Danielle Lee: Good evening Jacksonville and happy Saturday. This is our first live show with our new voice and new music. I’m Danielle Lee and welcome to the conversation with Dr. Ali Kasraeian, as always you too can joining the conversation. Give us a call, 340-1045. How are you doing today Dr. Ali?
Dr. Ali Kasraeian: I’m not sure after that music, to be honest with you.
Danielle Lee: It’s different, it’s a little different.
Dr. Ali Kasraeian: Okay. I don’t know how to feel right now. But welcome to the conversation. I’m Ali Kasraeian. Joining me in the studio is Dr. Bijoy Telivala, a good friend of mine and medical oncologist at cancer specialists of north Florida, and on the line joining us will be David Albala, who is a world renowned robotic prostatectomist and minimally invasive surgeon, who is also a world renowned expert in prostate cancer.
So the reason for this is prostate cancer awareness month, and we are going to be discussing prostate cancer, really from beginning of disease to the end of disease, and really today we’re going to be talking about advanced prostate cancer, and the reason for that is other than skin cancer, prostate cancer is the most common cancer in American men. It is the second leading cause of cancer death in American men behind lung cancer, and one man in 41 will die of prostate cancer in the United States, and fortunately most men who are diagnosed with prostate cancer in the United States do not die from their disease, and in fact, at this moment more than 2.9 million men are alive and living with prostate cancer and not dying of their prostate cancer here in the United States. And a big part of that are people like our guests who deal with the prostate cancers through the spectrum of their disease. So guys, thank you for joining us.
Dr. Bijoy Teliv: Thank you.
David Albala: Thanks so much.
Dr. Ali Kasraeian: So one thing that’s interesting in looking at, for me, always looking at the spectrum and the fact that prostate cancer screening remains still even to this day one of the most controversial screenings for any kind of malignancy, or any kind of disease really, is the following statistic. People talk about now one in nine men are diagnosed with prostate cancer during their lifetime. When I was a resident it used to be one out of six. So I went back today and looked at all the statistics going back to when I graduated medical school and when I finished my residency and my fellowship, and compared to today. So based on the CVC’s data, in 2018 164,000 men about, the specific number is 164,690 men are predicted to be diagnosed with prostate cancer in 2018, of whom more than 29,000 are going to die of their disease.
If you go back to 2015, a little bit more than 183,000 men were diagnosed with prostate cancer, of whom just shy of 29,000 die of their disease. In 2012 when all the screening controversies got a lot of their strength, with the US preventative services taskforce recommendation against screening with a grade D recommendation, and that year we had 188,232 men diagnosed, of whom 27,000, just a little bit more than 27,000 died. Go back to 2007 when I graduated from my residency in urology, just shy of 239,000 men were diagnosed with prostate cancer, of whom in that year 29,093 men died of their prostate cancer. And if you go back to 2002, when I finished medical school, 214,000 men were diagnosed with prostate cancer, and 30,000 men died of prostate cancer.
So if you look, the amount of men diagnosed with prostate cancer is going down, but the amount of men who die of that disease has remained relatively stable, and in the recent past is actually going up a little bit, and we’ll talk about some studies that show that the amount of men being diagnosed with advanced disease and metastatic disease is actually going up a little bit in wake of less screening and the fact that we may be diagnosing men at a later stage of their disease.
So that’s what I want to talk about, and the exciting fact in the world of advanced disease, we’re finding a lot of new medications, a lot of open minded more focal attempts of curing this disease in later stages, that we may not have thought about before with [inaudible] tools that we have. So open it up, Dave, for you as a urologist that deals with this disease from the PSA forward, what are your thoughts on looking at where we’ve come and where we’re going from screening forward, with the breadth of what we have, from the screening controversies forward?
David Albala: Well first Ali, again thank you for inviting me. It’s always an honor. I love to listen to your show, and for those of you down in Florida, I’m up in upper state New York in a big large urology group practice. We have 30 urologists in our group, and I do a significant amount of prostate cancer work, and I think over the years we’ve seen big changes taking place. Obviously when you were just talking it made me think about our residency, and initially the way that we diagnosed prostate cancer was with our fingers and a rectal examination, and that was not a very accurate way of assessing prostate cancer. It would pick up those people that had very advanced prostate cancers, and then the PSA era came in and that really revolutionized things.
As any of the people in the audience know, PSA is a simple blood test, stands for prostate-specific antigen, it’s a protein that’s measured, but it’s not a prostate cancer specific marker, and it can be elevated in people that have prostate cancer, but also in people that have an enlarged prostate and an infection in their prostate can elevate the PSA, and so on, and so forth. We used the combination of the blood test and the rectal examination to identify patients, and we did a pretty good job of it, and we were picking up disease earlier, and obviously if you can pick up the cancer, prostate cancer is known to grow very slowly, if you can pick it up early you have much more options. Whether it’s radiation, surgery, and now the latest fad is with active surveillance if some of these don’t actually need to be treated, but we had a whole array of different treatments available.
Then the taskforce came out with their recommendations, initially suggesting that prostate cancer screening doesn’t need to be done and there’s really no benefit, and that was then changed to the current recommendations, which are men that are between 55 and 69, those patients should undergo a periodic examination and the PSA, and then the other piece of that recommendation is that if you’re 70 years and older, you may not need to be screened. And we’ve seen a migration take place, and there’s good data in the literature. There’s a paper coming out from the large urology group practices that have suggested that this early diagnosis, now because of the recommendations, we’re starting to see more advanced disease. Disease that’s spreading to the bones, spreads outside of the prostate, and then it becomes a much more difficult form of cancer to treat.
So I think the recommendations have pushed things back a little bit. The recommendation initially was screening wasn’t very good, and urologists around the country complained about it. The recommendation was changed and now men 55 to 69 should undergo periodic PSA screening based on each individual, but I think we stepped back a little bit, and now hopefully we’re going to, as we prepare to move forward, be much more effective in identifying patients that have prostate cancer. Whether you have it is to me, is where the real crux of the question is, is once you get diagnosed there are many options, and not every patient needs to get treated. So we have been able to identify these indolent diseases that can just be followed with routine PSA and a repeat biopsy over a period of time. So the pendulum has swung, now it’s starting to swing back I hope, and that we can still identify these patients, because the best way to try to treat these patients is making a diagnosis early and treating it before it becomes into that advanced stage.
Dr. Ali Kasraeian: Dr. Telivala, what is your perspective, as someone who deals with the disease in the later stages through the same question?
Dr. Bijoy Teliv: Ali, thank you. Thank you very much for having me on the show.
Dr. Ali Kasraeian: Of course.
Dr. Bijoy Teliv: I completely echo what has been said. There has been a pendulum switch that patients are getting diagnosed at a later stage. What I always tell my cancer patients is it’s much easier to treat localized and a small amount of cancer than a cancer which has spread to various parts of the body. When the cancer spreads outside of the prostate, the chance of curing it drops dramatically, the patients have much more symptoms, and it becomes a much more difficult and different ballgame. The screening controversy is probably costing us some lives-