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>> Well hello and welcome to HealthLine.

I'm Jennifer Blomquist.

I have the privilege of hosting this program this evening and I appreciate you tuning in if you're one of our regulars, you know the routine here live here in the studio we have a live guest with us and we welcome any of your questions.

Our topic tonight is going to be focusing on prostate cancer.

We were talking about prostate issues last week with a urologist and tonight we have a radiation oncologist joining us.

So I want to tell you that maybe maybe we're not specifically talking about an issue you're having but maybe it's prostate related.

>> Feel free to give us a call .

So I'm going to go over how to do that.

The numbers that for calling and also for texting are going to be at the bottom of the screen throughout the show.

So if you would like to call in and ask a question it's (969) 27 two zero.

It's a toll free call if you put it 866- in front of their you can ask the question live which is nice for our guest because he might need to ask you some questions to give you a better answer.

So that's one way of doing it or you can just relay your question to the call screener and we'll get your question answered that way texting is great.

We've had a lot of people text and it's really easy and we keep your number private.

Nobody will see your number.

But if you feel comfortable maybe giving us your name and telling us where you're calling from that would be great.

Just your first name.

That number is a little different though.

It's (969) 27 three zero.

So lots of ways to get a hold of us tonight.

And let me go ahead and introduce you to our guest.

>> So he is a radiation oncologist.

Dr Brian Chang, thank you so much for coming on.

Yeah, thanks for having me.

>> Appreciate it.

I talk to you about before the show we were talking and I said, you know, we had discussed last week with a urologist some different prostate issues that people could be happier having.

We did not address the issue of prostate cancer.

You came up with some slides which I think will be very helpful.

One thing we didn't do last week is we didn't really show people the anatomy of a man's body where the prostate is.

>> People have trouble.

I'm sure everyone's heard of it maybe don't know where it is so I don't know if you'd want to start with that explaining its location.

Yeah.

So the prostate we have a nice diagram.

The slide one shows a nice side view of the anatomy of the male pelvis.

You can see that the prostate is this green one I see plan that's at the bottom of the pelvis.

It sits immediately next to the bladder which is a reservoir that fills with urine and another organ called the that is a reservoir that fills with stool.

The bladder actually empties through this pipe called the urethra and that urethra passes directly through the prostate to the outside world.

>> The proceeds only function is to create fluid um for and that is all yeah.

>> I think a lot of people probably didn't even know what its function was.

>> So what what would be something for people to because you know we talked about some things last week problems people going to have with their prostate you know the urologist was Dr.

Palmer, you know, was talking about if you're getting up at night to urinate, you know, the nighttime urination or just an enlarged prostate, things like that that you know ,he said wouldn't necessarily be life threatening but could cause more issues down the road and was talking about different procedures that could be done to alleviate those issues, medications that can be tried.

Those were, you know, some conservative methods that you could do.

But what would you advise men watching or you know, with a loved one of them?

Is it because men don't always want to address their health issues?

>> What are some symptoms to look for if you for prostate cancer, what would be concerning?

>> Yeah, actually the reality is, uh, typically prostate cancer presents without any symptoms.

Um, fortunately with the advent of PSA which is just a simple blood test.

Yeah.

Tacked on to your other um routine labs uh you can actually catch prostate cancer very early when it's at its most curable um with the least amount of treatments.

So it's really important that you uh consider PSA testing um bring it up with your primary health care provider uh and see whether or not it makes sense for you.

>> That's what was going to ask you.

>> So is that something that would be appropriate during like a yearly physical um to have something like that done?

Yeah.

So the recommendation is to start a PSA screening at the age of 50.

OK, if you have any first degree relatives with prostate cancer or uh you're African-American may consider uh PSA screening earlier say at the age of forty five OK, PSA screening has become very ill.

It's gone through a lot of changes over the past couple of decades.

Um you know prior to my time I was told before PSA people would present with symptoms because their prostate cancers were just so advanced large based on the anatomy you can see they could obstruct their urethra causing trouble urinating.

They could cause blood, uh, to to show up in your urine or in your store.

Patients would even come in with pain in their bone, which is very unusual today because their prostate cancer had spread through the bloodstream.

But with the advent of PSA, which is a simple blood test we were able to shift the stage of presentations to patients presenting with more curable disease treatments were improving over that time.

But what we learned was we were actually over diagnosing prostate cancer and the bigger problem was we were over treating.

So in 2012 the US Preventative Services Task Force actually recommended against PSA screening just giving like false positives.

Is that kind of what was not false positives but close to there we were finding a lot of prostate cancers that actually were not what we call clinically significant.

So these were prostate cancers that wouldn't be a problem in this person's lifetime and they were being treated because of fear that this is cancer and it needs treatment.

But we did figure out that there's a new or there's an approach that we can use that's sensible called active surveillance where you just follow the patient very carefully after their diagnosis if they have the most common form which is low risk and a very high percentage of those patients never need treatment.

But for those patients who progress their PSA rises or their biopsies show more aggressive cancer, we do recommend treatment.

So in twenty eighteen because of that shift in how we approach prostate cancer, they then made the recommendation that patients should make their own decision based on discussion with their primary health care provider um to determine whether or not PSA testing made sense for them.

All right.

We're going to talk more about prostate cancer and treatment options and we have some more slides that are very helpful.

I want to share those with all of you.

Just want to remind you though, the phones have been quiet so far but we we'd love to have somebody call in, ask a question.

Dr Chang is only here until a little before eight o'clock and the show always goes really quickly.

So feel free to give us a call again if you'd like to ask a call whether it's live on the air or just relay it to the call screener it's (969) 27 two zero.

It is a toll free call with an 866- in front of their texting is great as well.

If you want to just give us your first name, tell us where you're texting from and that's a little different.

Number (969) 27 three zero and again we keep your number private.

So there was another slide slide number two and I know you were saying that was an interesting slide if you could kind of yeah.

Is this when you're involved in treatment?

Is this imaging that would be from like an MRI or CT scan?

>> Yeah.

So a lot of patients will ask me, you know, how do you treat the prostate without hitting my other organs and yeah the the analogy I make is if you're in an auditorium that's very dark and then you have spotlights on kind of like in this room up ahead it's only where all those spotlights intersect where the performance standing on the stage that's brightly lit so the picture on the upper left kind of shows that concept.

That's actually what we call cyber plans.

So there there's no knife.

It's just the name of it but there's basically like one hundred pencil thin spotlights or radiation beams of energy that are coming in.

>> They're all intersecting on the prostate gland and you can see in the three different views of the prostate that the radiation dose which is the red line very nicely conforms to the shape of the prostate and that allows us to really spare the adjacent tissue.

So essentially each beam in the example if you have one hundred beams each beam covers or brings one percent the dose it's only where they all intersect that's getting one hundred percent.

So where the beam is traveling through the patient really that's a negligible dose of radiation.

So we're not really you know although we are traveling through the body in order to get to the prostate it's a dose that's actually not very clinically significant.

>> It's only where they intersect on the target that that's really getting the full dose.

I remember interviewing a gentleman years ago that had been diagnosed with prostate cancer, had one of those PSA blood tests like you had mentioned before and was surprised to find his wife was what it was kind of forced him to do it.

You know, she was just concerned and as it turned out, you know, he had the cancer but he said he never missed a beat.

>> You know, I said well, did you have to take time?

He was a English teacher at a local high school and I assumed he would have had to take some time off and he said no.

He said the only thing is from having the radiation treatments.

He said he felt a little tired.

He said I maybe went to bed thirty minutes early at night but it did not impact his life whereas I think some people were always dreading that they'll be out of work for months and months so I was I was amazed when he when he told me that no especially if you catch it early with PSA screening we can treat your prostate cancer in five outpatient treatments where you just lay on a table for thirty minutes.

You don't feel a thing.

It's just like an X-ray you're done with in a week and a half and we put no restrictions on you.

You can continue to work full time.

I have patients golf right after and they're getting their prostate cancer treated so that they can live a cancer free life .

>> Yeah, this this teacher was an English teacher wrote like a really cool poem about his experience and how nice everybody was to him.

He said he actually looked forward to going to his treatments because it was such a positive experience.

>> You know, actually yeah.

A lot of people do say that you have their treatment.

>> Yeah.

So it's you know, I think some people dread they it's like they don't want to find out, you know.

But actually I mean like I said, his experience is wonderful and you're saying that's the same for a lot of other people.

I do want to ask you, Dr Chang, somebody had called him or wanted us to ask the question for her.

So Susan was wondering if cervical cancer treatments are similar to the prostate cancer treatments.

>> So I actually you know you know, cancer's sort of this general term that just means, you know, the hallmarks of cancer that you know, it's a cell that's dividing and growing uncontrollably and it has the, you know, ability to then spread all the cells in our body and we're made up of tens of trillions of cells like 30 to 40 trillion over time.

They all develop the ability well over time they do accumulate injuries, errors to their blueprint, the DNA and with time some of those cells develop errors in the wrong places and that leads to cancer so cancer can form in many different organs.

Cervixes is one of the cancers that we unfortunately see.

But the treatment is actually very, very different than prostate cancer treatment.

So there aren't a whole lot of there are some similarities but there are managed quite differently.

>> Yeah I and it sounds from what I've read that a lot of times the some of the reproductive organ cancers for women can be difficult to treat especially if it's not caught caught early can be very painful and require a lot lot more than what you said five it's usually five radiation treatments for the prostate cancer.

>> Yeah.

It could be as good as five X-ray treatments and then you know, all you have to do is check your labs every six months and make sure that it worked.

Yeah, I was going to ask you what the follow up is so you every six months do basically some blood work.

>> Exactly.

Just a PSA test to make sure that the PSA is going down on the average it takes, you know, 12 to 18 months for the PSA to go down.

But the key is to make sure that we're on top of it so that if it does start to rise that we address that immediately are there are certain people, certain men who be more at risk of prostate cancer that others you know, you had mentioned if you have a first degree family member you'd want to start screenings earlier.

But let's say your dad had it.

You know, does that mean, you know, that guy is more likely a certain percentage higher risk?

>> Yeah, he's going to be a little bit at a higher risk.

>> It also depends on the age at which, you know, in this hypothetical situation your father was diagnosed.

So if you're dying if your father's diagnosed at an earlier age, that makes me more concerned that maybe there's a potential for you being at higher risk.

And I would certainly encourage you to consider PSA screening at an earlier age.

>> Forty five or younger what about any other you know, any other risk factors?

>> I don't know like being overweight or smoking or I'm not familiar with any any interaction between smoking or weight.

I might be but um really the big ones are race and uh you know first degree relatives.

>> OK, what races would you say are impacted African-American in particular.

OK, all right.

Any idea why?

>> Uh I do not know.

Yeah OK yeah I've never heard I had not heard that before so I was I was curious they did Dr.

Chang just show me a couple minutes ago the car to say that we're down to ten minutes the show so it goes very quickly.

That means that we are only maybe at eight eight minutes left or so right now that's still plenty of time to get some questions answered.

So I encourage you to give us a call.

We got a couple of people message just before we appreciate that.

>> So again it's (969) 27 two zero still toll free call with an 866- in front of there you'll see that phone number at the bottom of your screen and texting is so easy you text all day anyway.

Why not text us a question?

The number is (969) 27 three zero.

How does the prostate cancer form is there is it kind of is it kind of the same for everybody as far as how it forms or.

Yeah it's uh you know all cancers start to develop because of errors in your DNA.

Right.

And um and basically the DNA gives the cell instructions as to what to do and the hallmark of cancer is these cancer these cells um lose the ability to respond to signals around it telling to stop dividing and growing and then they also start to because their dividing and growing so quickly and they're not really paying attention or doing a good job of copying their DNA accurately .

They then develop mutations and then uh develop other abilities like the ability to spread through the blood to other organs.

Uh, typically the bone in the case of prostate cancer or uh through the drainage pipe system we call lymphatics and they get cognito filters called lymph nodes.

>> OK, all right.

We did get somebody who texted us a question just it was from a gentleman named Mike and he was just asking about how to maintain a healthy prostate the things that that you can do to to maintain a healthy prostate I don't know I don't know diet.

>> Exercise is it yeah.

I mean I'm not really familiar with that.

>> Um but what I would say is living a healthy lifestyle is a good idea.

Um I always encourage my patients to use the opportunity um uh of their diagnosis of prostate cancer to maybe make some changes to their behaviors.

So if there are smokers consider quitting smoking because that's clearly um a risk factor for a lot of different cancers.

Um, eating a well-balanced diet uh you know, high fiber diet, uh, preferably organic if you can.

These are all things that and exercise obviously moderate exercise.

Um, those are all good habits to develop and it's it's amazing we've met and had so many professionals come on this program over the years say oh you know I know I sound like a broken record you know eat eat well sleep get sleep exercise.

But I'll say that's what works.

You know, there's no magic pill .

You know we see all these ads, you know, for you know, weight loss pills and fads and things like that and it's amazing they will say the difference even it's like mentally that it makes that a person when they've lost weight they just feel so much better and have a much more positive outlook which a lot of the doctors we've had on our program over the years have said that helps that makes a big difference.

>> Yeah, that's a great point.

Sleeping's also very important.

Yeah, these are all like simple things to do but they're also very hard to do.

>> I couldn't say that there are many patients that I have that actually, you know, sleep well, eat well, exercise um you know do all those things.

>> It's hard it's hard with our culture and the cell phone was always ringing, you know, and always getting a text message or an email so it makes it challenging.

We did get another person who Tom called in and wanted me to ask the question for him.

So he wanted to he was about testing for prostate cancer, which I think you've already covered but maybe you want to reiterate it and then is it still when you have to have I guess an exam does it involve having a exam which a lot of people really don't want?

>> Yeah, no, that's understandable.

You know, PSA screening is just a simple blood test and they can add that to your regular labs that you're having drawn at your health care providers office.

Usually if your PSA is elevated though they'll then refer you to urologist and they'll then order an MRI scan of your prostate to assess whether or not or any abnormalities that they want to direct a biopsy to because that's really the way to diagnose prostate cancer.

The PSA just gives us sort of an indication that maybe you have a problem with the prostate.

It doesn't necessarily mean you have prostate cancer.

It's the biopsy that actually confirms it.

So they take a little sample with a small needle, look at it under the microscope and if it looks like cancer then they call it so if it's very aggressive looking under the microscope or your PSA is very high, they might order an additional test called a PSA my PET scan and that scan looks all across your body for prostate cancer and you you know, I'm glad you mentioned that about the the low the high PSA because we did have somebody call it Rosano one of our regulars he was asking if low or normal PSA levels mean you're going to develop cancer and he was asking what is considered a high level of PSA.

>> Yeah, that's a good question.

So PSA is not a perfect test.

None of the tests that we have are perfect.

So um you know, your PSA can be normal, can be low and you could still have a prostate cancer.

So playing the odds though an elevated PSA is more likely to be a prostate cancer but doesn't necessarily mean you have prostate cancer and that's where it's important to then meet with the urologist who can then sit down with you ,evaluate your numbers and then potentially order further tests like an MRI scan.

>> All right.

Thank you so much to everybody who called and texted in.

We could still quickly answer another question if if you want to contact us so the phone numbers are at the bottom of the screen if you'd like to do that.

>> I wanted to make sure that we showed one more of your slides.

So I think it was the last one no for you were calling it the bonus slide and so I wanted to make sure we showed the bonus slide tonight and if you can kind of explain what we're looking at in this.

>> Yeah.

So there have been a number of advancements in radiation oncology over the last decade.

This is just one of them.

It's what we call radio like in therapy.

So we talked briefly about the PSA PET scan.

We use that because there are proteins called PSM that are highly expressed on prostate cancer cells and we take advantage of that by having a tracer link to the PSA may that lights up on our scan and so they took that concept and then linked linked it to a radioactive source.

So essentially we have targeted radiation therapy that's injected into the bloodstream and is taken up by prostate cancer cells and we proved in a clinical trial that we actually enrolled patients too that we can improve survival and also improve quality of life in patients with unfortunately stage four prostate cancer.

>> Yeah, we only have less in a minute now but if you're feeling pain or and I mean that could be a real emergency at that point that's nothing to fool around with at that point I would say definitely if you have pain that's worsening, not getting better it's constant those could be signs that you have advanced prostate cancer but more than likely it's going to be musculoskeletal issue.

>> OK, all right.

Never but better be safe than sorry.

Yes.

Yeah, you should definitely get checked out.

>> Well thank you so much.

It's hard to believe the show is already done.

I told you it goes fast so that really does.

>> Dr Brian Chang appreciate you coming on this evening.

Thank you and many thanks to all of you for participating by asking questions.

We love that you have a good rest of the night and we'll have another helpline right here next Tuesday.

>> Take care.

Bye bye