Joey Wahler (Host): It's a relatively common but treatable condition. So, we're discussing prostate cancer. Our guest, Dr. Don Bridges. He's a radiation oncologist and prostate cancer specialist with Holy Cross Health.

This is Your Best Life Podcast from Holy Cross Health. Thanks for joining us. I'm Joey Wahler. Hey, Dr. Bridges, welcome aboard.

Dr. Donald Bridges: Glad to be here.

Host: And it's so interesting to me that your initial background was in Nuclear Chemistry and Nuclear Engineering. In fact, you have a Bachelor's in Chemistry from the U.S. Naval Academy, serving 29 years on active Navy duty. So first, thanks for your service, of course, but what in a nutshell was the main thing that motivated you to transition from all that into Radiation Oncology?

Dr. Donald Bridges: I was stationed in Charleston, South Carolina for those nine years. My sister was the physician there, and I saw what she did. So, I thought, "Well, I'm very interested in science and technology." Therefore, I decided I was going to leave the submarine service and go to medical school. Then when I got to medical school, as all students, somewhere near the end of your fourth year and you're getting ready to do an internship, you got to decide what you're going to do when you grow up. And I fortunately went to a career day conference where they had a radiation oncologist talking about Radiation Oncology. And I didn't even know it was a specialty. I thought I would probably go into Radiology and Nuclear Medicine so I could use prior, you know, radiation background. So when I heard about that, I decided I was going to go to medical school, and then do a residency in Radiation Oncology, which I ultimately did do all those things and ended up finishing my training at the National Cancer Institute.

Host: Understood. So, that being said, in terms of your current career now, what cancers do you treat most?

Dr. Donald Bridges: The big sort of four are prostate cancer, breast cancer, lung cancer, they're the most common cancers, not counting a little skin cancer, for example. There are more of those, but the big cancers is those three.

And then, the other area we get into is we do quite a bit of palliation, palliative treatment. If you look at the overall use of Radiation Oncology in cancer patients, over 70% of all cancer patients will receive radiation at some point in their treatment of their disease. And a lot of people don't know it's that common. The fourth group is the metastatic patients who you're treating for palliation. The first three I listed, generally our goal is to cure them. But a lot of our patients, they got pain from bone mets or have other symptoms that we can relieve with radiation.

Host: Gotcha. So as mentioned, you are, among other things, a prostate cancer specialist. How common is prostate cancer in the U.S.?

Dr. Donald Bridges: It's extremely common. Every year in January, they put out a publication in the American Cancer Society that lists the incidence, prevalence, how many cancer cases are reported every year. And prostate cancer is right up there as one of the top three cancers that we're seeing this country. I treated my first prostate patient in August of 1988. And at that time, there were about, 130,000 cases a year. However, at that time, we were just getting this blood test called PSA, which you could get a blood test. And if it was elevated, it was a chemical only made by prostate tissue. And it was very accurate at predicting prostate cancer if you had a certain level. Well, since we had a new blood test, every Internal Medicine doctor started getting it on every man that walked in their door. I mean, there were some age limits that I'm sure they instituted. They weren't formal at that time. that time. And so, over my first three or four years, prostate cancer went from 130,000 to 300,000. So, the incidence of prostate cancer dropped back down into the high 100,000s. And then, over the last 20 years, it's significantly increased again, and we are up to in the 300,000 cases of prostate cancer a year.

Host: Well, those are certainly attention getting numbers to say the least, and you let me beautifully, Doc, into my next question, which is how important are prostate cancer screenings like the granddaddy of them all, if you will, the PSA blood test, and how often should they be done?

Dr. Donald Bridges: Well, it's very important because again when I first got into the cancer field and we were just getting PSA, the way you were found with prostate cancer generally could be your annual physical, they did a DRE and felt a hard nodule. You could have come in with a complaint like blood in your urine or you're _____ and you can't pee because your prostate was so big it was closing down your urethra. So, those things led to the typical diagnosis of prostate cancer. And it was found later in life, the average age of a prostate patient is about 68 years old. But we started the NCC guidelines, which is a group of documents made up from a committee picked by over 30 cancer centers in the United States, they have made a go by for every one of the cancers that we deal with. And you can go to there and read it, and you can learn how do you diagnose this, how do you treat it, and a lot more about it.

Host: And so, what treatment options are there these days for prostate cancer?

Dr. Donald Bridges: The treatments for prostate include surgery to remove it. We have at least three different ways to do radiation. You can do external beam where you lay on a table and a machine generates radiation from the outside and is focused and you treat it externally. You can put in these little radioactive pellets that are about the size of a grain of rice. They contain radioactive material and you can inject, in this case I put in a hundred seeds in this patient's prostate. And each one generates a cloud of radiation the size of a grape, and the grapes add together and you get a nice cloud. It is a very good treatment, because it keeps the radiation very tight, you minimize hitting your rectum in the bladder.

In addition to surgery and the radiation, and you can do that radiation seeding with or without the external radiation. And all three of those treatments, you can do with or without a chemical treatment. There is treatment called androgen deprivation therapy, ADT. And what it is, androgen is testosterone that's made by the male testicles. And it turns out, testosterone is like fertilizer on prostate cancer. It makes it go bigger and stronger and faster. And we learned, again, back late '80s, early '90s, that if you turned off a man's testosterone, not only would the cancer stop growing, and your PSA would down, it turned out the cancer would start killing itself. And we thought we had a home run with hormonal therapy. However, we found out that, eventually, those little buggers, those cells, the cancer cells would realize, "Hey, this is not good. We're going to morph ourselves, so we don't care about having testosterone."

Host: Interesting. A couple of other things. First, what are the side effects that come with prostate surgery and how much conversation do you have with patients weighing the treatment options, focusing much on which side effects may occur and what they're willing to tolerate?

Dr. Donald Bridges: Well, that's a very good question and an interesting topic. And the answer to that lives with the physicians who first see the patient and who first are recommending therapy for the patient, because doctors have a significant amount of leeway on what they tell their patients, I'm not saying they should have that leeway, and then what is offered to the patient can be somewhat selected based on the doctor and the doctor's personal preference. And one of the advantages of the NCC guidelines, it's now a standard document that all clinicians dealing with cancer, in particular this case, prostate, can look at and see what the world's experts, what they think the standards are. And it's clear-cut what the standards are. The issue with the prostate though is the standard never gets one choice. For example, most every one of my patients, if you're middle of the road or early, you can have surgery, you can have external beam radiation, you can have external beam and seeds, and can have seeds. And if you're a little more aggressive cancer, you can add the ADT to it. So, the doctors have to be willing to sit down and go through each one of these choices.

So, my view has been, and most people, is that if get diagnosed with prostate cancer and you're considering treatment, you need to have a consultation and be seen by a urologist, i. e., the urologic surgeon, they're the ones that do the surgical removal. And you need to be seen by a radiation oncologist who can talk to you about the radiation options.

Host: Dr. Don Bridge, a privilege to meet you. Keep up your great work, and thanks so much again.

Dr. Donald Bridges: Well, thank you very much.

Host: And for more information, please visit holycrosshealth.org. Again, that's holycrosshealth.org. If you found this podcast helpful, please share it on your social media. I am Joey Wahler. And thanks again for being part of Your Best Life Podcast from Holy Cross Health.