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How an Injection Can Treat Prostate Cancer · Meaningful Medicine with Novant Health

• 0:04
  Joey (Host): It's common, but treatable if caught early.
• 0:06
  So we're discussing prostate cancer screening and treatment.
• 0:10
  Our guest is Dr.
• 0:11
  Rex Kiley.
• 0:12
  He's a radiation oncologist with Novat Health.
• 0:15
  This is Meaningful Medicine, a Novat Health Podcast, bringing you
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  access to leading doctors who answer questions they wish you would ask.
• 0:24
  From routine care to rare conditions.
• 0:26
  Our physicians offer tips to navigate medical decisions
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  and build a healthier future.
• 0:31
  Thanks for joining us.
• 0:32
  I'm Joey Wahler.
• 0:34
  Hi, Dr.
• 0:34
  Kiley.
• 0:35
  Welcome.
• 0:36
  Rex Kiteley, MD: Thank you very much.
• 0:37
  Happy to be here.
• 0:38
  Joey (Host): Great to have you board.
• 0:39
  We appreciate the time.
• 0:40
  So first, just wondering, how did healthcare and radiation
• 0:44
  oncology specifically first become a passion of yours?
• 0:48
  Rex Kiteley, MD: you know, it's interesting.
• 0:49
  My, my undergrad degree is in mechanical engineering, so I've
• 0:52
  always liked the technical aspects of medicine and radiation oncology
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  is probably one of the more.
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  Technical fields along with radiology that really allows me to
• 1:02
  use that background and appreciate the math, science side of, my job.
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  But it's really nice 'cause it combines patient care so that I
• 1:10
  still have a, relationship with patients unlike, you know, not to
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  pick on my colleagues, but unlike radiology you tend to just see images.
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  I get to deal with patients all day long and establish
• 1:21
  relationships with them, which is probably the best part of the job.
• 1:24
  Joey (Host): Gotcha.
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  And you're actually the second doctor I've interviewed lately
• 1:28
  that said that engineering led to them practicing medicine.
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  So interesting indeed.
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  Now, as you well know, a.
• 1:36
  Out one in eight men, big number will be diagnosed with prostate cancer
• 1:41
  sometime during their lifetime.
• 1:42
  So what are the demographic groups there that are at highest risk?
• 1:47
  Rex Kiteley, MD: So the age is the most important thing, and men
• 1:50
  over 65 tend to be more likely to be diagnosed with prostate cancer.
• 1:54
  But there's also racial difference.
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  African American men tend to be more likely to be diagnosed
• 2:01
  with prostate cancer, and then of course, family history.
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  If you have a first degree relative, a father or brother that.
• 2:07
  Has had prostate cancer, you're at higher risk as well.
• 2:10
  Joey (Host): Now in terms of screening, talk to us please about how
• 2:14
  important it is for prostate cancer.
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  What screening is there?
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  Because if you're a younger person, you may not be aware of it just yet.
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  And what are the latest screening guidelines?
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  Because they've changed of late, right?
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  Rex Kiteley, MD: Absolutely.
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  So there's been a bit of a moving target.
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  the main screening tool for prostate cancer is the prostate specific
• 2:34
  antigen or PSA blood test, which your primary care doctor can take for you.
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  The current American Cancer Society guidelines say.
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  At a certain age, depending on your risk group, whether that be 40, 45 or
• 2:48
  50, and I'll go into that in a second.
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  But if you're in that age range, you should have a conversation
• 2:54
  with your doctor about it.
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  So they don't come out and recommend the PSA for everyone.
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  Because in the past there was some controversy that the wrong men are tested.
• 3:04
  For PSA, we might.
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  Diagnose some men that don't really need treatment.
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  And I think those of us that are oncologists don't really believe that.
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  We think that the tool is an important test.
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  That should be, if you're 50 and you have a reasonable life
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  expectancy, you should get it.
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  tested.
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  Uh, You should have the PSA test.
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  If you're 45 and you have a first degree family relative,
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  or you're African American, you probably should get the PSA test.
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  And if you're 40 and you have a couple of relatives, first degree
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  relatives, a brother or father that have had prostate cancer, you should
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  probably go ahead and get tested.
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  Joey (Host): remind us, please, both what PSA stands for and then
• 3:43
  what exactly is that measuring.
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  Rex Kiteley, MD: so the PSA is the prostate specific antigen, and we
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  all men have it in their bodies because the prostate gland secretes
• 3:55
  this antigen into the blood.
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  So you can draw a patient's blood and look for the level PSA in the blood, and it's,
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  measured in very small quantities, and then as long as that is in a, acceptable
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  normal range, typically zero to four for most men then you're probably okay.
• 4:14
  As it starts to rise above that, then you may need a, biopsy or, testing.
• 4:20
  Joey (Host): Now, correct me if I'm wrong, but one of the issues with
• 4:23
  prostate cancer is that it's often symptom free to the average person.
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  Right?
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  So are there any things that pop up that might tell a lay
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  person they could have it or no?
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  Rex Kiteley, MD: Well, for most patients if they do have symptoms,
• 4:39
  they're pretty advanced and that's why screening is so important.
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  But if you start to have urinary frequency that's unexplained or
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  obstructive type symptoms where you don't feel like you're emptying your
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  bladder all of the way pelvic pain, even worse bone pain if it's spread.
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  But a lot of those symptoms are for more advanced cancer.
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  So really the PSA screening tool is, is important so that we can
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  catch patients at a curable stage.
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  Joey (Host): But definitely if you're experiencing any of those symptoms you
• 5:10
  just mentioned time to see a doctor.
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  Right.
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  Rex Kiteley, MD: Absolutely.
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  Joey (Host): Okay.
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  Now, regarding treatment, if caught early, as we alluded to earlier, how
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  much more likely is it that prostate cancer can be treated and cured?
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  Rex Kiteley, MD: So it's very curable.
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  I've caught before it's spread outside of the prostate gland in
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  the nineties, high nineties for many patients long-term survival rates.
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  So most men will be cured if they're caught early enough.
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  Joey (Host): if it's not caught early, what kind of treatment options would
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  be discussed for prostate cancer?
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  Rex Kiteley, MD: So if the cancer is caught after to spread outside
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  of the prostate gland, then we're looking at systemic therapies.
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  Therapies that go.
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  throughout the entire body.
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  So androgen deprivation therapies is the mainstay, but there's
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  also newer targeted therapies.
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  There's new radiopharmaceuticals that are available and sometimes
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  there's localized therapies with radiation that can be used in addition
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  to some of the systemic options.
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  Joey (Host): when we talk about newer treatments, there's a modality
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  you are offering called pto.
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  So how does that work and what patients may be candidates for that?
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  Rex Kiteley, MD: Right.
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  So it's pretty exciting new treatment.
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  And the candidates, let's start with that.
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  The patients that are good candidates have metastatic
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  prostate cancer, so it has spread.
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  They are no longer responding well to the hormonal type therapies or a DT therapies.
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  So they have what we call castration resistant prostate cancer.
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  They have A-P-S-M-A PET scan, which is relatively new.
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  PET scan as well that shows uptake of cancer in different areas of their body.
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  All those are requirements.
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  And then lastly, they have had to have been treated with some of the antigen
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  receptor inhibitor type drugs, which many of your viewers won't know of,
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  but a abiraterone and is one of 'em.
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  There's a, list of them.
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  So those are the patients that are, good candidates for it.
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  How it works, it's injected into the patient's bloodstream
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  and it's a two-part molecule.
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  Lutetium 1 77 is the radioactive isotope that's attached to another
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  molecule that will seek out a prostate specific membrane antigen, PSMA,
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  which is on prostate cancer cells.
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  So it brings the radiation directly to the prostate cancer
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  cell, avoiding other cells.
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  Once it gets to that cell, it attaches.
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  Goes into the, molecule and the little tiny radiation particle is
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  emitted with a very short range.
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  So it only affects that cell damages that cell's DNA and that cell dies.
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  So very novel, very interesting.
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  Method.
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  Joey (Host): Sounds pretty amazing, huh?
• 7:59
  Rex Kiteley, MD: Yeah.
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  Yeah.
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  It's very, very much so.
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  Joey (Host): A couple of other things.
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  While that's not a cure, if the cancer is spread naturally, how can some patients
• 8:09
  benefit from that and what kind of side effects could they experience as well?
• 8:13
  Rex Kiteley, MD: Right.
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  So it has been shown to prolong patients PSA free or, you
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  know, meaningful survival.
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  But it also the side effect profile's pretty good.
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  Some patients experience nausea, decreased appetite, their
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  blood counts can be affected.
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  And there is a risk for some patients for long-term kidney
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  and or liver damage that we, we.
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  keep on the lookout for and of course decreased blood cell counts.
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  Those are the main things that patients might experience.
• 8:41
  Joey (Host): Lemme go back to the PSA test.
• 8:43
  We hear so much about it nowadays.
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  It seems years ago you heard practically nothing about it in the general
• 8:49
  public, but now it's really being pushed, promoted, the importance
• 8:53
  of it, and of course, that's great.
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  Is that foolproof?
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  If you have a PSA blood test and the number is within the normal range,
• 9:01
  especially toward the lower end of that spectrum, does that pretty much
• 9:05
  guarantee that you don't have prostate cancer or is there still a possibility?
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  And if so, should you be doing something further for screening?
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  Rex Kiteley, MD: Right.
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  So, for the vast majority of patients, yes, if your PSA is in a normal range
• 9:20
  and not changing, so sometimes it can be normal, but it's jumped up a good bit.
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  From the prior year.
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  So your, PSA velocity or that change is greater.
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  There's a small subset of patients that have very aggressive prostate
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  cancers that do not secrete PSA.
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  They're so unlike the prostate cancer that they come from certain neuroendocrine
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  cancers that no longer even secrete PSA.
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  So it is possible but not very common.
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  So I think you're gonna get.
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  99 plus percent of the prostate cancer cases with screening.
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  Joey (Host): And in summary here, doctor, any common misconceptions
• 9:59
  about prostate cancer or its treatment that you can clear up for?
• 10:03
  Us for instance.
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  I know that patients of course, are often very concerned about side
• 10:09
  effects of different kinds of ways of attacking this, and that's a big thing
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  that often needs to be weighed, right?
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  So are there any misconceptions about that?
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  Well, if I have it treated and a certain way, then that
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  could cause me other issues.
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  I don't know if I should do that, if you know what I'm saying.
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  Rex Kiteley, MD: absolutely.
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  So patients have preconceived notions when it comes to cancer itself.
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  And then treatments, I would say that, the best thing you can do is educate yourself.
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  Obviously if you're found out prostate cancer, you're gonna be.
• 10:37
  Seen by urologists, radiation oncologist to hear about your options.
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  And each treatment modality does have various risks that you're
• 10:45
  going to have to weigh with whether or not you want treatment.
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  So I think it's individualized as the bottom line.
• 10:52
  Joey (Host): And is there a certain misconception or myth, if you will,
• 10:56
  that people tend to have about all this?
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  Rex Kiteley, MD: would say that in general, patients that have stage four or
• 11:03
  metastatic cancer tend to think that it's a death sentence and with prostate cancer.
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  With some of the new modalities that are available, men are living long,
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  healthy lives minus prostate cancer.
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  For.
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  Years as opposed to what used to maybe months.
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  And so I, I think that make sure patients are aware that there's still
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  hope if you're diagnosed at a late stage.
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  And certainly if you're diagnosed at an early stage, if you're good about
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  your screening, which is the really, the take home message I think is that
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  you're most likely going to be cured.
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  And the side effect profile they're usually pretty favorable.
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  Joey (Host): And it seems like that side effect profile has
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  really improved in recent years.
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  Right.
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  Rex Kiteley, MD: It has, it really has, especially from a
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  radiation oncology standpoint.
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  The therapies get more targeted and the technology has improved
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  to the point that we're able to spare the normal organs very well.
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  And so we see a lot of the side effects than we did, 30 years ago, 20 years ago.
• 12:04
  Joey (Host): Absolutely.
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  And I'm sure for those joining us, that's comforting to hear, to say the very least.
• 12:09
  Well, folks, we trust you're now more familiar with pro.
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  Prostate cancer screening and treatment.
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  Dr.
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  Kite, we such a crucial message that can't be delivered enough.
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  Keep up all your great work and thanks so much again.
• 12:21
  Rex Kiteley, MD: Thank you very much for having me.
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  Have a great day.
• 12:23
  Joey (Host): Absolutely same to you.
• 12:25
  And for more information, please visit novant health.org/healthy
• 12:31
  headwinds.
• 12:32
  If you found this podcast helpful, please do share it on your social media.
• 12:36
  I'm Joey Wahler, and thanks again for being part of Meaningful
• 12:40
  Medicine, a Novant Health Podcast.