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Prostate Cancer Defined: Dr. David Ahlborn
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This is an important epidsode to share with the men in your life. September is Prostate Cancer Awareness Month.
How does it start? How does it grow? And who’s at risk?
The prostate is the walnut-sized gland in men, located just below the bladder. Prostate cancer is marked by an uncontrolled (malignant) growth of cells in the prostate gland.
Hartford HealthCare’s Jocelyn Maminta talks with Dr. David Ahlborn, a urologist with Tallwood Urology and Kidney Institute at St. Vincent's Medical Center. They discuss the risks and causes of prostate cancer and the latest advances on screening and treatment, including a recently launched multidisciplinary virtual visit program where patients can meet with all of their doctors together.
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More about a prostate cancer diagnosis
Learn more about prostate cancer and the new virtual visit options for prostate cancer patients.
Join a FREE webinar
You can join a number of free webinars offered by Hartford HealthCare about prostate cancer, in English and Spanish, and on a wide range of other topics.
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I am troubled by that because I'm thinking, why didn't you go see a doctor sooner?
SPEAKER_03I know. Like I said, there's a lot of reasons people don't come see to come see the doctor. We're really trying to make it open and easy for everybody so that we can catch these cancers early and save lives. Prostate cancer is graded on a scale of one to five, sort of like hurricanes, where one is good and five is bad. Okay.
SPEAKER_00Welcome to more life. This is an important episode to share with the men in your life. September is prostate cancer awareness month. How does it start? How does it grow? And who's at risk? Hartford Healthcare's Jocelyn Mamenta talks with Dr. David Auburn, a urologist with Tollwood Urology and Kidney Institute at Hartford Healthcare's St. Vincent's Medical Center. They discuss the risks and causes of prostate cancer and the latest advances in screening and treatment, including a recently launched multidisciplinary virtual visit program where patients can meet with all of their doctors together in one virtual room. Here's Jocelyn.
SPEAKER_01First of all, Dr. Alborne, how common is prostate cancer?
SPEAKER_03Yeah, well, thanks for having me on the show, Jocelyn. Prostate cancer is very common. It's actually the leading cause of cancer diagnosis in men. It'll affect about one in eight men in their lifetime, so very common.
SPEAKER_01Do we know what actually causes prostate cancer?
SPEAKER_03Like most cancers, we don't know exactly what causes the cancer, but there are a number of risk factors that are well documented. Age is the biggest one. Certainly at the age of 50, your risk starts going up. And by 65, if you're 65 or older, that'll be 60% of cancer diagnoses. Other risk factors would be family history or African-American race.
SPEAKER_01Yes, we'll talk more about that in this discussion. How does it actually begin? Can it and can it spread quickly?
SPEAKER_03Yeah, so uh prostate cancer starts in the prostate with a cell that has either acquired a mutation and starts to grow abnormally. Luckily, it grows in the prostate for a period of time and doesn't typically grow aggressively and spread aggressively like some of the cancers. There are more aggressive cancers that can, uh prostate cancer that can uh grow outside of the prostate, but it typically doesn't grow very fast.
SPEAKER_01But so you just mentioned though that there are aggressive types of prostate cancer.
SPEAKER_03Right. So prostate cancer is graded on a scale of one to five, sort of like hurricanes, where one is good and five is bad. Okay. And depending on what uh your pathology shows on biopsy, we can risk stratify you and give you a sense of how aggressive your cancer would be.
SPEAKER_01At what age should um a man begin to be screened for prostate cancer? You said fifty is generally the time.
SPEAKER_03Yeah, so uh your risk starts going up at 50. Uh the American Urological Association recommends that men 55 years of age and older get screened uh through the age 69. If you have risk factors like I described above, um either a family history or African American race, then they actually recommend you start that discussion at the age of 40.
SPEAKER_01So much earlier than the recommended dates for everybody else if you have risk factors. What is that screening process?
SPEAKER_03So the screening process starts out with a discussion with either your primary care doctor uh or your urologist. Uh you'd have a discussion about what your risk factors are and you know what how your other general health is. Uh it would then go on to be a rectal exam, which would feel for any kind of lumps or bumps on your prostate, which might push you towards a more aggressive cancer. And then it would include a blood test called PSA or prostate-specific antigen. And this is a molecule that's made in the prostate and it circulates in the blood. There are lots of reasons that your PSA could be elevated, but one of the reasons is cancer.
SPEAKER_01For a lot of men who've never had to go through that, is that process can it be uncomfortable?
SPEAKER_03Yeah, the rectal exam certainly can be uncomfortable. Um it's very quick. It's not certainly not painful unless you have some other kind of uh prostate pathology going on. Uh, but the exam is you know very quick and well tolerated.
SPEAKER_01Very good. Now let's talk about some of the early warning signs. Is there something that would indicate to a man anyway that they should perhaps bring up the subject of prostate cancer before getting the before they get screened?
SPEAKER_03Yeah. Well, luckily, because there's been a big push towards prostate screening, um, the majority of cancers are caught before they're really symptomatic. That being said, if you delay screening, uh you can develop uh symptoms that are related to urination, including urinary frequency or waking up at night. You can develop blood in your urine or your semen, and then if you really let it go long, you can start to develop symptoms in your bones like bone pain.
SPEAKER_01And that's why it's really important to communicate with your primary care physician. Yeah. But we also know that men generally don't make those yearly visits.
SPEAKER_03Right. Yeah, it's um, you know, it's hard. A lot of people don't want to visit the doctor, or it's hard to get appointments. So we try to create an environment that's open and welcoming to everybody, and we try to offer you know flexibility uh to work around people's schedule.
SPEAKER_01Okay. At what stage though do most men um get diagnosed with prostate, bec knowing the fact that a lot of men ignore the signs?
SPEAKER_03Yeah, well, so the majority of men are actually caught in what we call the localized phase, and that's when the cancer is just in the prostate or very close. That's very good news. Um, you know, 85% would be in this category. It's a small sub subset of people who um are presenting with metastatic disease.
SPEAKER_01Yeah, and when I do hear that though, I I am troubled by that because I'm thinking, why didn't you go see a doctor sooner?
SPEAKER_03I know. You know, there's there's like I said, there's a lot of reasons people don't come see to come see the doctor. Um and you know, at Hartford Healthcare we're really trying to uh make it open and easy for everybody so that we can catch these cancers early and you know uh save lives.
SPEAKER_01You you discussed that uh you discussed some of the folks who are more at risk for prostate cancer. Why is it that African American men are at risk for this at a higher level than other men?
SPEAKER_03Yeah, we don't we don't know the exact reason for that. Um in terms it could be some genetic component, but there's not we haven't really pinned down exactly what it is about that race that's causing it to be more aggressive.
SPEAKER_01We just want to make sure that they get in there sooner than later.
SPEAKER_03Absolutely.
SPEAKER_01What is the prognosis though if prostate cancer is caught early?
SPEAKER_03Yeah, so the prognosis is excellent, particularly if it's uh caught early. The five-year life expectancy uh is 97% uh for all comers, and nearly 100% if caught early. Then if you look out at 15 years, which is a typical time course for prostate cancer, it's still above 85-90% uh if it's caught early enough.
SPEAKER_01Right, what are some of the treatment options?
SPEAKER_03So there's lots of treatment options. Uh the two main stays of treatment are surgery or radiation, uh, both of which we do at Hartford Hospital St. Vincent's. Um we also, depending on the type of cancer you have, if you have very low-grade cancer, it's we could just watch it with PSAs and biopsies every uh couple years.
SPEAKER_01And that's why it's really important to maintain that open communication line with your primary care physician as well as your urologist.
SPEAKER_03Absolutely, yeah.
SPEAKER_01I understand that you are now offering this virtual visit option, and it's called the prostate cancer multiblist multidisciplinary virtual visit. Uh we've had other doctors explain it in other Facebook lives, but tell us more about it.
SPEAKER_03Yeah, so this is a really exciting uh adventure that we have going on right now. It's basically because prostate cancer tends to be uh multidisciplinary um pathology, we get a urologist, a surgical urologist, a uh radiation oncologist who would be administering the radiation, and even a medical oncologist who would be responsible for um kind of any hormonal therapy or chemotherapy that you would need should your cancer progress. And it's a great way for you to get introduced uh to that team who would be taking care of you, to give you all of your options because there are lots of options. It's not that there's just you know one size uh fits all.
SPEAKER_01Yeah, so this visit, do you meet with all three at the same time, or how does that work?
SPEAKER_03So we block off an hour and a half of your time, and each uh provider would have a half hour with you in sequence. Um the urologist would come on uh and talk with you over the virtual on over Zoom and explain what the surgical options are. Uh then the radiation oncologist would come on and do the same, and uh then the medical oncologist would come on. And after everyone has explained what their role is, we would all come back together as a group and explain, uh, you know, kind of do a wrap-up and see how the patient is feeling and which way they're leaning, answer any kind of lingering questions that they might have.
SPEAKER_01What kind of response are you getting?
SPEAKER_03Oh, it's great. Uh patients really love it. It's nice that it can be done uh from your home. It kind of consolidates a lot of appointments, otherwise, this would be three appointments that you have travel time, waiting in the office, seeing the doctor. You know, so it it's the patients really love it.
SPEAKER_01Is the patient more comfortable knowing that he can take it from home?
SPEAKER_03A lot of times, yeah, uh yes. And the other nice thing about the virtual platform is we can share our screens, and there's a lot of resources on the internet that we use. I use um uh different tables and charts and data. I like to go over the you know, some of the science behind what's going on in the patients and why we do what we're doing. And it makes it really easy to be able to show the patients that, and I think they appreciate that.
SPEAKER_01So it's really comprehensive, isn't it?
SPEAKER_03It's very comprehensive, yeah. Yeah.
SPEAKER_01All right, Tallwood will also be offering the a free webinar on these virtual visits in Spanish. Oh, good. Which is great, right, on September 30th. Well, what will patients learn at this webinar?
SPEAKER_03Yeah, so it's basically going to be just a summary of kind of what of what we talked about. What we just shared? What we just shared, um, kind of what the process is like when you go through this uh multidisciplinary video visit um and what your other options are. Uh patients will also have an opportunity to interact directly with an expert such as myself and ask questions.
SPEAKER_01I love that it will also be in Spanish, though. That's really reaching out into a population that normally wouldn't get the important information.
SPEAKER_03Absolutely. And you know, that's just one of the amazing things about St. Vincent's and Hartford Healthcare that they really do a good job of reaching out to the whole community.
SPEAKER_01Talwood has multiple locations throughout the state. Where do you actually see your patients?
SPEAKER_03So I primarily see patients in Bridgeport at 2660 Maine.
SPEAKER_01Just or down the street really. Just right down the street.
SPEAKER_03That's right. Um I'll also be seeing patients at Milford. We have an office at Milford that will be opening up in October.
SPEAKER_01We're excited about that.
SPEAKER_03That'll be really excellent. Um, and then I have partners, I have four other partners who see people in either Stamford or uh will be in Wilton when that opens in uh later in this year.
SPEAKER_01Very good. We actually have some viewer questions. You ready for them?
SPEAKER_03Absolutely.
SPEAKER_01Great. Our first question is oh, here's it's is prostate cancer a genetic, something you touched upon.
SPEAKER_03Yeah, so there is a large genetic component of prostate cancer. Um of the genes that everyone's already very much aware of, such as BRCA1 and BRCA2, are heavily implicated in uh the pathogenesis of prostate cancer.
SPEAKER_01And we've developed drugs and that that's interesting you say that because we hear that linked to breast cancer.
SPEAKER_03For sure, yeah. So it's it's very heavily linked to breasts, obviously, but also with prostate cancer. And some of the medications that we use that target BRCA, uh, you know, if you've are found to have these mutations, can be very helpful uh, you know, in your treatment. There's lots of other genes that um are implicated in prostate cancer as well, and we're doing lots of research every day to try to find more and develop new therapies.
SPEAKER_01So you really should know your family history.
SPEAKER_03Absolutely. Family history is very important. If you have a father or a brother who has prostate cancer, you're twice as likely to develop prostate cancer. So it's important to know your family history. Um we do run genetic tests if you have a strong family history, either of prostate cancer, but also of breast for that very reason. Uh pancreatic cancer, ovarian, some of the other cancers.
SPEAKER_01Yes, and that is something that a lot of men don't talk about or don't know about is that a man can actually also be diagnosed with breast cancer.
SPEAKER_03That's right. Yeah, that's a lot of people don't know that.
SPEAKER_01Yes. Our second question is what can I do to prevent prostate cancer besides screening?
SPEAKER_03Right. So uh, you know, many of the risk factors for prostate cancer are things that you can't change. Your age, your family history, your race. Uh, but and there haven't really been a whole lot of other things that have been strongly linked with prostate cancer. The general recommendation is kind of your general uh good, healthy living lifestyle. So try weight loss, healthy eating. There's been some uh research to suggest that dairy can increase your risk, so limiting your dairy. Um those are kind of like the general recommendations.
SPEAKER_01Well, at least you can there are some things that people can't actually do. Sure.
SPEAKER_03Yeah.
SPEAKER_01All right, our next question is if I had another type of cancer, is my risk higher for prostate cancer?
SPEAKER_03Yeah, I mean, if you have one of these um genetic abnormalities, then you could be at increased risk of prostate cancer. Um and like I said, certainly if you have a family history of other cancers, breast cancer, ovarian, colon cancer, then you could be in you could be at risk. Yeah.
SPEAKER_01All right, very good. And for more information about Tollwood Urology and Kidney Institute, go to Harvard Healthcare.org/slash tallwood. And to register for that free webinar on September 30th, again, also in Spanish, call this number, 1-800-442-4373. Dr. Alborn, thank you so much for joining us.
SPEAKER_03Yes, thanks for having me.
SPEAKER_00Thank you. Jocelyn and Dr. Alborne. Check this episode's links to learn more about prostate cancer and the new virtual visit options for prostate cancer patients. You can also join a number of free webinars offered by Hartford Healthcare about prostate cancer in English and Spanish and on a wide range of other topics. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_05I'm ready for my close up on the faces that are light up. You know I love this feeling. I've got more life in my life. We're gonna go anywhere we want to go.