I am Dr. Paul Leger.
I'm a medical oncologist at MedStar Georgetown University Hospital.
I take care of patients with genitourinary cancers; meaning patients
with prostate cancer, kidney cancer, bladder cancer and testicular cancer.
I also take care of patients
with gynecologic cancers, which include uterine
cancer, ovarian cancer and cervical cancer.
For me, the most important is to provide the best possible
treatment to my patients.
And the other thing that's very important for me is to have
my patients involved in their treatment decisions.
I usually like to take quite a bit of time
with my patients to go over their diagnosis, review
all possible treatment options to educate them. Because there,
I think that they are
more involved with their care and they understand what's going on.
I'm so excited about the opportunity to make a positive impact,
a positive difference in the life of my patients.
I love when I get into the clinic and I enter the room and
start with some good news to tell them how well their treatment is doing.
I like to pick up the phone and call them at the end of the day to let them
know, for example, that their PSA is being very low or being undetectable.
I think that's the most gratifying or rewarding thing
for us in this field, and that's what keeps me going.
But I do believe that there is great advantages for patients
to come to MedStar Georgetown, because we do take care of our patients
and we really care about them.
And we also have the team work where we have
a multidisciplinary team of experts working all together.
We have medical oncologists,
we have radiation oncologists,
we have urologists, the surgeons, and we have radiologists and pathologists.
All of this team working together.
We hold weekly or bi weekly team meetings to go over these patients
with more complicated situations to figure out the best way to treat them.
I think it's a great advantage for patients.
So, a medical oncologist is....usually in medicine
we think of medicine like
internal medicine or surgery.
So, internal medicine would take care of the entire body, all of the organ system,
compared to the surgeon who does surgery to just cut,
for example. A medical oncologist is, initially, an internal medicine doctor,
who did some additional studies to become a specialist in treating cancer.
So, we basically treat cancer,
but the medical aspect of treating cancer, because you can also
treat cancer with surgery. But we do not do surgery. What do we do?
Systemic therapies like chemotherapy and this kind of treatment.
Most of my research is more focused on prostate cancer,
but also as a GU oncologist, I treat patients
with kidney cancer, bladder cancer and testicular cancer.
Those are what we call genitourinary cancers.
Many of my patients ask me if they can find different treatment.
Treatment other than hormonal therapy for their disease.
Well, unfortunately, the backbone of the treatment, for example, of advanced
prostate cancer consists to suppress the testosterone level
because testosterone is the hormone that feeds the cancer.
The best way that we know to treat this cancer is through
suppressing the testosterone level with hormonal therapy.
for patients with very early stage disease
or patients with very localized disease, we may treat them with surgery.
And in that case, we may not need to do the hormone therapy, but basically
For patients with more advanced disease or high risk disease, even when they are
treated with radiation therapy, they do need to receive hormone therapy.
Unfortunately, when we suppress the testosterone,
this is the equivalent of what we can call a castration.
When you suppress the testosterone, you will obviously have side effects
such as the patient will have a decrease in their sex drive,
what we call libido, or they will have erectile dysfunction.
Some of them will feel
hot flashes like a woman going through menopause.
Also, they will feel a little bit more tired or have some weakness.
And some of them may lose their muscle mass or the bone mass as well.
Those are the most common side effects you will expect with hormonal therapy.
A patient on hormonal therapy,
who has a good response to hormonal therapy, still needs
to go through radiation therapy,
because the the the standard treatment
for localized prostate cancer is either surgery or radiation.
When we do radiation, we usually associated with hormone therapy.
So even when they respond well to a hormone therapy, initially,
they still need to go and have their radiation therapy.
For a patient, for example,
who receives a time-limited treatment for the disease,
particularly when we treat them with hormonal therapy and radiation therapy,
when we stop treatment, we would expect that they may improve the
side effects, particularly for their libido and for the erectile dysfunction.
However, I would like to caution patients that they may
also have side effects from the radiation on their erectile function.
And also the other thing is that these hormone therapies,
they have a long half-life, meaning that
this treatment will still be active in the blood,
even when we discontinue treatment.
So, it may take time before they can feel any significant improvement.
Some of my patients taking hormone therapy, they feel weak,
they feel tired.
And if experiment as well,
this decrease libido in their sexual drive.
They tend to think that
maybe taking some testosterone supplement could help.
But actually, this is very counterproductive
because this is exactly what we want to do.
We want to suppress their testosterone.
So we cannot recommend them to take supplements. It's very counterproductive
and it's not helping at all.
Surgery and radiation therapy are considered
to be equally effective to treat localized prostate cancer.
Sometime we base the decision on some characteristics
of aggressiveness, the level of extension of the disease.
And for some patients,
we give them the choice, because both are
equally effective.
And in that case, patient may
choose which one they prefer.
For metastatic prostate cancer, the first thing is that
this is basically palliative treatment, meaning that we can no longer
cure the disease and they need to be treated with
either chemotherapy or new hormonal therapy. For patient,
chemotherapy and hormone therapy can be equally effective,
particularly for patients with what we call high volume disease.
And in this case, we base our decision on toxicity
profile and level of tolerance.
Metastatic prostate cancer,
we can no longer cure
those cancers and those patients should be treated for
as long as the total with the treatment and the benefit from the treatment.
Usually, most of the treatment regimen will work very well for a year or two.
And then after that, we will need to switch to a different regimen.
But the good news is that we have many different options to choose from.
I also treat a gynecologic cancers.
That means ovarian cancer, uterine cancer and cervical cancer.
And for that, I work with the gyno team to develop a treatment plan,
and I'm taking care of the medical aspect of this treatment
because some of them may require surgery as well.
And the gyno team will take care of the surgery.
So the multidisciplinary care team means that we have different specialists
working together to to provide the best possible treatment for our patients.
In the case of prostate cancer, we have medical oncologists,
radiation oncologists, surgeons, a urologist,
radiologists and pathologists.
All of us working together to come up with the best treatment plan.
And this is definitely a very, very
effective way to treat our
patients and offer them the best possible treatment.
These days, I'm particularly focused on research on prostate cancer.
I'm interested in looking into health disparities,
and looking into better understanding
how can we promote health equity to address disparities in prostate cancer?
And also, how can we make sure that all of these wonderful progresses that we have,
how can we make sure that everyone, everywhere,
and at all times can benefit from this progress?
I'm also interested in research
to discover new tools to earlier and better diagnosis,
new tools for restratification and prognosis, but also new treatment.
We definitely need more treatment options to prolong the life of our patients
and also more tolerated treatment to minimize side effects on them.
I believe that participating in clinical
trial is the best way to help us move forward and
to promote discovery, innovation and
and do better in terms of treating our patients.
In fact, there is no way we can make progress
without having volunteers into these clinical trials.
And what I would like to remind my patients
is that participating in clinical trial does not mean necessarily
that the participant will benefit directly benefit from those trials,
but at least they will allow us to gather more knowledge,
more information so that we can treat better other patients.
And these other patients may be the family, their friends, their loved ones
and the community in general.
So, the best way for a patient
to figure out if they're eligible is to talk to their doctor
or talk to the team
in charge of the clinical trial to figure out if they meet the criteria.
Are they eligible for these studies?
Often, they may need to do additional testing
to make sure that those patients meet the requirement of those studies.
Participating in clinical trial,
I believe, is a way for patients sometimes to have access to even better treatment.
Definitely. However, I would say as well that participants should be aware that
participating does not necessarily
mean that they will directly benefit from those treatments.
However, we would always gather new information to help us treat better
other patients and improve our knowledge on how to the better.
The NCI-designated comprehensive cancer centers are academic
institutions of excellence who have the scientific background
and standard to develop very high level
clinical trials and provide excellent care to their patients as well as training.
So taking I mean, having care at those institutions usually will
will give you access to better treatment, better care and higher
higher standard of care and access as well to clinical trials.
And MedStar Georgetown is one
of the NCI-designated comprehensive cancer centers.
So, MedStar Georgetown is an NCI-designated comprehensive cancer center.
I believe that one
strong reason for patients to consider
coming to MedStar Georgetown is because we do care about those patients.
We really care about them.
And the other reason is that we have the teamwork,
the multidisciplinary team approach, where all of our experts weigh together
to come up with the best treatment plans for our patients.
Definitely, I would encourage patients to come and receive care at our center.