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Prostate cancer is unique to males because women don’t have a prostate.
Prostate cancer is unique to males because women don’t have a prostate.

It’s a gland that sits in between the bladder and the rectal region and basically is a gland
It’s a gland that sits in between the bladder and the rectal region and basically is a gland

that allows lubrication to some extent, and unfortunately the vast majority of men the
that allows lubrication to some extent, and unfortunately the vast majority of men the

older you get the more likely for you to develop prostate enlargement and often times unfortunately
older you get the more likely for you to develop prostate enlargement and often times unfortunately

develop cancer, which is basically a growth within the prostate gland.
develop cancer, which is basically a growth within the prostate gland.

I like to tell my patients that the most important part once you’ve been diagnosed with cancer
I like to tell my patients that the most important part once you’ve been diagnosed with cancer

is to actually identify the right team of people that you want to work with, whether
is to actually identify the right team of people that you want to work with, whether

it’s a surgical team, a radiation oncology team, or a medical oncology team.
it’s a surgical team, a radiation oncology team, or a medical oncology team.

I believe that patients with high risk prostate cancer or what I call, locally advanced disease,
I believe that patients with high risk prostate cancer or what I call, locally advanced disease,

or advanced disease, do require a multi-disciplinary approach which means it’s not only one treatment,
or advanced disease, do require a multi-disciplinary approach which means it’s not only one treatment,

but that is a group of people offering multiple lines of therapy that can actually improve outcomes.
but that is a group of people offering multiple lines of therapy that can actually improve outcomes.

So I always believe that a second opinions are super important when you’ve been diagnosed with cancer.
So I always believe that a second opinions are super important when you’ve been diagnosed with cancer.

Even if you’re comfortable with your doctor, you still want to see someone to actually
Even if you’re comfortable with your doctor, you still want to see someone to actually

help you understand a bit more.
help you understand a bit more.

I would think of prostate cancer in three different ways.
I would think of prostate cancer in three different ways.

Patients who have localized disease, patients who have locally advanced disease, and patients
Patients who have localized disease, patients who have locally advanced disease, and patients

who have advanced disease or incurable disease.
who have advanced disease or incurable disease.

So for men with localized prostate cancer meaning that the cancer is confined to the
So for men with localized prostate cancer meaning that the cancer is confined to the

prostate gland, the standard of care in the United States is actually a bit more complex
prostate gland, the standard of care in the United States is actually a bit more complex

than one single treatment.
than one single treatment.

It includes radical prostatectomy, which is the surgical removal of your prostate gland,
It includes radical prostatectomy, which is the surgical removal of your prostate gland,

For men with localized disease, improvement in technology has allowed us to actually do
For men with localized disease, improvement in technology has allowed us to actually do

minimally invasive surgeries.
minimally invasive surgeries.

A lot of people now are doing laparoscopic prostatectomies or
A lot of people now are doing laparoscopic prostatectomies or

using the robotic da Vinci to do the prostatectomies.
using the robotic da Vinci to do the prostatectomies.

it can also include radiation therapy which is basically giving you radiation from the
it can also include radiation therapy which is basically giving you radiation from the

outside, also called external beam radiation therapy.
outside, also called external beam radiation therapy.

Or also you could receive what we call Brachytherapy or seeds which is basically radiation therapy
Or also you could receive what we call Brachytherapy or seeds which is basically radiation therapy

but done internally.
but done internally.

Basically what you do is you actually put seeds of radiation in the prostate gland and
Basically what you do is you actually put seeds of radiation in the prostate gland and

they get released over time and that actually does the radiation instead of getting radiation
they get released over time and that actually does the radiation instead of getting radiation

from the outside.
from the outside.

There are many other techniques, obviously there are many other treatment options that
There are many other techniques, obviously there are many other treatment options that

men could explore, it does include HIFU, which is high intensity frequency ultrasound,
men could explore, it does include HIFU, which is high intensity frequency ultrasound,

which is FDA approved in the United States.
which is FDA approved in the United States.

Cryotherapy which is sort of freezing your prostate gland, it will [inaud.] if you will.
Cryotherapy which is sort of freezing your prostate gland, it will [inaud.] if you will.

And perhaps another treatment choice, active surveillance has become part of what we do
And perhaps another treatment choice, active surveillance has become part of what we do

in the United States, which means there are selected men who have low, indolent, non-aggressive
in the United States, which means there are selected men who have low, indolent, non-aggressive

prostate cancer that can be considered for active surveillance which means we’re going
prostate cancer that can be considered for active surveillance which means we’re going

to follow you without intervention and at any given time if things change we may actually intervene.
to follow you without intervention and at any given time if things change we may actually intervene.

For men who have locally advanced disease, which is disease that is still localized to
For men who have locally advanced disease, which is disease that is still localized to

the prostate gland, but by virtue of their features, you know, can actually, [inaud.]
the prostate gland, but by virtue of their features, you know, can actually, [inaud.]

we may find disease outside the prostate gland but luckily next to the prostate gland, where
we may find disease outside the prostate gland but luckily next to the prostate gland, where

the seminal vesicles which are a couple little glands sitting underneath the prostate gland.
the seminal vesicles which are a couple little glands sitting underneath the prostate gland.

Or it’s involving the cord of the gland or even in the lymph nodes, then those standard
Or it’s involving the cord of the gland or even in the lymph nodes, then those standard

options change a bit.
options change a bit.

They may include surgery, they may also include radiation therapy, but often times it includes
They may include surgery, they may also include radiation therapy, but often times it includes

the combination of both either systemic therapy and local treatment.
the combination of both either systemic therapy and local treatment.

And for men with advanced disease the standard of care is suppressing the testosterone production.
And for men with advanced disease the standard of care is suppressing the testosterone production.

Testosterone is the major fuel that drives prostate cancer growth, once you have it.
Testosterone is the major fuel that drives prostate cancer growth, once you have it.

So, the goal is what we call castration, which is a harsh statement for most of us, but the
So, the goal is what we call castration, which is a harsh statement for most of us, but the

reality is where the goal is quite simple.
reality is where the goal is quite simple.

We want to remove the fuel that is feeding your cancer cells.
We want to remove the fuel that is feeding your cancer cells.

That fuel is made in the testicles and therefore the goal for us is to suppress that production.
That fuel is made in the testicles and therefore the goal for us is to suppress that production.

That can be accomplished in two ways, one is surgical castration which is basically
That can be accomplished in two ways, one is surgical castration which is basically

the removal of both testicles. Or the other way and probably most commonly utilized now
the removal of both testicles. Or the other way and probably most commonly utilized now

in over the last two decades or so, is medical suppression of testosterone which is basically
in over the last two decades or so, is medical suppression of testosterone which is basically

you get an injection either monthly, every two, every three months, however we do it,
you get an injection either monthly, every two, every three months, however we do it,

and it suppresses the testicular production just by virtue of blocking the signal that
and it suppresses the testicular production just by virtue of blocking the signal that

goes between your brain and your testicles telling the testicles to make testosterone.
goes between your brain and your testicles telling the testicles to make testosterone.

Only until recently perhaps actually the last two years the standard of care had evolved
Only until recently perhaps actually the last two years the standard of care had evolved

a bit and now for selected men who have significant disease outside the prostate gland, we offer
a bit and now for selected men who have significant disease outside the prostate gland, we offer

them not only suppression of that testosterone production but also [inaud.]
them not only suppression of that testosterone production but also [inaud.]

chemotherapy with a treatment called docetaxel.
chemotherapy with a treatment called docetaxel.

We recognize that one treatment doesn’t fit all, meaning that the same chemotherapy
We recognize that one treatment doesn’t fit all, meaning that the same chemotherapy

may not work for five different patients and the biggest question that we have right now,
may not work for five different patients and the biggest question that we have right now,

not only in prostate cancer but certainly in oncology, is how we can do a little bit
not only in prostate cancer but certainly in oncology, is how we can do a little bit

more of what we call precision medicine, which is I want to understand your disease and I
more of what we call precision medicine, which is I want to understand your disease and I

want to actually treat you based upon your makeup not what happens to 100 other people.
want to actually treat you based upon your makeup not what happens to 100 other people.

Every man who dies with prostate cancer or from prostate cancer, they do so because they
Every man who dies with prostate cancer or from prostate cancer, they do so because they

develop this disease called castration-resistant disease, which is simply defined by you’re
develop this disease called castration-resistant disease, which is simply defined by you’re

not making male hormone and your PSA going north or you’re developing symptoms from
not making male hormone and your PSA going north or you’re developing symptoms from

your disease or your scans are changing despite the fact that you don’t have male hormone production.
your disease or your scans are changing despite the fact that you don’t have male hormone production.

So when that happens we have over six lines of therapy approved in the last five years.
So when that happens we have over six lines of therapy approved in the last five years.

We have powerful oral agents that are able to block adrenal production of hormones that
We have powerful oral agents that are able to block adrenal production of hormones that

mimic testosterone and can go activate [inaud.]
mimic testosterone and can go activate [inaud.]

cancer growth of the prostate.
cancer growth of the prostate.

We have oral agents that block that antenna directly.
We have oral agents that block that antenna directly.

We have newer chemotherapies that are also effective.
We have newer chemotherapies that are also effective.

They lead to survival improvement and make people live longer, control symptoms effectively,
They lead to survival improvement and make people live longer, control symptoms effectively,

maintain quality of life, and control disease progression in the later progression of disease.
maintain quality of life, and control disease progression in the later progression of disease.

And more recently you know, we have radionucleotides that are agents that actually are specifically
And more recently you know, we have radionucleotides that are agents that actually are specifically

designed to target bone disease, also with survival improvement and there is immunotherapy
designed to target bone disease, also with survival improvement and there is immunotherapy

which is probably the hottest topics to speak today in solid tumor oncology,
which is probably the hottest topics to speak today in solid tumor oncology,

an agent that actually works through the immune system to improve your survival, to improve
an agent that actually works through the immune system to improve your survival, to improve

your ability to live longer.
your ability to live longer.

I think a particular website that I find reliable is Cancer.net where patients can actually
I think a particular website that I find reliable is Cancer.net where patients can actually

really go and understand, you know, basically the entire scope of prostate cancer, from
really go and understand, you know, basically the entire scope of prostate cancer, from

the diagnosis, how do we define the disease, how we manage the disease, treatments and
the diagnosis, how do we define the disease, how we manage the disease, treatments and

also opportunities for them to understand a little bit more about their illness.
also opportunities for them to understand a little bit more about their illness.

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