured Speaker:
Dr. Pisick earned a bachelor's degree in biology at the University of Rochester; he earned a medical degree from Boston University. Thereafter, Dr. Pisick completed an internship and residency at Mount Sinai Medical Center in New York City, followed by a fellowship at Tufts Medical Center in Boston. His extensive research on small cell and non-small lung cancer, as well as malignant mesothelioma, has been published in a variety of scientific journals, including Hematology/Oncology Clinics of North America, Anticancer Research and the Journal of Experimental Therapeutics and Oncology.
Transcription:
Advances in Prostate Cancer Treatments
Melanie Cole (Host): We're talking today about advances in prostate cancer treatments, and my guest is Dr. Evan Pisick. He is a medical oncologist. Welcome to the show, Dr. Pisick. Can you tell us a little bit about prostate cancer? Give us a working definition.
Dr. Evan Pisick (Guest): Prostate cancer obviously is cancer of the prostate and also one of the most common non-melanoma skin cancers in men. In 2013, upwards of 240,000 men will be diagnosed with prostate cancer of all stages.
Melanie: Are there certain risk factors that men and their wives should be aware of that might predispose them to getting prostate cancer?
Dr. Pisick: Yes. One of the most common risk factor includes age. The older you get, the more likely you are to have prostate cancer. In fact, over the age of 60, one in 15 will be diagnosed. Also race is important. African-American men develop prostate cancer about, on the average, 10 years younger than Caucasian or Hispanic men. Family history is also very important so men who have brothers, fathers, uncles, sons with prostate cancer may be at higher risk for developing prostate cancer as well as obesity, diets high in saturated fat. There are other genetic syndromes as well, but they are much rarer.
Melanie: If somebody is going to see their doctor on a regular basis, which is what we certainly would encourage, but they are having some symptoms that they haven't really had before, let the listeners know what they might be experiencing that would send them to their doctor.
Dr. Pisick: Symptoms that men can look for include frequent urination, incomplete voiding of the bladder, urinating a lot at night while sleeping, erectile dysfunction, blood in the urine, blood in the semen. Those are some of the symptoms that if men are developing, they should be seeing their physicians about. The other issue with these symptoms is that they can come on very slowly. So they will not happen overnight. It is something that men will notice over time but may get used to, so they have to be more aware of their urinary habits.
Melanie: And it's important for men to see their doctor regularly, isn't that true, Dr. Pisick? Because as men age, their prostate does grow. And so that goes along with it, and they see their doctor on a regular basis.
Dr. Pisick: Correct. A lot of these symptoms that I described aren't only associated with prostate cancer. They're also associated with a benign enlargement of the prostate, which is treated in very different ways.
Melanie: So then, how would cancer be diagnosed?
Dr. Pisick: Prostate cancer is diagnosed by biopsy of the prostate, where parts of the prostate are removed that we can look at under the microscope. The men who do have prostate biopsies are usually men in which high suspicion is noted, including elevated PSAs, clinical histories, family histories, as well as physical exam of the prostate on what's called the digital rectal exam if the prostate is noted to be hard, irregular, swollen, or even if nodules are palpated.
Melanie: Dr. Pisick, if you would, please explain the PSA test. What are the normal ranges? Men get these numbers; they don't quite always know what they mean. And explain the Gleason score and the clinical staging, if you would.
Dr. Pisick: PSA is a blood test which stands for prostatic-specific antigen, which is a prostate noted in the blood made by prostate cells, both normal cells as well as cancer cells. This number, the range changes as men age. The range you use for a 50-year-old may not be the same range you use for an 80-year-old. The Gleason score is a pathologic diagnosis. When we do a biopsy and our pathologist looks at the cancer under the microscope, they basically determine its pattern from what they can see. It's based on a scale of 2 to 10. You have two scales of one to five. The primary growth pattern, which is the most common pattern you see within the specimen, gets a number of one to five. What we call the secondary pattern, which is the second most common pattern that is under the microscope, also gets a score under one to five. Those numbers are added together. Gleasons of six and lower are considered low risk, while Gleasons 8 to 10 are considered more of a high-grade tumor. The clinical staging of prostate cancer is based on digital rectal exams—how does the prostate feel under an exam with a finger itself. We also can use ultrasound to the prostate as well as MRIs of the prostate to get a picture of what the prostate looks like. Can we see cancer invading from the prostate into nearby structures such as bladder or rectum? Are there enlarged lymph nodes? Are the seminal vesicles involved? Is the cancer going through the capsule, which is the lining of the prostate? By using PSA, Gleason score, and clinical staging, we can develop a clinical risk in which patients can be low risk, intermediate risk, or high risk. For patients who have localized disease within the prostate, it helps us to better stratify when discussing treatment options moving forward.
Melanie: For most men, they'll have many treatment options, and the tricky part is then how to come to the decision that's best for them. So speak about some important developments in prostate cancer treatment.
Dr. Pisick: Many of the advances that have recently come in prostate cancer treatment apply mostly to men with metastatic prostate cancer. So that's cancer that has already spread beyond the prostate to lymph nodes, bones, in other internal organs. These are also men who, in their initial treatment, will receive what's called androgen deprivation therapy, which is very commonly referred to hormonal therapy. What we are accomplishing there is we give medications to get men to stop making testosterone. Low testosterone levels don't allow the prostate cancer to grow. But over time, these cancers learn to grow in low-testosterone environment, and thus we have to use other therapies. In the last several years, several have been developed, such as Provenge which is a vaccine therapy some people refer to as immunotherapy, in which white blood cells are removed from the body and actually conditioned to go back and fight prostate cancer. A new drug called Xofigo or radium-223, which is a radioactive drug that is infused into the patient on a monthly basis and actually binds into bone in areas in the bone where prostate cancer likes to grow. The only downside to this drug is that it does not fight cancer that is in lymph node or other organs, only in bone. But it is also a great drug.
Melanie: Dr. Pisick, let me ask you about surgery for a minute, because many men think that if they're diagnosed with prostate cancer, they're going to have to have their prostate removed. Surgery has advanced quite a bit these days, so tell us a little bit about surgery for prostate cancer.
Dr. Pisick: Men who have clinically localized disease, we have the surgical option. One is an open prostatectomy, where, as it says, it's an open procedure. Men are opened up, prostate and lymph nodes are removed by a trained urologist. They also have the new robotic and laparoscopic procedures, where small holes are made into patients, where probes and other devices are inserted, and the prostate and lymph nodes are removed as well.
Melanie: Can you please tell us the most important information that you would like men listening to hear about prostate cancer?
Dr. Pisick: I think the most important thing for men to know about prostate cancer is to be encouraged to talk with their doctors about their risk for prostate cancer and whether they should or should not be tested; second, to encourage men to know that they have options about prostate cancer treatment should they be diagnosed with either early disease or late-stage disease; and that the Cancer Treatment Centers of America are committed to finding the right treatment for them and offers an integrated approach to care that many men may benefit from.
Melanie: You're listening to Managing Cancer with Cancer Treatment Centers of America. Thanks for listening. This is Melanie Cole. Have a great day.
Advances in Prostate Cancer Treatments
Melanie Cole (Host): We're talking today about advances in prostate cancer treatments, and my guest is Dr. Evan Pisick. He is a medical oncologist. Welcome to the show, Dr. Pisick. Can you tell us a little bit about prostate cancer? Give us a working definition.
Dr. Evan Pisick (Guest): Prostate cancer obviously is cancer of the prostate and also one of the most common non-melanoma skin cancers in men. In 2013, upwards of 240,000 men will be diagnosed with prostate cancer of all stages.
Melanie: Are there certain risk factors that men and their wives should be aware of that might predispose them to getting prostate cancer?
Dr. Pisick: Yes. One of the most common risk factor includes age. The older you get, the more likely you are to have prostate cancer. In fact, over the age of 60, one in 15 will be diagnosed. Also race is important. African-American men develop prostate cancer about, on the average, 10 years younger than Caucasian or Hispanic men. Family history is also very important so men who have brothers, fathers, uncles, sons with prostate cancer may be at higher risk for developing prostate cancer as well as obesity, diets high in saturated fat. There are other genetic syndromes as well, but they are much rarer.
Melanie: If somebody is going to see their doctor on a regular basis, which is what we certainly would encourage, but they are having some symptoms that they haven't really had before, let the listeners know what they might be experiencing that would send them to their doctor.
Dr. Pisick: Symptoms that men can look for include frequent urination, incomplete voiding of the bladder, urinating a lot at night while sleeping, erectile dysfunction, blood in the urine, blood in the semen. Those are some of the symptoms that if men are developing, they should be seeing their physicians about. The other issue with these symptoms is that they can come on very slowly. So they will not happen overnight. It is something that men will notice over time but may get used to, so they have to be more aware of their urinary habits.
Melanie: And it's important for men to see their doctor regularly, isn't that true, Dr. Pisick? Because as men age, their prostate does grow. And so that goes along with it, and they see their doctor on a regular basis.
Dr. Pisick: Correct. A lot of these symptoms that I described aren't only associated with prostate cancer. They're also associated with a benign enlargement of the prostate, which is treated in very different ways.
Melanie: So then, how would cancer be diagnosed?
Dr. Pisick: Prostate cancer is diagnosed by biopsy of the prostate, where parts of the prostate are removed that we can look at under the microscope. The men who do have prostate biopsies are usually men in which high suspicion is noted, including elevated PSAs, clinical histories, family histories, as well as physical exam of the prostate on what's called the digital rectal exam if the prostate is noted to be hard, irregular, swollen, or even if nodules are palpated.
Melanie: Dr. Pisick, if you would, please explain the PSA test. What are the normal ranges? Men get these numbers; they don't quite always know what they mean. And explain the Gleason score and the clinical staging, if you would.
Dr. Pisick: PSA is a blood test which stands for prostatic-specific antigen, which is a prostate noted in the blood made by prostate cells, both normal cells as well as cancer cells. This number, the range changes as men age. The range you use for a 50-year-old may not be the same range you use for an 80-year-old. The Gleason score is a pathologic diagnosis. When we do a biopsy and our pathologist looks at the cancer under the microscope, they basically determine its pattern from what they can see. It's based on a scale of 2 to 10. You have two scales of one to five. The primary growth pattern, which is the most common pattern you see within the specimen, gets a number of one to five. What we call the secondary pattern, which is the second most common pattern that is under the microscope, also gets a score under one to five. Those numbers are added together. Gleasons of six and lower are considered low risk, while Gleasons 8 to 10 are considered more of a high-grade tumor. The clinical staging of prostate cancer is based on digital rectal exams—how does the prostate feel under an exam with a finger itself. We also can use ultrasound to the prostate as well as MRIs of the prostate to get a picture of what the prostate looks like. Can we see cancer invading from the prostate into nearby structures such as bladder or rectum? Are there enlarged lymph nodes? Are the seminal vesicles involved? Is the cancer going through the capsule, which is the lining of the prostate? By using PSA, Gleason score, and clinical staging, we can develop a clinical risk in which patients can be low risk, intermediate risk, or high risk. For patients who have localized disease within the prostate, it helps us to better stratify when discussing treatment options moving forward.
Melanie: For most men, they'll have many treatment options, and the tricky part is then how to come to the decision that's best for them. So speak about some important developments in prostate cancer treatment.
Dr. Pisick: Many of the advances that have recently come in prostate cancer treatment apply mostly to men with metastatic prostate cancer. So that's cancer that has already spread beyond the prostate to lymph nodes, bones, in other internal organs. These are also men who, in their initial treatment, will receive what's called androgen deprivation therapy, which is very commonly referred to hormonal therapy. What we are accomplishing there is we give medications to get men to stop making testosterone. Low testosterone levels don't allow the prostate cancer to grow. But over time, these cancers learn to grow in low-testosterone environment, and thus we have to use other therapies. In the last several years, several have been developed, such as Provenge which is a vaccine therapy some people refer to as immunotherapy, in which white blood cells are removed from the body and actually conditioned to go back and fight prostate cancer. A new drug called Xofigo or radium-223, which is a radioactive drug that is infused into the patient on a monthly basis and actually binds into bone in areas in the bone where prostate cancer likes to grow. The only downside to this drug is that it does not fight cancer that is in lymph node or other organs, only in bone. But it is also a great drug.
Melanie: Dr. Pisick, let me ask you about surgery for a minute, because many men think that if they're diagnosed with prostate cancer, they're going to have to have their prostate removed. Surgery has advanced quite a bit these days, so tell us a little bit about surgery for prostate cancer.
Dr. Pisick: Men who have clinically localized disease, we have the surgical option. One is an open prostatectomy, where, as it says, it's an open procedure. Men are opened up, prostate and lymph nodes are removed by a trained urologist. They also have the new robotic and laparoscopic procedures, where small holes are made into patients, where probes and other devices are inserted, and the prostate and lymph nodes are removed as well.
Melanie: Can you please tell us the most important information that you would like men listening to hear about prostate cancer?
Dr. Pisick: I think the most important thing for men to know about prostate cancer is to be encouraged to talk with their doctors about their risk for prostate cancer and whether they should or should not be tested; second, to encourage men to know that they have options about prostate cancer treatment should they be diagnosed with either early disease or late-stage disease; and that the Cancer Treatment Centers of America are committed to finding the right treatment for them and offers an integrated approach to care that many men may benefit from.
Melanie: You're listening to Managing Cancer with Cancer Treatment Centers of America. Thanks for listening. This is Melanie Cole. Have a great day.