Deborah Howell (Host): Hearing that your prostate cancer has metastasized can be devastating, but there's something new on the horizon that's giving patients hope. Welcome. I'm Deborah Howell. And today, we'll be talking about a new PSMA PET scan study at Memorial Care Cancer Institute for prostate cancer patients whose cancer has metastasized. Our guest is Dr. Linda Chan, Medical Director of Radiation Oncology at Memorial Care Cancer Institute at Saddleback Medical Center. Welcome, Dr. Chan.

Dr Linda Chan: Thank you for having me.

Host: Our pleasure. Now, can you explain to us how we typically used to treat metastatic prostate cancer patients, specifically those with prostate cancer, before this new study?

Dr Linda Chan: So, prostate cancer patients are previously worked up like almost any other cancer patient. They go see their physician, they undergo staging scans, which means they get a CT scan, some form of x-ray, possibly an MRI to determine the location, size, and position of their disease. And then, they meet with a team of specialists, including a radiation oncologist, to determine what is the best course of treatment.

Host: Sounds good. Now, how does this new PSMA PET scan study change or improve the treatment process for these patients?

Dr Linda Chan: Well, right now, treatment is static, meaning that we take a picture of what the cancer looks like at the very beginning, and then we treat with surgery or radiation or chemotherapy, and then we look after treatment is completed. But with the PSMA PET scan study that we devised, we're looking to see what the cancer's doing through treatment. So, my question was, how is the cancer responding to radiation? Is it shrinking? Is it changing in terms of activity? Is all of the cancer shrinking or is it potentially only part of the tumor? I wanted to utilize that information to individualize, basically to customize treatment, and respond to how the cancer is responding so we can be as personalized in treatment as possible.

Host: That makes perfect sense. And what patients are eligible to participate in this clinical trial?

Dr Linda Chan: So, any patient with prostate cancer that unfortunately has metastasized to another location, which makes them stage IV, are eligible to participate at this time?

Host: And what inspired you to come up with this clinical trial?

Dr Linda Chan: Well, it was a basic question. I think that for all standard of care for cancer treatment right now, we just do treatment, like I said, and wait to see the outcome and reassess afterwards. But I think that the way that a tumor is responding to treatment mid-course can help us course correct. It can help us figure out how better to tailor treatment. And I wanted to see whether that was true and wanted to see how we could better help people. So, that was the inspiration for this clinical trial.

Host: Right. And this is all targeted treatment, correct?

Dr Linda Chan: Correct.

Host: Okay. And how is Memorial Care's unique study different than anyone else's in the nation?

Dr Linda Chan: Well, to my knowledge, there are no studies looking at targeting radiation for metastatic prostate cancer patients midcourse. We're the only institution in the country that is doing this type of work.

Host: Now that I'm hearing mid-course, it makes perfect sense. That's part of the way you should assess it. I'm wondering how this hasn't been adopted before.

Dr Linda Chan: I think that unfortunately in medicine, like in a lot of fields, there is dogma that has sustained throughout that field forever. And so, one of the things that we've been taught in medical school and in residency and in training has always been that you set the course, you complete the course, and then you assess afterwards.

So, I just wanted to go back and circle around and question that very basic tenet of medicine. Is that actually true? Perhaps we should be looking to see how a person is responding. Because I would imagine that someone whose tumor is shrinking halfway, for instance, I could modify the radiation course, make it smaller because the tumor is now half the size and perhaps spare a patient from unnecessary side effects or the opposite. If a patient's tumor is not responding, that might be telling me that their tumor is more resistant and I can turn up the volume, so to speak, modulate the radiation that I'm delivering to try to yield a better response. So that way, I don't have to wait until the very end and then course correct. I can adjust, fine tune it, so to speak, as we're going through.

Host: Wow. I have to think this is the way of the future, Dr. Chan. I just have to think

that's the way it's going to be.

Dr Linda Chan: I hope so. I think that as we continue, there'll be more and more of this work. I can say that there are other studies looking at this same question in lung cancer, but this is the first study that is looking at it in prostate cancer.

Host: Okay. And now, switching gears just a minute, I'm a little bit curious, how has Memorial Care, without being strongly affiliated to an academic institution, become a leader in cancer research studies?

Dr Linda Chan: Well, I think one of the benefits we have is that we are basically boots on the ground. So, I am directly treating patients. Patient care is my number one priority. My group, the entire cancer institute, we're the same. So, our number one goal is patient care, but because it is patient care and we're not in an academic ivory tower, we are closer to the patients and the issues for treating them. And I think that actually helps to give us a better perspective.

Host: I understand completely. Now, that leads me to my next question, because I know there are some people listening right now that want some information after hearing what you've said today. If anyone listening knows someone who this would benefit or can benefit themselves, how can they get more info to enroll?

Dr Linda Chan: Well, the best way would probably be to come in for a consultation and to speak to myself or one of the physicians participating in the clinical trial so that we can review that person's individual circumstances and see if they would be eligible for the trial?

Host: Okay, got it. Is there a number they can call for an appointment?

Dr Linda Chan: Yes. So, my departmental phone number is 949-452-8880.

Host: And I'll say it one more time for people that just took a pen in their hand. It's 949-452-8880. Is there anything else you'd like to add to our conversation?

Dr Linda Chan: One of the goals for the research trials that we have at Radiation Oncology at Saddleback Medical Center is to try to better improve the lives of all the patients we treat. So, that means to improve their quality of life, to improve their cancer outcome; to also, most importantly, remember them as a whole person and not just the cancer that they have. But I'm very proud to work with an amazing team of folks, so I hope that we will be able to help any loved ones who may unfortunately be suffering from cancer.

Host: Beautifully said. This has been really, really interesting and inspiring, and I do think the way of the future. Thank you so much, Dr. Chan, for your time and your expertise today. We so enjoyed having you on the show.

Dr Linda Chan: Thank you so much for having me.

Host: For more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.