You've Been Diagnosed with Prostate Cancer - Now What?

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Topics include: Understanding and Living Well

Close to 200,000 men will be diagnosed with prostate cancer this year. Although prostate cancer is very treatable if caught early, the numerous treatment options can be overwhelming for patients and their families. On this Patient Power program, Gwen Sokoloff, the nurse coordinator at the Multidisciplinary Prostate Cancer Clinic at Oregon Health & Science University, joins host Andrew Schorr to discuss the latest treatment options. Nurse Sokoloff stresses the importance of patients taking part in their care understanding the different elements of each treatment regime in order to come up with the plan that is best for them.

During the program several treatment options are discussed including: surgical approaches to prostatectomy, both nerve-sparing and those performed robotically; radiation, which encompasses external radiation, targeted radiation with the new GPS for the Body ® approach and implanted radiation seeds; drug and hormone therapy; cryotherapy; and watchful waiting. The advantage of the Multidisciplinary Prostate Clinic at Oregon Health & Science University is that patients see a urologist who specializes only in prostate cancer, a radiation oncologist and a medical oncologist. All of these experts work together to make a comprehensive recommendation for treatment. However, the ultimate decision goes to the patient.

Listen as Nurse Sokoloff explains the sequence of events that takes place when a patient contacts them and the patients the clinic is most apt to treat. Also during the program, Andrew and Nurse Sokoloff highlight the advantages of being at a research institution when seeking treatment, particularly for a condition like prostate cancer, where tremendous progress is being made in the field. This Patient Power program offers prostate cancer patients and their families a valuable resource to sort through the various treatment options and find care that is best for them.

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Produced in association with Oregon Health & Science University

Transcript

Andrew Schorr:

Hello and welcome to our Ask the Experts program. I am Andrew Schorr from Patient Power, and we are delighted to do these programs with Oregon Health and Science University, which of course is a leading research institution, but it also has wonderful clinicians who can help you with really whatever your health concern is.

When you think about it for men, and I’m a middle-aged guy and maybe a little more than that in my late 50s, we are aware and kind of scared of the diagnosis of prostate cancer. That happens to close to about 200,000 men I think every year. Now prostate cancer is typically a slow growing cancer, and has a lot of healthcare professionals like to say most men if we live to be a ripe old age will die with prostate cancer and not from it, but obviously there are some men where it requires intervention and earlier intervention. There are men in their 40s or 50s who are diagnosed with it. Maybe it has spread out of the prostate and there’s more to do; maybe drug therapy, hormonal therapy, certainly surgery and which kind, radiation and which kind. We are going to talk about that, and also let’s face it, for us men it’s often our partner, typically a female partner, that is more attuned to health issues than we are. Now you may be the guy who is more attuned to it, but generally we don’t think it, like to think about it that much, and when we have a problem we would often like to ignore it, but when it comes to prostate cancer at some point you can’t ignore it. If your PSA is rising or high what do you do?

So, OHSU has really a wonderful place to go, a multidisciplinary specialty clinic concerned with prostate cancer, and it’s been open since January 2008, and that’s where everything can come together, all your options. So today our guest on our Ask the Experts program is Gwen Sokoloff. She’s a nurse. She’s the nurse coordinator at that multidisciplinary prostate cancer clinic. Gwen thanks for being with us on our program.

Ms. Sokoloff:

Thank you for having me.

Andrew Schorr:

So, you see it all the time. A man comes maybe by himself, maybe with a partner or family, and they’ve gotten this diagnosis of prostate cancer, and they are probably a little scared or a little more than scared trying to understand their options because certainly if you ask around or go on the Internet it’s daunting, and you are trying to figure out what’s your personal situation and then what are their options. So, tell us what your job is in helping men begin to get information, know what they’re dealing with, and understand what the options are.

Ms. Sokoloff:

When you get diagnosed with prostate cancer the first call they would make would be to me, and I just go through some basic health issues of what the PSA was, the biopsy scores, and past medical/surgical history, and then talk to them about how they are feeling, and then we get them scheduled into our clinic, and depending on what their biopsy shows that would determine how many physicians that they would see.

Andrew Schorr:

Now, of course let’s talk about the medical specialties that come into play, certainly urology.

Ms. Sokoloff:

We have a urologist who specializes only in prostate cancer. We have a radiation oncologist, and then we have a medical oncologist also available.

Andrew Schorr:

Right, and I will mention that we have done an earlier program with Dr. Beer who is leading specialist in medical oncology and prostate cancer, and OHSU has many clinical trials underway, some breakthrough clinical trials for men with more, typically but not always, but with more advanced prostate cancer, but there are trials going on throughout the spectrum of prostate cancer.

So someone might see a urologist let’s say and a radiation oncologist, but the point is that this can be done at one place and usually in the same day, right?

Ms. Sokoloff:

Correct. They would have either two or three one-hour appointments with each physician and then at the end would have a wrap-up of about 15 minutes with whatever, if they’ve chosen a treatment plan at that time that would be with whatever physician. If they chose surgery it would be with a urologist. If they chose radiation it would be with a radiation oncologist to start getting their treatment set up.

Andrew Schorr:

Right, and you said “if they chose” so really it’s very much a dialogue. There is no doctor coming in and saying, “Do this.” There is a recommendation made and that’s from the brainpower of OHSU specialists coming together and then in consultation with what the patient feels they are comfortable with.

Ms. Sokoloff:

Right, it’s a team approach, so we all kind of agree on a recommendation, and then we also take into account the patient’s idea of what they would like as treatment. Sometimes patients come in with one idea and walk out with another.

Andrew Schorr:

Right, I’m sure you see that. Well information, knowledge, we like to say is power, and so people can get knowledge from OHSU, which of course is a preeminent institution in Oregon. So that must make it very convenient that it can all happen in one place and really deal had on what at that moment in is the major issue in a man’s life.

Ms. Sokoloff:

Yes. They feel that one, it’s a complete comprehensive recommendation, but it’s also extremely overwhelming for them so sometimes they do go home and think about it and then call me with questions about what the doctors have recommended.

Andrew Schorr:

Let’s talk about the overwhelming part for a second. Is there a social worker who can come into play or support groups because obviously there are men and families who have dealt with this before, that man who was sitting in your chair then, to help them kind of really begin to understand it from the patient’s perspective and deal with the emotional issues for them or their partner?

Ms. Sokoloff:

Yes, we do have social work available but not always in the clinic, so it would be a separate phone call that they can make, and also with our social workers they do have a few patients that have gone through this already, and we try to pair them up with the same age and the same kind of diagnosis as far as the severity of it and really get them connected as a mentor program.

Andrew Schorr:

And there is a support group as well?

Ms. Sokoloff:

There is a support group that meets monthly.

Andrew Schorr:

So there is emotional support and resources at OHSU. There is a one-stop-shop, if you will, for consultation with a urologist who could end up being a primary doctor for a radiation oncologist, as needed medical oncology comes into play, and then the clinical trials. Being a research institution those can be considered as options as well.

Ms. Sokoloff:

That’s correct. Some patients come in thinking they needed surgery and ended up on a clinical trial, which was kind of exciting.

Andrew Schorr:

Right, certainly. Well, I was in a clinical trial for leukemia treatment, and I am glad, and the treatment that I had a number of years ago is what most people around the world have now, so I have lived it myself. That was a single-center phase-II trial, and then trials go on to phase-III and start out at phase-I. We have other programs where we discuss clinical trials in depth. Certainly there are trials, some trials like Dr. Beer has or maybe the other physicians that are starting at OHSU. That may be the only site, or it could be one of many major sites around the country.

Let’s talk a little bit about when somebody comes to your clinic. That is, I know you can come for a second opinion. Some men get a third opinion and you welcome that, but there is no reason you couldn’t start out OHSU too, right?

Ms. Sokoloff:

That is correct. We have a lot of referrals from our urologists and are radiation oncologists, and even though they have made phone calls to urology or radiation oncology they get back-filtered through me, and I put them back through the whole system and really talk to them about what we offer as a multidisciplinary clinic versus what they’ve already gone through being just in urology or radiation oncology.

Andrew Schorr:

So if a man gets a diagnosis and listens to our program may be way across the state in Pendleton or someplace, they can with an awareness that prostate cancer is suspected they could call you up and say, ‘I haven’t really had an in-depth appointment with a urologist here, but my doctor tells me prostate cancer is suspected, and I just want to come see you all for a consultation.’ You all welcome that, right?

Ms. Sokoloff:

Oh, absolutely. The only thing we ask is that they sign a release with their primary physician, and we can then get the records.

Andrew Schorr:

That’s pretty straightforward. Now let’s talk about testing. When someone comes for this visit where really for several hours they are meeting with different specialists one by one and then a wrap-up visit as you described, what tests typically do they need performed so that the information is sort of available and ready to go?

Ms. Sokoloff:

What they ask is that they either have a PSA or a trend of PSAs, their biopsy results, sometimes if they have had bone scans or CAT scans we ask that they have those available to us prior to the consultation, and when they get here all the records are here, the doctors would have already reviewed them, so they go right into the consultation with whatever physician is the first one up, and most likely at the visit they have the consultation, and then they would get an exam done, and the exam would just be feeling the prostate.

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