麻豆传媒

Prostate Cancer Awareness Expert Panel 

What: Expert panel from the American College of Surgeons and the American Urological Association will address the latest news on preventing and treating prostate cancer, the most commonly diagnosed cancer in men after skin cancer.

When: Monday, September 11, 12-1 PM ET

Who: 

• Kara L. Watts, MD, Associate Professor of Urology at Montefiore Medical Center*
• Kevin Koo, MD, MPH, Associate Professor of Urology at Mayo Clinic College of Medicine and Science
• James Eastham, MD, FACS, ACS Governor and Chief of Urology Service, Memorial Sloan Kettering Cancer Center

*Able to answer questions in English and Spanish

Where: 麻豆传媒 Live Events Zoom Room (link will be given once you register)

Details: A recent report from the American Cancer Society detailed an alarming increase in rates of advanced prostate cancer among men, and the disease continues to disproportionally affect Black men, who are twice as likely to die from the disease than White men. 

With Prostate Cancer Awareness Month in September, this panel will address the latest facts that the public should know about this common, yet often misunderstood, disease. Panelists will discuss populations at higher risk for prostate cancer, proper screening and prevention of prostate cancer, reluctance among men to discuss prostate cancer and other urological diseases, and advice on how men can best advocate for their health.

Topics the panelists can address:

• Rise in advanced cases of prostate cancer and what men can do to protect their health
• Patient populations most at risk for prostate cancer, including Black men, who are twice as likely to die of prostate cancer than White men and have a 73% increased incidence of the disease compared to White men.1 Some research indicates that prostate cancer has the widest racial disparities of any cancer.2
• Prostate cancer screening guidelines and what to know about the Prostate-Specific Antigen (PSA) test and other screening techniques
• Common misconceptions about prostate cancer screening and treatment
• How patients can effectively talk to their doctor about prostate cancer 
• Latest advances in how prostate cancer is treated

TRANSCRIPT

Thom Canalichio (麻豆传媒): Hello and welcome to today's 麻豆传媒 live event. How's your prostate? If you have a prostate and you don't know the answer to that question, then this panel of experts is going to have some very important information for you. This is Prostate Cancer Awareness Month and we have with us three experts. First I want to introduce Dr. James Eastham. He's MD FACS., and he's the American College of Surgeons Governor and Chief of Urology Service at Memorial Sloan Kettering Cancer Center. Dr. Eastham, thank you so much for joining us. Can you tell us a little bit about your background and about your area of focus related to prostate cancer?

Dr. James Eastham: Sure, thanks for having me. So I manage and diagnose men with early stage prostate cancer. So from the point where a gentleman is considering screening for prostate cancer, going through the process of screening and detection, and then, once or if a cancer is diagnosed, assessing the risk of that cancer, and reviewing what management strategies might be available. So my practice is basically devoted to the diagnosis and management of early stage prostate cancer.

Thom Canalichio: We also have with us Dr. Kara watts, she's MD and Associate Professor of Urology at Montefiore Medical Center. Dr. Watts, thank you so much for joining us, and please tell us a little bit about your background and your area of focus.

Dr. Kara Watts: Thank you for having me today. I am at Montefiore Medical Center in the Bronx, New York, and my practice basically focuses on the diagnosis of prostate cancer screening, discussions regarding treatment, and my particular focus within the treatment realm is within focal therapy, so a subtotal treatment for the proper patient with the proper cancer.

Thom Canalichio: Thank you, Dr. Watts. We also have with us finally Dr. Kevin Koo. He's MD, and MPH. And he's also Associate Professor of Urology at Mayo Clinic, College of Medicine and Science. Dr. Koo, tell us a little bit about your background and area focus.

Dr. Kevin Koo: Thank you and good morning. Thank you to all of our guests for joining us today. I'm Kevin Koo. I'm Associate Professor of Urology at Mayo Clinic in Rochester, Minnesota. I take care of patients who are thinking about prostate cancer at every stage of their lives, and thinking about whether screening is right for them and approaching that conversation about how to get started thinking about your prostate cancer, your risks for prostate cancer, and then what that road looks like. I care a lot about decision making and how to help patients, and the people who care for them, make the right decision for themselves about when to get screened, when to get treated, and the risks and benefits of doing so. More broadly, I also work a lot with the American Urological Association and the American College of Surgeons, who are two hosting organizations today, to make sure that we're doing the best we can as surgeons and as advocates and champions for patients and families who are dealing with prostate cancer and to make sure that, especially during this month, prostate cancer awareness month, but through all months of the year, that we're doing the best we can to help patients who are managing this condition, have survived this condition, or thinking about this condition, to seek the care and make sure they have the access to care that they need. Thanks so much.

Thom Canalichio: Back to Dr. James Eastham. Please tell us just more specifically for those who maybe don't know very much about it. What exactly is the prostate?

Dr. Eastham: So the prostate is a male sexual organ. It's located deep within the pelvis. It's near the bladder and surrounds the urinary tube, and it's basically an organ that allows guys to father children. After men are no longer interested in fathering children, it really becomes an organ that causes issues with either its risk of becoming cancerous, which is the focus of today's conversation, but it can also increase in size which is normal benign growth and result in urinary issues. So in general, a younger man needs a prostate and an older man is bothered by a prostate.

Thom Canalichio: Thank you, Dr. Eastham. Dr. Watts, what are some of the signs and symptoms of prostate cancer that men should be aware of?

Dr. Watts: So this is actually one of the commonly misconceived questions in the general population. Typically, early prostate cancer doesn't actually have a lot of symptoms. It can get confused with benign enlargement of the prostate, which happens over time - it's very common, especially as male patients are to be over 50 years old. And so it can be confused sometimes with some of the urinary symptoms that come with enlargement of the prostate such as changes in your urinary flow, slow stream, hesitancy or pushing to urinate, or having to urinate more frequently. Occasionally, you may see some blood in the urine, which does not mean you have prostate cancer or even enlargement. But, generally speaking, there are not a lot of signs or symptoms with early prostate cancer. Later stages may have some changes in urination, or if it spreads outside of the prostate and there can be symptoms related to the spread of that, you know, to bones or other places, and that can cause some pain.

Thom Canalichio: Dr. Koo, tell us a little bit about the screening and the recommendations for that and what they should be looking out for and when.

Dr. Koo: I think it's important for men and people who have prostates to think about prostate cancer screening exactly for the reasons that my colleague Dr. Watts has mentioned. In the early stages, prostate cancer may not have symptoms, and sometimes men can be confused by the urinary symptoms that we often think about - the slow stream, the hesitancy, the straining to get the urine stream started - as the first signs of prostate cancer. But in fact, we know that those things are often separate in the early stages, and prostate cancer, when it's most treatable, and most curable, may not have any symptoms. That's why screening for prostate cancer and encouraging men to talk to their clinicians about prostate cancer screening and whether it's right for them is so important. And that's what we're trying to encourage everyone to do during Prostate Cancer Awareness Month, is to think about whether prostate cancer screening is right for them and when they ought to get started.

Thom Canalichio: If anyone has any questions, please do chat them and I'll ask the panelists. Dr. Watts, tell us a little bit about when most men should begin getting screened, and tell me more about the populations that may be at higher risk and should consider different screening recommendations.

Dr. Watts: So this is a little bit different between how we as urologists approach screening and perhaps what some of the general primary care population consider when they approach prostate cancer screening. So from our perspective, generally, we recommend at least screening starting at age 50, or having a conversation about whether or not screening is appropriate for you. There are some populations that are higher risk for prostate cancer or even developing prostate cancer at a younger age, and those particular populations are black or African American, Caribbean American patients. Those patients, who have either a first or to second degree relatives who have had prostate cancer particularly diagnosed at a younger age of onset, so younger than late 60s, or if you have any family history of some of the genetic syndromes that are associated with prostate cancer, and even lethal prostate cancer. So the braca, one and two gene mutations that are associated with breast and colon and ovarian cancer, or Lynch syndrome. And so it's important to know your family history, both within your brothers, if you have them with your father, and some of your extended male members on both sides of the family. Most importantly, just ask your doctor if screening is appropriate for you, because they may or may not ask you and bring it up specifically.

Thom Canalichio: I'd like to get all of the doctors to weigh in on this because these disparities are one of the key awareness points that this month really deserves to get hit on. So Dr. Eastham, would you tell us about, you know, these disparities amongst black minority populations, and others? Any thoughts about what might be some of the reasons for that and what some remedies could be as we go forward in science and medicine?

Dr. Eastham: Right. So, you know, the incidences, and also the death rate from prostate cancer is the highest in African American men than in any other population in the world. Why that is, we really don't know. There's likely a genetic component, certainly; potentially, environmental and dietary components. But we don't have a specific reason as to why that happens. There's also appropriately hesitancy on all minorities to seek health care. There's some concerns about things that have been done in the past and the health care system and not trusting physicians which I think all of us are trying to overcome, but there is some hesitancy. And, in the United States, there's also financial hurdles to getting appropriate health care. So I think there's a number of reasons in general, not just prostate cancer, why underserved populations tend to have worse outcomes. Having said that, if we can diagnose any population, even a higher risk population, at an earlier stage of disease, that population is equally curable. So it's education, making folks know that they may be at increased risk for a particular malady, whether it's high blood pressure, prostate cancer, etc., and then encouraging them to seek the appropriate health care, and then follow up on that. Those are obviously societal issues as well, but as a urologist and focusing on prostate cancer, it's really having a conversation and getting tested. I think that's the the most important aspect of finding prostate cancer to curable stage is getting tested in the appropriate timeframe.

Thom Canalichio: Dr. Koo, Dr. Eastham just made a really good point about the early detection. How much do you think that's a factor in these racial disparities? And what would your advice be about getting tested? Many patients may be feeling, not only because of these racial and ethnic factors, but also just that it is an uncomfortable and, you know, somewhat embarrassing health issue to address. Any thoughts or advice on what are some ways of approaching that, Dr. Koo?

Dr. Koo: We know that there are many potential factors that can affect a patient's decision to be screened, or even to have access to timely screening for prostate cancer. Some of those factors include racial and ethnic disparities. They can also include a patient's geography and ability to access primary and specialty care. They can also include financial concerns or other socio-economic factors. But one important overarching factor to consider is that the prostate can be a very misunderstood part of the body, and prostate cancer, or male sexual function, can also be intimate concerns and perhaps embarrassing to talk about. Opening up that conversation, having that initial dialogue about the role of the prostate, what can happen to the prostate in older age, is a really important, and a really timely conversation to ensuring that men and people with prostates get the health care that they need and that have the conversations they should be having at the age when prostate cancer screening is an important topic. So we encourage men to have these conversations with their primary care clinicians, who know them best, but also with urologists, who are the specialists and the surgeons of the prostate and the male genital urinary tract, because we can help to guide those conversations. Screening for prostate cancer may not be for everyone, and we want to use a shared decision making model in men of average risk for prostate cancer to ensure that we are addressing men's concerns, that we are correcting any misconceptions about what prostate cancer is or is not, and then offering them individualized, appropriate clinical advice, whether they choose to go on to have prostate cancer screening, diagnosis and treatments, or just have general concerns about their their sexual and reproductive health. I'd like to also mention that there are broader policy and societal factors at play here, too. It wasn't too long ago, about 10 to 15 years ago, when the advice about prostate cancer screening really took a dramatic turn and health professionals were being advised that prostate cancer screening might do more harm than good. We know now that some of those recommendations were misguided or based on misinterpretations of the best evidence we had at the time. And since then, that advice from the US Preventive Services Task Force and other organizations has shifted back to using shared decision making as the primary model for deciding whether men of average risk should undergo prostate cancer screening. But one of the consequences of some of those policies and regulatory decisions has been confusion about whether prostate cancer screening is right at all. And some primary care clinicians, and some patients, may still shy away from the conversation about prostate cancer screening. So we as urologists, as members of the American College of Surgeons and the American neurological Association, and as clinicians who see patients who are considering prostate cancer screening, want to encourage all men and their loved ones to talk to their trusted clinicians about prostate cancer screening to get the right information about their personal situation and decide together whether engaging in prostate cancer screening is right for them.

Thom Canalichio: Dr. Watts, share with us your thoughts about these disparities, and in particular, are there possible misconceptions about prostate cancer that may drive some of the late diagnosis and reluctance to go into screenings?

Dr. Watts: So I think disparities is a challenging word because it's multifactorial, and the word that we use to think about disparities is intersectionality. Within urology, there are a lot of reasons that lead to what we know to be disparities in prostate cancer diagnosis, lethality of prostate cancer, how aggressive prostate cancer is. And as Dr. Koo and Dr. Eastham have mentioned, you know, some of it is biology, and we're still learning more about it, some of it is language barriers, some of it is socio-economic factors, some of it is comprehension and education level, and you cannot assume, just looking at a patient, their outside appearance, anything about what they may or may not have, because there's so many factors that go into this. So you know, one of the one of the things that we have discovered here in the Bronx, where I work, is that when we look at our incidence-to-ratio of prostate cancer compared to the national incidence of prostate cancer, and then look at that compared to mortality, we actually have the highest ratio of mortality in our non-Hispanic white men, which is not what you see in the rest of the country. You see that actually disproportionately affecting African American and black men. So while African American black men do have a higher risk of more aggressive prostate cancer, it is not those men who are being disproportionately affected here. And so we've drilled down and looked at that, and it turns out that, you know, there's a lot of factors that contribute to that. But our non-Hispanic white men here do not look like the typical non-Hispanic white men and the rest of the country. There are other factors that are challenges to them in seeking health care. So the point I want to make here is you have to look at what's happening around you and not assume based on big numbers and studies that we have that that's exactly what's playing out in your area around you. And the only other thing I will just say is that, in terms of misconceptions about prostate cancer, I think there's a lot of misconceptions amongst, as Dr. Koo mentioned, the primary care population who's really doing a lot of the screening, that there still is not a benefit to it, and we do know from large data that there is a benefit to screening to detecting at earlier stages when there's more treatment options available. And so it's your right as a patient to seek a consultation with a urologist if your primary care doctor perhaps doesn't want to offer prostate cancer screening to you but you're interested in it. And there's also a misconception that if you have prostate cancer that, you know, you will have to have treatment and you'll have terrible side effects from that. You know, we don't treat every prostate cancer. We know that not every prostate cancer needs to be treated, and while we try to not find the low risk cancers that perhaps we can safely monitor as much as before, we have so many more tools available to us now as urologists to help guide proper treatment conversations, think about alternative options that limit side effects, to help every patient make the right decision for themselves.

Thom Canalichio: Dr. Eastham, Dr. Koo had made a point a little earlier about some of the changing guidelines about PSA tests over the years and I wonder if you can illuminate us a little bit more on the controversy over that why the back and forth and where are we now going forward with really good strong recommendations for when to get screened?

Dr. Eastham: Sure. Being the oldest person on this panel, I remember when PSA screening just started, and we didn't know as much back then as we know now, meaning that 15 years ago, 20 years ago, if a gentleman had an elevated PSA test, virtually the next step for every one was a prostate biopsy. And that led to many men undergoing unnecessary biopsies. And we were diagnosing what now would be called low-risk prostate cancer, the majority of those men were getting treated. So there was an overall assessment of an elevated PSA, there was over treatment of prostate cancer. So I think urologist earned a reputation for somewhat misusing PSA, although that is from, you know, 10 more years of knowledge. Looking back, we weren't using PSA well, but we didn't know it at the time. We thought we were benefiting patients, but we kept investigating and what we found out is that not every man with an elevated PSA needs a further evaluation, needs a biopsy. So we markedly reduced the number of men undergoing even an initial assessment. And, as Dr. Watts mentioned, not all prostate cancers carry the same risk, so just because a man has an elevated PSA doesn't in any way imply that he has prostate cancer, doesn't even apply needs an evaluation for prostate cancer, meaning with a biopsy. And even if a man is diagnosed with prostate cancer doesn't mean that man needs treatment. Active surveillance is a very reasonable strategy. There are newer treatments that don't focus on the entire prostate but can be delivered in a more focal way, which will reduce side effects while still managing the cancer, and we still have patients that will benefit from a whole gland treatment with either radiation therapy or surgery, so it's not simply you have PSA, you need a biopsy, and if you have any cancer, we need to treat it. It's a much more refined approach right now, and I think that's the main reason for the swinging back and forth of the pendulum. There's very good data now that an appropriately counseled and screened patient will benefit from that process rather than simply not being screened at all.

Thom Canalichio: Dr. Koo, how can men really better advocate for themselves with especially awkward medical issues like urology? What's your advice about that?

Dr. Koo: We understand that talking about the prostate, talking about prostate cancer, and even talking about general urological concerns as men get older, such as erectile dysfunction, or urinary incontinence, can be embarrassing and intimate issues. As urologists, we're accustomed to talking to our patients about these issues, and offering them the best treatment options available. But it's easiest to engage in these conversations when we are all advocates for men's urological health. I like to encourage patients in my clinic to think about their urological health the same way they might think about their car's health. You take your vehicle into the mechanic to get it tuned up a few times a year. You need regular oil changes, get the tire pressure checked. You wouldn't necessarily want to wait until there's a major transmission problem before going to seek some care. The parallel is that as we get older, there are issues that can come up like prostate health, and so having these regular conversations, these regular checkups, is akin to getting your car maintenance performed. By having these checkups, it allows us the time and the opportunity to discuss these issues, to check in with our patients, to allow our patients to raise the issue and raise the conversation about perhaps their urinary stream slowing down or their erections no longer being as satisfactory as they once were. That's how men and their loved ones can be the best advocates for their own health, and how we as urologists, as surgeons, and as advocates for men's health, can partner with our patients to ensure that everyone gets timely access to urological care.

Thom Canalichio: Dr. Eastham, if you would please tell us a little bit more about the process of active surveillance, how would you describe that? What kind of patients should undergo that active surveillance?

Dr. Eastham: Sure. So, active surveillance is a management strategy. It's not benign neglect, it's not you forget about things until you have symptoms. That's what would fall under the heading of watchful waiting. What active surveillance means is basically periodic testing to reassess risk. It typically involves PSA testing, we very frequently will use imaging, primarily prostate MRI, and periodically, the patient will have to undergo repeat biopsies because no one’s test is perfect to determine has something changed within the prostate. So we basically use all of the tools that we have available to continue to assess and reassess risk. The patients who are candidates for active surveillance are those with what are called Low Risk prostate cancers. In general, anyone who has been diagnosed with what's called a Gleason score six prostate cancer. Gleason scoring is a way that we convey what the pathologist sees under the microscope, when the pathologist looks at a biopsy or other tissue, and that's the most important way in which we assess risk. We have expanded active surveillance to include some men with what's called favorable intermediate risk prostate cancer, and when a man is diagnosed, it's really a conversation with your urologist, your clinician, your radiation oncologist, whomever, what is the risk of my prostate cancer? What are the benefits of treatment versus not treatment? And what are the side effect profiles? So that's the conversation that any man will have, but it initially involves a risk assessment, and then based on risk, there's always options.

Thom Canalichio: Question now from the chat. Dr. Watts, can you tell us what's the most underrated or unappreciated story related to prostate cancer right now? In terms of the trends, and in particular, the issue with late diagnosis maybe would be where you would go with that. But that's the question here from Ben Saylor.

Dr. Watts: I know Ben. Hi Ben, nice to connect with you here. You know, what people may or may not be aware of is that we in the United States have witnessed a stage migration in prostate cancer diagnoses over the last 10 to 15 years. What that essentially means in simple terms is that on average, patients who are being diagnosed with prostate cancer are actually being diagnosed on average at later stages of disease than they were 10 or 15 years ago. And there's a lot of reasons for that, and some of that's because we're not finding as many of the low risk prostate cancers, as Dr. Eastham mentioned, that we would otherwise be monitoring or surveilling, not necessarily treating, but when patients are diagnosed with late stage or metastatic disease, you have lost the window or the opportunity to cure. And so it changes the conversation about what treatment options are available. We do not in the United States have any national screening program. In fact, the only country in the world that has a national screening policy for prostate cancer is Lithuania, and so it's very, very heterogeneous depending on where you live, who your doctor is, what your access is to urologists. So I think the more that people know about this and talk about it and know that this is an ongoing challenge that we're trying to work with the community on, the more we'll be able to offer to our patients.

Thom Canalichio: Dr. Watts, Can you also tell us a little bit about focal therapy and what specific options there are for treatment that would fall under that category.

Dr. Watts: So focal therapy is the concept of finding the area in the prostate with the most important or the most aggressive prostate cancer and only delivering treatment to that area while sparing treatment to the rest of the prostate. And if you think about it, this is exactly what we do with essentially every other solid organ in the body. With the breast, with the the kidney, with the brain, with the lungs, with the pancreas, even with the liver. If you have a small cancer that we see in these organs, we don't just take out the entire organ, you know, in the case of smaller, specific cancers, we treat that area and we try to spare the rest of the organ and so this is the same concept that's just, frankly decades behind in prostate cancer because of some of the ambiguities and challenges with diagnosing prostate cancer. But finding that area to the best of your ability and treating that area, while minimizing side effects, there's a number of options available. And it really depends on you know, where you are and what urologists around you are offering. It's much, it's newer in some areas within the United States. But the most common options are HIFU, which is focused energy ablation with heat. There are needle based therapies, which is cryo therapy to freeze or irreversible electroporation. There's also photodynamic therapy that I believe Dr. Eastham is involved with for cases that have recurred after radiation in the past. So this is definitely a very much growing area within our field. And the overall goal of this is to achieve good treatment outcomes for the cancer while minimizing the side effects, specifically incontinence and erectile problems with whole gland radiation or surgical removal of the whole prostate.

Thom Canalichio: Dr. Eastham, would you please tell us a little bit of your thoughts about these late diagnosed cases and that trend? And what are the most pressing concerns that you've noted in your area as well as national trends about that?

Dr. Eastham: I think it relates back to what Dr. Koo mentioned, in terms of the national recommendation about a decade ago, against routine use of PSA testing. Now, I don't think anyone's in favor of every man getting a PSA checked every year. That's not shared decision making. But I think we got away from using one of our most important tools, which is PSA testing, to better identify men who are at risk for prostate cancer. Importantly, nowadays, we can actually identify men who are not at risk for prostate cancer, and they don't need to go to undergo testing as often, as annually, they may wait two to five years before getting another PSA test. So I think, you know, information is important knowledge is what guides our ability to make good decisions. And knowing your PSA test, I think is a critical aspect of healthcare. And that will help assess your risk and better decide for the individual patient, whether or not they want to pursue what that tests mean, what that test means. So I'm an advocate for anyone who are concerned about developing prostate cancer getting a PSA checked at a relatively young age, seeing what your PSA is at a relatively young age between age 40 and 50. The guidelines say 50 or 55 and above, but I like getting a PSA at a relatively young age, deciding what the risk is at that point, and then adjusting follow up based on that risk. If the PSA is under one at age, say 45 come back in five years. If it's above three, you probably need to get evaluated sooner rather than later. That doesn't necessarily mean a biopsy. That just means further evaluation. And if it's between one and three, then you're in a group that's at a higher risk. So sort of a get a baseline assessment, risk adjust based on that initial PSA test, and then follow the gentleman accordingly. But I think PSA earned a bad reputation because of the way it was used 20 years ago. I think we know a lot more today about how best to use PSA testing.

Thom Canalichio: Dr. Koo to Ben Salers question earlier about the most underrated factor going on and prostate cancer trends any thoughts you'd like to share?

Dr. Koo: An underappreciated threat to men having access to timely appropriate prostate cancer screening and treatment is misinformation. We live in a time now of great technological and scientific innovation. And access to health information has never been easier or faster than it is now. We all remember when we used to have to make an appointment with a clinician see the clinician then receive information after testing about what conditions we might have and what the treatment options might be. Now we know that many of our patients are asking health questions and getting health information before they even consider seeing a clinician because it's right literally at their fingertips on their mobile devices on the internet through social and digital media. This explosion in accessibility to health information is a double edged sword. We know now that there's a lot of good information, but also a lot of misinformation on the internet and on social and digital media, about all sorts of health conditions, and health conditions that may be confusing that where there may be uncertainty, such as prostate cancer are especially at risk. So I think it's especially important during Prostate Cancer Awareness month that we encourage men and their loved ones to seek health information from trusted sources, from their primary care clinicians, from their urologists, and from trusted health organizations like the American Neurological Association, and the American College of Surgeons. We want to help connect our patients with the education and the information that they need to make decisions that are right for them. And we as a community want to combat misinformation, and sources of of bias and confusion that can lead our patients astray. I think that's a challenge that we'll continue to face in health care that we as a community need to address together.

Thom Canalichio: Dr. Koo, if you would, please tell us what advice you have for patients who have gotten a diagnosis with prostate cancer and how to decide between the different treatment options and managing symptoms.

Dr. Koo: My advice for patients who have recently been diagnosed with prostate cancer is to take a deep breath. And know that's the options for treating and managing prostate cancer while preserving those lifestyle aspects that are most important to each patient. Those options have never been greater. And our understanding of those options has never been better than it is now. So take a deep breath and speak to your urologist and your prostate cancer team to understand what options are going to be best for you. And you're going to bring to that conversation, your own goals values and preferences, about your urinary function, about your sexual health, about your preferences for risks and benefits of treatment. Bringing those preferences, and the preferences of your loved ones to that conversation can allow us as your prostate cancer team to help you navigate the many treatment options that may be available to you. And to keep your goals and preferences top of mind when we are deciding which next step is best for you. I think it's important for men and their loved ones, to use their voice and to be their best advocates to ask the questions, even if difficult, even if embarrassing about their treatment options, and to allow us to be their partners and their champions in navigating the prostate cancer treatment process.

Thom Canalichio: Dr. Watts, what would your advice be for patients recently diagnosed with prostate cancer so they can determine the course between different treatment options and symptom management?

Dr. Watts: My best advice is, I like how Dr. Koo said it is to take a deep breath. And don't feel pressured to make a decision right away. You know, most, if not all, prostate cancer, if you don't even do treatment for you know, six to 12 months, the outcome will not necessarily change. Okay, we have large data's supporting this. So take the time to seek consultations with the you know, either different urologists or multidisciplinary. So urologist, radiation oncologist, medical oncologist, depending on your particular cancer and your pathology and your stage. And don't feel pressured to make a decision when you get the diagnosis. It's important, I think that you have a comfortable working relationship with your urologist. Because if you do have seek treatment or you pursue treatment, and if you do develop side effects, you do want to be working with somebody who's going to help you navigate through that and find treatments that will help you with those. It's not a you know, close the door and not see you again.

Thom Canalichio: Dr. Eastham, would you please tell us your thoughts on how patients can navigate the different treatment options and managing their symptoms?

Dr. Eastham: Yeah, I think it's a bit of education. And while we tend to think of prostate cancer as one sort of box of you know, it's a disease, it really does carry different risks. Not all prostate cancers justify immediate treatment. Not all prostate cancers require whole gland treatment. And not everyone has the same feeling of what they're willing or not willing to accept. So I think taking, you know, the deep breath taking a step back, getting more information about well, what is the risk of my prostate cancer? And based on that risk, what are my options? And based on those options? What am I willing or not willing to accept? I very frequently say during consultations with patients that I could have your prostate twin sitting next to you give each of you the same information. And you may decide on totally different treatment strategies. And you're both right. Because based on how you perceive things, you will have different priorities. And based on those priorities, what you want to accomplish, that will help guide what you ultimately select to do. Not everyone requires treatment, many men will and then of the treatment options. What are the nuances based on the patient's age, health, what the treatment involves? That's a conversation and getting educated is the most important thing in terms of not having regret regarding the treatment strategy that's opted for.

Thom Canalichio: Dr. Watts, would you please help us to bring things toward a conclusion here by summarizing the most important takeaway you'd like people to gain from this discussion about prostate cancer?

Dr. Watts: So I think the most important thing to take away from this about prostate cancer is is to not be afraid to have a conversation about screening for it. I think there's a lot of fear in the public, in patients their loved ones about even just being screened for it whether it's fear of the exit, you know, the the rectal exam or the blood tests and then what that may lead to and if they have prostate cancer, what may happen if they end up needing treatment and side effects, but we know so much more now than we did 20 years ago. The treatment landscape looks so different now even the biopsy looks so different now compared to what it did before. And knowing is the first step. So be an advocate for your health. If you don't have a primary provider or doctor who can check the PSA for you then go see a local urologist or get a second opinion and, and know that it's, there's a lot of options available. And we're here to help you navigate that.

Thom Canalichio: Dr. Koo, what's your key takeaway that you'd like the public to gain from this discussion and this year's prostate cancer awareness month

Dr. Koo: If you're a man in your 40s, or you care for a man in his 40s and you haven't thought about prostate health, or whether prostate cancer screening is right for you. This is a great time during Prostate Cancer Awareness Month to have a conversation about your prostate health, to seek a consultation with your primary care clinician, or urologist about prostate cancer screening, and to end to be a champion for your own health. Remember that prostate cancer screening is nothing to fear. And that there is a whole team of experts who we're here to help guide you through testing, screening, diagnosis, and potential treatment options. We're here to help. We're here to get you the answers you need. And we want to be your partners and your champions in navigating this process. So get started today.

Thom Canalichio: Dr. Eastham, tell us your key takeaway for the public for this year's prostate cancer awareness.

Dr. Eastham: Yeah, I think if you're a man who has at least a 10 year life expectancy, you should get your PSA checked. I mean, we don't think twice about getting our blood pressure checked because that can save lives, getting our cholesterol checked and the like. I'm an advocate of knowledge. And I know we talk about shared decision making and that's absolutely the right thing to do. But I think, you know, to go over all the pluses and minuses of PSA testing, we've spent an hour on it, and we've just touched the tip of the iceberg. I think knowing the result, knowing what your PSA is, and then, then you can say, Okay, I know what my PSA is, what do I want to do now? That's how I look at things. I may be off the charts on that. But I think having that information can make a more informed decision. So I would say if you're a man who can benefit from screening, you have about a 10 year life expectancy. You know, by age and health, I would encourage you to get a PSA checked.

Thom Canalichio: Thank you Dr. Eastham. If anybody in the audience would like further information, we'll provide a video and transcript of today's discussion along with the contact information for the communications offices at the American College of Surgeons and also the American Neurological Association, so that you can follow up with any of these panelists for more questions. And in that to close, I'd like to say thank you to Dr. James Eastham, Dr. Kara Watts and Dr. Kevin Koo. Thank you all very much for bringing information to this very important subject and for the audience. As doctors said, knowledge about your prostate health is the first step toward prevention of disease. So get checked out. And thank you all very much for attending today. With that, we'll say goodbye. Thanks very much. Stay safe, stay healthy and good luck.

References

1. Prostate Cancer Research Highlights, American Cancer Society:
2. Chowdhury-Paulino IM, Ericsson C, Vince Jr R, Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer and Prostatic Diseases. 2022 Sep;25(3):397-402.