Prostate Cancer Awareness

Prostate Cancer Awareness

September is Prostate Cancer Awareness Month. In the United States, 1 in 8 men will be diagnosed with prostate cancer in their lifetime. It is the most common non-skin cancer in the U.S.
Dr. Malini Patel, Director of Medical Oncology, at the Cancer Center at Robert Wood Johnson University Hospital Hamilton, tells us more about the causes and symptoms of prostate cancer, risk factors, prevention, and treatment options.

welcome to RWJ Barnabas Health's Health talk show I am Dr Douglas oshinski of RWJ Barnabas Health Medical Group September is prostate cancer awareness month in the United States one in eight men will be diagnosed with prostate cancer in his lifetime it is the most common non-skin cancer in the United States on today's show we will learn more about the causes and symptoms of prostate cancer risk factors prevention and treatment options we are pleased to welcome Dr Milani Patel director of medical oncology at Robert Wood Johnson University Hospital Hamilton and RWJ Barnabas health facility and the Rutgers Cancer Institute of New Jersey welcome to the show thank you foreign thank you Dr Patel for being here before we start the audience knows a little bit about you can you tell us a little bit about your backgrounds where you're from where you practice Etc sure so uh my name is Malini Patel I am a medical hematologist an oncologist by training I am from New Jersey and did much of my training in New Jersey I did undergraduate studies at Rutgers University followed by medical school at St George's University I did my residency training in New York City in the Mount Sinai system and was out in the midwest at Loyola University for fellowship and then came back to my alma mater I was at the Cancer Institute of New Jersey in New Brunswick from 2017 to 2021 where I focused primarily on lung and head and neck Cancers and then recently became the medical director at Robert Wood Johnson Hamilton um a little south of New Brunswick where I see uh all types of malignant or cancerous conditions as well as benign condition blood disorders as well so for the audience to know you basically a hematologist oncologist who deals with different types of cancers including what today's the discussion prostate cancer correct so tell us a little bit about prostate cancer tell us about uh what causes it if we actually know what causes it and basically the history of what people should think about sure you know cancer is basically when there are abnormal cells that divide in an unregulated manner after this happening for quite some time they will form small tumors and organs in this case the prostate um and um and that is uh basically where prostate cancer would start in more advanced disease they can these cancer cells can travel to the lymph nodes our body has uh lymph nodes throughout our body and that's normal and they serve kind of like the highway system and cancer cells can move to these nodes as a way to travel to farther away places um so but in general prostate cancer will begin in um in a confined space in the prostate move to different parts of the prostate organ and then um Can eventually move to the lymph nodes and other organs um if it's allowed to advance in terms of common symptoms of prostate cancer we don't really see see many symptoms a lot of folks may not even know that they have prostate cancer because it's not causing any symptoms and more advanced cases as the tumors are allowed to grow you may start feeling some symptoms will which I'll go over shortly we don't you know we don't quite know what specifically causes prostate cancer but we do know that there are certain risk factors so for example age is the um most common risk factor as you get older your risk of prostate cancer increases we do know that uh you know some folks have a higher chance of developing um prostate cancer based on their Race So African Americans and uh plaques for example uh tend to have more aggressive disease or may be diagnosed with prostate cancer earlier certainly a family history or any genetic syndromes but we don't we don't know quite what causes prostate cancer short of abnormal cells dividing in an unregulated manner so in men uh we're looking basically this is a men's disease because that's where the prostate gland is we're looking at the just below the bladder going into the urethra is this gland called the prostate glands in men who are younger uh basically it helps function with uh when they're having a sexual contact with their spouse but other than that in the younger people it really doesn't contribute very much as we get older unfortunately it sometimes increases in size and when men get to be in their 40s that's when we start to look at some type of screening for these men in the past we didn't have very much good screening basically we would draw a blood test called a PSA on the person and unfortunately that PSA is not the most accurate of tests and we'd sometimes get high numbers we get low numbers if they had a urinary infection that could also increase it so now that we've gotten into the year twenty two thousand you know 2023 tell us what are the common tests and what who should be screened for prostate cancer sure so um certainly if you have some of the risk factors that I mentioned so African Americans and blacks are at a higher risk of developing prostate cancer so they um you know they certainly should be screened family history is another big risk factor by having male relatives with prostate cancer you can increase your risk of prostate cancer by double to Triple so certainly if there's a family history there are a couple of genetic a few genetic syndromes that put you at an increased risk of prostate cancer for example if you are a carrier of the Bronco one or two Gene you have an increased risk of prostate cancer now um so you know some folks may know the braco one and two Gene is genes are genes that put you at a higher risk of breast and ovarian cancer we all often hear about its association with breast and ovarian cancer and many females start screening for these cancers at a much earlier age but there are some uncommon cancers such as prostate cancer pancreatic cancer which are also associated with the broca one and two Gene where increased screening for prostate cancers indicated there's also a syndrome called Lynch syndrome that can put you at an increased risk for cancer such as colon cancer breast cancer endometrial cancer and prostate cancer are some of the common ones so if there's a family history I would say of any of these cancers or there's a known history of family members having the braco one or two gene or Lynch syndrome I think it um you know I think screening for prostate cancer would certainly be appropriate and then also there there's also a certain environmental exposures that put you at an increased risk as well agent orange which was an agent that many Vietnam veterans were exposed to during the war has been implicated with an increased risk of different types of cancers prostate cancer being one of them so if I have a patient in my practice or a patient in a primary care practice at me um where the uh there were they have a history of being overseas and served during Vietnam then they certainly likely had agent orange exposure and certainly would be at an increased risk for prostate cancer where screening would be appropriate so I think you had asked about the tests that we use is that correct correct correct okay so uh you know in the primary care office which is usually where screening uh screening starts um you know like you said uh it starts with the PSA test um which is which stands for prostate specific antigen um so this is um this is a protein that's secreted by prostate the prostate tissue that we can pick up in Blood and when it's elevated it may be suggested a suggestive of prostate cancer now it does have its limitations it being elevated doesn't necessarily mean that it is prostate cancer like you had stated a few minutes ago it could be elevated in benign conditions such as benign prosthetic hyperplasia which is that enlargement of the prostate as men age and also in inflammatory or infectious conditions like prostatitis so if you have a young gentleman that has an elevated PSA then you really want to look more toward you know younger than 40 50 then you want to look more towards infectious causes and if it's um you know elevated and older gentlemen then it you know it would warrant more of a more of an evaluation so other evaluations for screening also include a digital rectal exam so that is where um uh it's a you know it's a physical exam where um uh a physician or a provider will try to palpate or feel for the prostate and see if they feel any hard lumps or bumps which may suggest that there's a cancerous tumor there if either of those screening tests are abnormal or patients are having symptoms uh further uh tests for evaluation would include things like an ultrasound or an MRI of the MRI of the prostate and then if any of those are abnormal then um you you know you would require further work or perhaps a biopsy by a urologist so as a primary care physician I start usually screening at age 40. usually after a discussion with the patient about the PSA and so with looking at a PSA we're looking at the value of under four micro nanograms per milliliter and we usually at age 40 were getting a Baseline and then based on the discussion with the patient since it is a discussion we consider when we should repeat it and most people usually repeated approximately once a year so we're looking for any changes in that especially if there's an elevation of greater than 1.0 nanograms per milliliter in a year if such a thing exists or if the patient has any symptoms of something usually at that point we refer them to a urologist the urologist usually is someone who'll do direct the digital rectal exam on the patient and then make a decision whether they do a ultrasound on the them or an MRI on the person or if they do uh you know the PSA where they break it down into a free and total to see whether there's any concern about it they then are the ones who then make some decisions along with uh whether there should be a biopsy or not based on whether they see any nodules or any abnormalities so they find a the urologist finds something like that now the what we do is that the urologist now refers them over to someone like you or someone over at the Rutgers Cancer Institute or at RWJ Barnabas University Hospital Hamilton to get treatment for prostate cancer what happens when they are referred there correct so um so you know uh you know like you were saying uh the screening starts at the primary care office and then they would um typically be diagnosed um you know by a urologist we do look at the tempo um and uh you know how quickly that PSA is rising if um if prostate cancer is diagnosed there are a few things that are looked at in terms of uh the diagnosis itself so depending on the um pathological features meaning how the cells looked under the microscope um one would categorize these patients into risk categories and they generally fall into low risk intermediate risk or high risk the first set of doctors they will typically see are a Urological surgeon at the Cancer Institute um if evaluation suggests that there's no distant disease meaning there's no concern that there's prostate cancer involvement of the lymph nodes or the bones which are a common area where more advanced prostate cancer likes to travel then they will typically see a urologist and a Urological surgeon rather and a surgical resection will be discussed with them so typically if surgery is um is undertaken then they will have a robotic surgery which leaves a small incision and they'll have the resection of the prostate alternatively patients may also opt to get radiation therapy for their prostate cancer so in most instances at the Cancer Institute both options are presented to the patient and they may see a radiation oncologist as well and then a decision will be made as to how the patients would like to proceed there are some side effects that generally tend to resolve within six months to a year with both modalities of treatment which include urinary incontinence meaning trouble with the control of your urinary function and um and erectile dysfunction but again these tend to resolve and the timing of them are a little bit different depending on whether one undergoes primary surgery versus radiation for their prostate cancer now this is under the assumption that someone gets treated for their prostate cancer in many instances it may be appropriate not to treat someone right away for their prostate cancer and I know that may sound that may sound a little funny but most prostate cancers fortunately are diagnosed at a very early stage and the majority of them act like Lambs as opposed to Lions so they tend to grow very slowly so as I was saying when the prostate cancer is diagnosed they're divided into risk categories and if they fall under the very low risk category or the low risk category or if a patient has other medical problems that they're also dealing with at the same time it may be perfectly appropriate to go into what we call a watchful waiting or active surveillance strategy and radiation oncologist or a surgeon may also discuss that with the patient especially if the disease is deemed to be very low risk that does not you know that does not mean that the patient is not followed with the active surveillance strategy what typically happens is um patients get cereal meaning repeated scans often MRIs and serial biopsies as well to see if the prostate cancer is progressing during the active surveillance period or if it's changing in its risk category and if at any time we see that those things are happening then therapy for the prostate cancer would be undertaken but it's not necessarily um you know given that everybody that's diagnosed with low or very low risk prostate cancer has to have treatment for their prostate cancer right away as most of these tend to be very very slow growing especially if someone is older and wants to avoid some of the side effects related to those you know those two modalities so that will that would also be a discussion but again this is more appropriate for people that have lower risk disease you know someone that has more intermediate or higher risk disease or does not have many medical problems or young would typically undergo primary surgery or radiation for their prostate cancer now they'll see a medical oncologist um uh at the Cancer Institute or at any of our system hospitals if it's deemed that the cancer is um higher risk and may need uh may need additional therapy to prevent the risk of it recurring and what I mean by additional therapy is typically hormonal therapy prostate cancer strives um uh in the presence of testosterone um you know which is a hormone that um you know all males uh possess and um and it testosterone basically serves as uh food or nutrients for prostate cancer so um by decreasing your testosterone levels usually via injections or pills you will reduce your risk of prostate cancer this type of therapy is also used for more advanced disease as a way to cut off cut off nutrient Supply so that the prostate cancer cells can't Thrive but typically for early stage cancer the Cancer Institute patients will start out seeing a urologist or radiation oncologist uh so the good thing at the Cancer Institute of New Jersey is the whole team approach because it is a very difficult subject to talk about because there are so many differences one if the person is an elderly person they're above the age of 85 and have multiple medical problems and it's a low risk watchful waiting may be the best uh uh maybe the best course of treatment for that person if the person's a young person more aggressive treatment may be necessary and there's so many different treatments you know I've been in practice since 1985 and when prostate cancer was done then it was a radical prostatectomy and everyone ended up with side effects from the surgery now with the advanced robotic surgery using all of the new uh Da Vinci type of machines it's minimal amount of side effects and basically you may end up with some minimal stuff but it's much lower risk of either the urinary incontinence or the erectile dysfunction and if the person opts instead for the radiation you have the external beam radiation or the implants and then of course we also have the injections of the hormones so you basically need a real good team to approach this and especially if you're finding it in someone's 50s and 60s because this is someone that needs to be followed for a long period of time and that's the whole benefit of going to a place like the Rutgers Cancer Institute of New Jersey correct and um and so you know even in earlier stage cancers it's possible that you may need multiple modalities of therapy so when you have the team approach where everyone is um you know under the same space and reviewing the cases together it leads to better patient care in my opinion um the other uh you know the other aspect that we have in the Cancer Institute of New Jersey's clinical trials so for more advanced disease um you know which I haven't gone much into but when the prostate cancer is diagnosed at a later stage meaning it is spread to other organs or the bones or if one was treated for prostate cancer a long time ago and it's returned um in distant or far away organs um people will need other types of therapy in addition to the hormonal therapy which may include chemotherapy or more advanced testosterone reducing medications which come in the form of pills or even medications that work with your immune system to eliminate cancer cells and whenever we see you know in general in Cancer Care when we see that the agents that we use in more advanced disease are effective the next logical question that comes up is can we use this earlier to improve the outcomes of earlier stage cancer or reduce the risk of the cancer recurring so we have clinical trials at the Cancer Institute that also look at some of these agents that are used and that would typically be used in more advanced disease from an earlier time point and you may have access to these clinical trials you know eligible which may serve as the uh you know a novel approach now but the new future standard of care later on so I you know the clinical trial aspect is big as well um when you come to the Cancer Institute uh you know with a new cancer diagnosis you'll also be screened by our clinical research team to see if there are any clinical trials you are eligible for where you'll have a detailed discussion with your doctors whether they're the Urological surgeons radiation oncologists or medical oncologists to discuss what the rationale of the clinical trial may be with the risks benefits are and patients will have the opportunity to decide whether they would want to enroll in such trial so what are what can a man do to reduce his risk or delay their risk of developing prostate cancer sure so you know like I said we you know while we know some risk factors for prostate cancer you you know unless there's a new youth serum I don't know about you can't change um genetic predisposition you can't change a family history your age um or uh you know or your race but there are other lifestyle um uh modifications that may be helpful even though the data is mixed we do know that smoking and obesity might slightly increase your risk for prostate cancer so to abstain from smoking um you know having a nutritious diet to avoid obesity related complications may also reduce the risk of prostate cancer certainly if there's um if someone is having um uh symptoms of prostate cancer which may include difficulty urinating or a decrease stream any blood in the urine or semen where they're having the urge to urinate more or painful ejaculations that may suggest um you know that may suggest prostate cancer so at that time they really want to follow up with their doctors so that I'm screening if it hasn't happened will be undertaken uh you know like we said the good news about prostate cancers most of them are diagnosed at early stage and most of them do not tend to spread quickly so if it's caught early there's a very very high chance of cure rate so in terms of you know prevention I would say um you know staining from smoking balanced diet um you know losing weight if you fall into the overweight or obese category there is some data which uh you know was um which uh came out in about the last 10 years or so that there are certain medications that um that are used for enlarged prostate um that many men are um men are on uh for example Pro scar finasteride which have been shown to reduce your risk of prostate cancer about 20 percent I don't quite think it's standard um that these meds medications are prescribed across the board um you know many men as they age in their prostate becomes enlarged and they have some of these symptoms that we talked about before that are not related to prostate cancer will be on these medications anyways when they come into my office but if you're not having these symptoms there is some data of medicines like finasteride which are used to treat the benign prosthetic hyperplasia and large prostate which may also reduce your risk of prostate cancer by about A fifth or so so the importance the important things are to keep yourself healthy low-fat diets plant-based the diet if at all possible for screening for prostate cancer seeing your primary care doctor if there are any symptoms that of any concern consideration of a referral to the urologist after a follow-up with the urologists the important thing is a referral over to the uh can't Rutgers Cancer Institute of New Jersey or to one of the other RWJ Barnabas facilities such as the one that you work out of Hamilton in order to get the team approach to prostate cancer correct and that everyone's treatment of prostate cancer differs and it's going to be individualized based on the uh you know whether it's aggressive non-aggressive the age of the patient where any other medical conditions and that the team Approach at Rutgers Cancer Institute is a wonderful one and that it's so close to us that one does not have to travel far to get the best possible treatment and be able to be part of the clinical trials which are currently undergoing over at the Rutgers Cancer Institute thank you Dr Patel for all of your information all of your work all of your work in Hematology Oncology all the previous work that you've done at Rutgers Cancer Institute and the current work that you're doing at Rutgers Cancer Institute and I hope hopefully in the future we can talk again more about these type of uh cancers sounds great thank you Dr shinsky that concludes today's episode of Health talk please remember that the opinions expressed here today buy a medical expert are not a substitute for medical advice from your own

#Prostate #Cancer #Awareness

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