Prostate Cancer and Genomic Testing

April 05, 2021

Information

April 4, 2021

Yale Cancer Center

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00:00Support for Yale Cancer Answers
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00:14Welcome to Yale Cancer
00:15Answers with your host
00:17Doctor Anees Chagpar. Yale Cancer
00:19Answers features the latest
00:20information on cancer care by
00:22welcoming oncologists and specialists
00:24who are on the forefront of the
00:26battle to fight cancer. This week,
00:28it's a conversation about prostate
00:30cancer with Doctor Michael Leapman.
00:32Doctor Leapman is assistant professor of
00:34urology at the Yale School of Medicine,
00:36where Doctor Chagpar is a
00:38professor of surgical oncology.
00:41Michael, maybe we can start off by
00:43laying the groundwork and giving us
00:46a bit of a landscape of prostate cancer.
00:49How common is it? How lethal is it?
00:51Who gets it? Why should we care
00:54about this disease?
00:55Prostate cancer is something
00:57that I think is always on our minds.
01:00We hear a lot about it on the news.
01:03It is the most commonly diagnosed non
01:05skin cancer in men and over 230,000
01:07American men are expected to be
01:09diagnosed with prostate cancer next year.
01:12And it's also the second leading
01:14cause of cancer death in men,
01:16and so that imbalance between how common
01:18it is and the risk of death from prostate
01:21cancer is really quite interesting,
01:23because the majority of men who are
01:25diagnosed with prostate cancer will
01:27not have a very aggressive cancer.
01:29But then again,
01:30there is a lot of aggressive prostate
01:32cancer that requires treatment,
01:34and so figuring out that balance,
01:36figuring out where one lives
01:38on that spectrum is really
01:40important.
01:42How does that happen? Is it a matter of
01:47seeing how aggressive the cancer
01:50cells look by their grade on a biopsy?
01:53Or are there other factors that kind
01:56of play into figuring out how
02:00aggressive this cancer is?
02:02A lot of factors really come
02:06together to help make that distinction
02:08about the risk level that someone has.
02:12Historically, we really had a very
02:14monolithic approach where if someone had
02:16cancer there was treatment right away.
02:18There was very little disconnection there.
02:20It was just kind of a one way path from a
02:24diagnosis of prostate cancer to treatment.
02:27And that really continued for decades
02:29and decades until the understanding came
02:31that many of the prostate cancers did
02:34extremely well and probably did extremely,
02:36extremely well without treatment.
02:37And there was growing data and really
02:40strong information that these are very,
02:42very common in men in their 80s.
02:45They may be as prevalent as 60%
02:48of people might have a low grade,
02:50non aggressive prostate cancer.
02:52So this story began to be written over
02:5530 years ago where there was increasing
02:57awareness of
02:58the spectrum of aggressiveness in
03:01prostate cancer and so the main criteria
03:03that we use to estimate a given man's
03:06risk of prostate cancer and the risk of
03:09cancer will behave aggressively relate
03:11to what it does look like on under a biopsy,
03:15and there is a scale used called
03:17the Gleason scale,
03:18which is a pathologist,
03:20will take a look at the biopsy under
03:23microscope
03:24and look at how normal or abnormal
03:26the cancer cells look.
03:28Look at the architectural pattern
03:29of the glands and assign a level.
03:32And that level is highly related
03:33to the outcome of the cancer.
03:35So that's a very good
03:37way of beginning to estimate
03:40the trajectory of prostate cancer.
03:42Some of the other tools we use,
03:44are PSA levels. PSA is a common blood
03:47test that is ordered and it's a
03:50protein that is made by the prostate.
03:53And it can be found in the blood.
03:55Now,
03:55having a PSA level doesn't mean
03:57that you have prostate cancer,
03:59but there is a relationship between
04:01how high that PSA level is and the
04:03risk that a man can have prostate cancer.
04:06So that level of PSA is also prognostic,
04:08meaning it can help us estimate how likely
04:11the cancer is to be aggressive or not.
04:14And the last classic thing that
04:16we do is is a rectal examination of
04:19physical examination where we feel the
04:21prostate and see if we can feel a lump
04:23or a bump which is also kind of an
04:26indicator of how big a tumor might be,
04:29or if there's something that has
04:31reached a significant level.
04:32So those are historically how we
04:34estimate aggressiveness and
04:35the appropriateness of treatment,
04:37or what treatment should be
04:38undertaken. So before we kind of
04:40dig into a little bit more on that
04:43just to take one step back when
04:45people often hear about PSA
04:47and digital rectal exams,
04:49they often think about screening more
04:51than they do about prognostication.
04:53And yet there have been some changes
04:56I understand to what people are
04:58recommending in terms of screening.
05:01So can you take us back and tell
05:03us a little bit about who should
05:06get screened when and with what?
05:09Should all men get screened if
05:12prostate cancer is really prevalent,
05:14should this be a foregone conclusion,
05:16or is there a benefit to screening?
05:20And if so, in what populations?
05:22I'm so happy you asked that because
05:25that really I think begins to speak
05:27to the heart of the controversy and
05:29what I see in my daily practices.
05:31There is so much
05:34ongoing communication about that and
05:36different perceptions about screening.
05:38And so the story does go back even further,
05:42again, probably several decades
05:43ago when that PSA blood test was
05:46discovered in the late 1980s,
05:48and they found that if you check PSA
05:53you will find some people
05:55who have abnormal PSA levels,
05:57and we typically do a biopsy next and we're
06:00identifying prostate cancer so historically,
06:02back in the late 80s and early
06:0490s and into the early 2000s,
06:07there was a lot of PSA testing.
06:09It was routinely used in pretty much all men,
06:12adult men,
06:13and a lot of prostate cancers
06:16were being found as a result.
06:18And so you know,
06:20it became clear that
06:22since a lot of prostate
06:24cancer is being detected,
06:25that more rigorous evidence was
06:27needed to be undertaken so very
06:29large national and International
06:31Studies were done to look at the
06:34benefits of PSA testing to determine
06:36and really quantify how beneficial it
06:38is to have a PSA checked and find a
06:41cancer that could be in the prostate
06:43which was previously undetected,
06:45because they generally don't
06:47cause symptoms and so
06:49when we talk about screening,
06:50we mean taking people who have no
06:52symptoms who are otherwise, well., NOTE Confidence: 0.90424776
06:53they have no evidence of prostate cancer,
06:55but trying to find something
06:57early before it is manifest before
07:00it comes to the surface.
07:01And a few studies have been done,
07:04and one landmark study was performed in
07:07the United States which really didn't
07:09find a big survival benefit to screening.
07:12And so as a result in 2012,
07:15the US Preventive Service Task Force,
07:17which is a guideline issuing
07:19body in the United States,
07:21said that because of that absence of benefit
07:25and the great potential for harm by
07:28treating that no men should undergo
07:30PSA testing under any circumstance.
07:32It was kind of a blanket recommendation.
07:36And this was really kind of a
07:38controversial statement for people,
07:40especially in the prostate cancer field,
07:42because it was clear that in the
07:4420 years where prostate cancer
07:46screening was occurring,
07:47there was a substantial reduction in
07:50the risk of death from prostate cancer.
07:53And so right after that guideline came to be,
07:56there was another study
07:57that finally came to fruition,
08:01which had been conducted for over 10 years,
08:03but the results weren't available,
08:05which was performed in Europe,
08:06which did find a large benefit to
08:09screening with PSA in terms of reducing
08:12the risk of prostate cancer death.
08:14So here you have these two conflicting
08:17randomized trials which create
08:18a lot of uncertainty at which
08:20that uncertainty still exists,
08:22and there's still a lot of
08:24controversy about which one is
08:26right and which one is flawed.
08:28There are some
08:29substantial flaws with the
08:32study performed in the United
08:34States because
08:35many of the patients who were in
08:36the trial were actually already
08:38screened for prostate cancer,
08:39so it was a bit hard to
08:43distinguish those who had been
08:45screened already versus those
08:46who were not being screened.
08:47So it was almost as if everyone
08:50was really getting the same thing.
08:51So the controlled element of the
08:54trial was hard to appreciate.
08:57So that's kind of a long winded
08:59way of saying that it's still
09:01a very controversial question,
09:03but the evidence has really continued
09:05to accumulate as these studies have
09:08been followed for more and more years,
09:10and it really does appear to
09:12be as a substantial risk reduction
09:15in death from prostate cancer by
09:18having a PSA checked and finding
09:20early stage cancers and
09:22so do you recommend that for all men
09:24or men over a certain age or men with a
09:29certain demographic characteristic?
09:30I mean, perhaps the difference
09:32between the two studies and
09:34I'm just surmising here,
09:36maybe that there were different
09:38characteristics of the people participating,
09:40such that some men may
09:43really benefit from early detection
09:45and other men, not so much.
09:48I think you're absolutely right.
09:50And so we really kind of
09:53have to be anchored in what the
09:57studies have shown and the studies
10:00in both Europe and the United States,
10:03really focus on men in their 50s and 60s,
10:06and so the best evidence would suggest
10:08that men who are above the age of
10:1175 really don't benefit very much
10:13from having a routine PSA checked.
10:15Now it's a different story if people are
10:18having urinary symptoms or have a reason
10:20to suspect that they have prostate cancer.
10:22But when we talk about screening,
10:24we're saying being asymptomatic,
10:26having no problems,
10:27but getting a PSA checked and going
10:29looking for potential prostate cancer.
10:31So the US Preventive Services Task Force
10:34which issues these these guidelines in
10:372018 revised their recommendation to
10:40suggest that prostate cancer screening
10:42with PSA can be considered kind of
10:45in a shared decision-making fashion,
10:47which means that a patient and their
10:50physician should have a conversation
10:52about the potential harms and benefits,
10:55and find a way to balance the potential
10:58harms of undergoing a PSA test,
11:01which could include
11:02having a prostate biopsy,
11:04having invasive testing or finding a
11:06cancer which is non aggressive and
11:09might not have changed their life expectancy.
11:12And balancing that with the potential
11:14benefit of reducing their risk from
11:16prostate cancer death so it is really
11:19kind of not a one size fits all approach,
11:21but it really should occur for men
11:23who are in the age of 55 to 69,
11:26which is kind of the recommended group.
11:28Some demographics appear to be higher
11:30risk and we do recommend earlier
11:32screening beginning at
11:3445 and potentially even earlier for
11:36people who are falling into a high
11:38risk demographic based on a strong
11:40family history of prostate cancer,
11:42and that means having a
11:44first degree family relative
11:45with prostate cancer,
11:46such as a brother or father.
11:48Or having a known genetic alteration,
11:50such as a mutation in the BRCA2
11:53gene which is known to be associated
11:55with prostate cancer risk and other
11:57certain racial demographics such as
11:59African American men are at higher
12:01risk for prostate cancer detection
12:03and death from prostate cancer,
12:04and so they also fall into a higher
12:07risk category where screening may
12:09be appropriate earlier.
12:10But it's definitely not a one size
12:12fits all approach.
12:14I do think that the way to do it
12:17is to really have a thoughtful
12:19conversation to understand
12:20the whole picture here and
12:22why we would even consider prostate
12:24cancer screening what we could find,
12:26what the outcomes could be,
12:28what could happen
12:30and so doing that in the context
12:32of a relationship with a physician
12:34or health care provider who
12:36you trust is really important.
12:39And going back to our
12:43earlier conversation,
12:44even if you're screened and an
12:46early prostate cancer is detected,
12:48not all men will undergo treatment
12:51for their prostate cancer, right?
12:53So how do you decide who gets treatment?
12:56Who doesn't get treatment,
12:58and what that looks like?
13:00Yes, and I think that has
13:02really been the transformational shift that
13:05has happened in the past ten years or so.
13:08And you know the harms of PSA testing really
13:12relate to treating cancers that we find,
13:15and there are real
13:18risks of cancer treatment,
13:20including changes to urinary function,
13:24and GI and rectal toxicity.
13:26So the big change is
13:29the acknowledgement that it
13:31is appropriate to not treat
13:33initially patients who have cancer that
13:35appear to be non aggressive and that is a
13:38process that we call active surveillance,
13:41which is a period of close
13:43monitoring of prostate cancer
13:45rather than immediate treatment.
13:47And so what's so
13:49transformative about that is that
13:52it sort of allows us to have
13:53the benefits of early detection,
13:55which are finding
13:56potentially lethal cancers earlier,
13:58treating those ones and forgoing or
14:01deferring treatment altogether for
14:02those cancers that are non aggressive.
14:05So we're going to have to take a
14:08short break for medical minute,
14:10but when we come back,
14:12we're going to dig into who gets treated,
14:14how they get treated,
14:15and how we can really personalize
14:17treatment for prostate cancer.
14:19So please stay tuned with my
14:21guest Doctor Michael Leapman.
14:23Support for Yale Cancer Answers
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14:28eliminate cancer as a cause of death.
14:31Learn more at astrazeneca-us.com.
14:35This is a medical minute about breast cancer,
14:39the most common cancer in
14:41women. In Connecticut alone,
14:42approximately 3000 women will be
14:44diagnosed with breast cancer this year,
14:47but thanks to earlier detection,
14:49noninvasive treatments, and novel therapies,
14:51there are more options for patients to
14:54fight breast cancer than ever before.
14:56Women should schedule a baseline mammogram
14:59beginning at age 40 or earlier if they have
15:02risk factors associated with breast cancer.
15:05Digital breast tomosynthesis or
15:073D mammography is transforming
15:08breast screening by significantly
15:10reducing unnecessary procedures
15:12while picking up more cancers and
15:15eliminating some of the fear and anxiety
15:18many women experience.
15:19More information is available
15:21at yalecancercenter.org.
15:22You're listening to Connecticut Public Radio.
15:27Welcome
15:27back to Yale Cancer Answers.
15:29This is doctor Anees Chagpar and
15:31I'm joined tonight by my guest doctor
15:34Michael Leapman and we're talking about prostate
15:36cancer and right before the break,
15:39Michael you were talking about the
15:41fact that some men can have
15:44what's called active surveillance,
15:45just monitoring their prostate cancer,
15:47particularly if it's found early.
15:50Because there is toxicity to
15:53prostate cancer treatment.
15:55But other men really do require treatment,
15:57so let's dig into that group.
15:59How do you figure out who
16:02requires treatment and who doesn't?
16:04Yes, so that is one of the
16:06really important things
16:07that we do at the time of diagnosis.
16:10So if a man has had a prostate biopsy,
16:13we detect prostate cancer,
16:15the first thing that we really want
16:17to do is is trying to gather all the
16:20information possible to come up with that
16:23estimate of what we're dealing with.
16:26And so, in addition to the
16:29things that we discussed previously,
16:31the Gleason score of the PSA level,
16:33the physical exam,
16:34there are other tools that can help
16:36us predict what we're dealing with,
16:38what the outcome would be
16:39if we did treatment,
16:41or if we didn't do treatment,
16:43and two of those tools that we
16:45want to talk about,
16:47one is called a prostate MRI,
16:49which essentially is a high
16:51resolution MRI of the prostate.
16:53That often actually precedes the
16:55biopsy and helps us to a more
16:57accurate biopsy by finding areas
16:59within the prostate that could
17:01harbor prostate cancer and allowing
17:03us to more accurately target them
17:05so that we can identify cancer.
17:07If we don't find something,
17:11the absence of an aggressive
17:12cancer is also reassuring to us,
17:15so that is an important component
17:16that helps us identify potentially
17:18more aggressive prostate cancer
17:20that could be present.
17:21And again increasingly happens
17:23before the time of diagnosis.
17:25But we incorporate that information
17:27to help come up with a sort
17:29of an assessment of risk.
17:31The other are a host of validated
17:33genomic tests which measure expression
17:34levels of panels of genes that are
17:36associated with prostate cancer outcome,
17:38and so these are not the tests that tell you
17:42do you have a good gene or a bad gene.
17:44These are genes that we all have
17:47present in all cells and what what we
17:49do is we sort of look at the tumor
17:52tissue and we send it off to various
17:55companies that can perform these
17:56tests and essentially get a score back,
17:58which is an estimate of risk.
18:01An estimate of the likelihood of a
18:04prostate cancer spreading beyond the
18:06prostate or returning after treatment.
18:09Now these tests are not recommended
18:11for all men with prostate cancer.
18:13They are not an absolute requirement
18:15because if the cancer appears to be
18:17sufficiently aggressive based on
18:19their Gleason score or PSA level,
18:21there appears to be little utility
18:23in doing the testing.
18:24However,
18:24for people who might be on the fence,
18:27who maybe are considering active
18:29surveillance or treatment and want
18:31a bit more information about their
18:33estimated prognosis or how they might
18:35do in either of those categories,
18:36these tests appear to have some value.
18:39And so putting all those together with
18:42of course very important things like
18:44a patient's personal preferences,
18:46what they want,
18:48what their functional status is,
18:50what their age and their overall
18:52medical health is helps to create
18:54a more holistic picture of a man's
18:57prostate cancer profile.
18:58And what treatment options
19:00or what management options
19:02would be appropriate.
19:03And tell us with that score,
19:07does it give men a concept of
19:10their survival rate
19:11or you were saying that it might give
19:14you a clue as to the likelihood that
19:16it'll spread beyond the prostate,
19:18what are the tangible measures
19:20that men get with that information
19:22rather than simply a score,
19:24which can be kind of nebulous.
19:27The information that they provide there are
19:29a few different tests, and they kind
19:31of frame the information differently.
19:33But the two main measures that they
19:35provide are the risk of death from
19:38prostate cancer within 10 years.
19:40And the other one would be
19:41a risk of recurrence of prostate
19:43cancer or metastasis from prostate
19:46cancer within five years,
19:47and so those are the estimates and
19:49keep in mind that these are not
19:52firm predictions because treatments
19:54have changed very much and they
19:56continue to change.
19:58But these are still estimates
19:59and they really do appear
20:00to be valid at distinguishing more
20:02aggressive and less aggressive
20:04prostate cancer,
20:05and so knowing where those risk
20:07estimates live are important because
20:09I think they can help people make
20:12more informed decisions about #1
20:14the necessity of treatment and
20:16the intensity of treatment.
20:17So should I be treated altogether?
20:20Should my treatment include one
20:22form of treatment such as surgery
20:24alone or should I have surgery
20:26and radiation therapy or
20:28additional sequences of treatment?
20:30Based on the risk level and so
20:32that premise of can I use genomic
20:34testing to make that decision is
20:36still being fleshed out a little bit.
20:39And so the number that men get, is there
20:43kind of a toggle where it
20:46will say your risk of survival
20:48or distant recurrence or even
20:51local recurrence at 10 years is X,
20:53but if you choose surgery alone
20:55it will reduce it by this much.
20:58If you choose surgery and radiation
21:00it will reduce it by that much.
21:03If you choose systemic therapy,
21:04it'll reduce it by this much.
21:07Is there that kind of granularity in the
21:10data with a toggle switch that will help
21:13men's decision-making that's such
21:14a wonderful question that I think
21:16we're not there yet because
21:18of the novelty of these tools,
21:20and because of that, frankly,
21:21the novelty of doing active surveillance,
21:23we don't have that longitudinal data yet.
21:25I think that is really the Holy Grail
21:28where if we could say, if you
21:31do active surveillance,
21:32your risk is X, but if you do treatment
21:35it would turn down to Y.
21:40But say if you had surgery
21:42as opposed to radiation,
21:43your risk will be A, so that that is clearly,
21:46I think, where the field is moving.
21:48It is a bit challenging because
21:51treatment for prostate cancer is
21:52very much up to the patients.
21:54There are many other factors that
21:56lead to these things and so really
21:58to do that in a rigorous way,
22:00we would need to do a randomized
22:02trial where we say we're going to
22:04flip a coin and
22:06half the group is going
22:08to have surgery and half is going
22:10to have radiation and we're going
22:11to look at
22:13how the genomic test or the
22:15MRI predicted the outcome,
22:16so I don't think that's ever going to happen,
22:19where we're going to be able to modify
22:21treatment decisions based on that.
22:22But we're getting closer with
22:25other studies that
22:27are looking at genomics to help
22:29guide treatment,
22:30and stratify risk and predict
22:31response to various treatments.
22:33So I think that is very much
22:35where we should be going,
22:36but we're not there yet.
22:39So Michael, you have mentioned
22:41surgery and radiation a few times
22:43and not so much systemic therapy.
22:46But when we talk on this show
22:48as we do a lot about genomics,
22:51very often we're talking
22:53about as you said,
22:55genes that are turned on or turned
22:57off within a particular tumor.
23:00Oftentimes these are targets
23:01for various systemic therapies.
23:03Has that been looked at in prostate cancer?
23:08The cancer is interesting because
23:09I think in comparison to some of
23:12the other cancers, such as lung,
23:14that really do have these actionable
23:16driver mutations that there are drugs
23:18specifically targeting a certain mutation
23:20that has not really been the case
23:22in prostate cancer for many reasons.
23:24Number one, the main systemic
23:26therapies for people who have advanced
23:27or metastatic prostate cancer
23:29work by suppressing testosterone.
23:31Those are very effective treatments
23:33regardless of genomic profile,
23:35that is kind of the mainstay of treatment,
23:38and they almost universally have
23:40a good response.
23:42But there is increasing recognition that
23:45there are molecular and biomarker
23:49hallmarks such as homologous
23:50recombination gene mutations,
23:52microsatellite instability or
23:53DNA mismatch repair deficiencies that
23:55can lead to targeted treatments for
23:58men who do have metastatic prostate
24:00cancer or advanced prostate cancer,
24:02and so that,
24:02I think is one of the big changes
24:05that has occurred in recent years,
24:08is the recommendation that we do
24:10germline testing for patients with
24:12regional or metastatic prostate cancer
24:14to see if they have an actionable
24:17mutation that could be targeted.
24:19And so kind of getting back to
24:22one of the confusing parts of
24:25terminology that I think a lot of our
24:28listeners might get mixed up about,
24:31it goes back to something
24:34that you just pointed out.
24:36The difference between germline
24:38mutations and somatic mutations,
24:39so earlier for example you
24:42mentioned that men who had a
24:45BRCA genetic mutation may be at
24:47a higher risk of developing
24:50prostate cancer,
24:50but that is fundamentally different
24:52than this genomic testing
24:54that you're talking about.
24:55Can you flesh that out for our listeners?
24:58Absolutely,
24:58when we speak about these
25:01germline mutations we're talking about
25:03the DNA that were born with that
25:06that essentially has been inherited to us,
25:09which is in our germ line is present in all
25:12of ourselves and they may predispose to the
25:14risk of developing cancer and the BRCA2
25:17mutation is a very well acknowledged
25:20mutation that confers cancer risk.
25:24When we speak about the
25:25panel genomic testing,
25:26we're looking at relative expression levels,
25:29how turned up or turned down
25:31genes are within tumors,
25:32and these are not necessarily
25:34genes which have been inherited,
25:36or mutations within genes,
25:37but it's a measurement
25:39of how active they are,
25:41so this is not a good gene or a bad gene,
25:47we're wondering,
25:48how this was conferred,
25:50because genetics and prostate cancer
25:52risk is such a common question
25:53that we get because prostate
25:55cancer is very common and there's
25:57a thought that many
25:59patients have that they inherited a
26:01certain cancer predisposition from a
26:03family member and that may be the case.
26:05And there are certain
26:08well recognized genetic mutations
26:10that can be inherited in the germline,
26:13but we're looking at levels of
26:16cancer levels of gene expression
26:18associated with the cancer outcome.
26:21Yeah, and so you had mentioned that
26:24in addition to this genomic profile,
26:27that men will often make decisions based on
26:30other factors based on personal preference,
26:32but for a lot of men I can
26:35imagine that you know they come
26:39in and you say you've got prostate cancer.
26:42You know you can have active surveillance.
26:45You can have surgery.
26:46You can have surgery,
26:48plus radiation and the
26:52genomic testing how to interpret
26:54that number, your 10 year disease
26:57free survival risk is going to be 10%.
27:00What does that mean?
27:01Can you help us to understand how
27:04you discuss that with the patient and
27:07how they might factor in that information
27:10and what other characteristics or
27:12factors they may consider when trying to
27:14figure out how they should be treated?
27:17I can just imagine that they
27:19say look doc, I don't want cancer.
27:22I want to live as long and as
27:25well as I possibly can.
27:30These conversations are universally difficult.
27:31I think having a cancer diagnosis
27:33no matter what the grade,
27:35no matter what the stage,
27:37no matter what your doctor tells you,
27:39is inherently an anxiety provoking
27:41and stressful experience.
27:42There has been a lot of change,
27:45I think in the awareness of men of the
27:48fact that prostate cancer is very common,
27:51that the outcomes without
27:52treatment may be excellent,
27:54and so that has changed.
27:55A lot of men are
27:57expecting that diagnosis and have
27:59had friends or family members who
28:01have gone through the same thing.
28:03But still there is the kind of reflexive
28:05belief that any cancer risk should be
28:08reduced that you hear that word you
28:10want it out of your body.
28:12You want it treated,
28:13no matter what
28:15the consequences is,
28:16and I think that's very often the initial
28:19reaction is I don't care what it does.
28:21I want this gone.
28:22I want to treat it,
28:24and so that's where I
28:26think building a personal relationship is so
28:28important to give people time, space,
28:31support for dealing with that and
28:33understanding what the diagnosis is
28:35and really in the cool light of day
28:38integrating all of the information and really
28:40trying to zone in on what the risks are,
28:43what the benefits are.
28:44And it's really not a one
28:46size fits all approach.
28:48Active surveillance is
28:49not right for everybody,
28:50but nor is treatment right for everyone.
28:52And so I think that really doing that in the
28:56context of a truly shared decision between
28:59stakeholders on the patient side and on
29:01the physician side are so important.
29:03These tools are just tools and
29:06the hope is that
29:08they do provide more clarity,
29:10but I don't believe they're
29:12sort of magically the answer.
29:13And actually we are leading a study
29:15right now to help understand the
29:17personal experience and it's an interview
29:19based study where we were interviewing
29:22people going through the experience
29:25and we essentially want to open
29:27the door and hear from them and learn
29:29what is the experience of having a
29:31prostate cancer diagnosis and what is
29:33the experience of having genomic testing?
29:35Does it help? Does it hurt?
29:36Does it create uncertainty?
29:37Does it alleviate uncertainty?
29:39And I'm very excited to be involved
29:41in that study.
29:42Right now I actually just came off
29:43of a call where we're going through
29:45these interviews and we've been so
29:48fortunate to have men share this
29:49very personal part of their lives
29:51with us and give us really new
29:53and what I believe will be transformative
29:55information about what it's like
29:57to go through this.
29:58Because when these tests are
30:00studied in laboratories and by companies,
30:02there's such an excitement to bring
30:05new technologies which do provide
30:07very helpful scientific information,
30:09but we're trying to anchor it back
30:11to the patient level and see how
30:13is this going to help
30:15a given person. How is it
30:17going to help their family?
30:18And so that's really what
30:20we're interested in in the in the next step.
30:23Doctor Michael Leapman is
30:24assistant professor of urology
30:25at the Yale School of Medicine.
30:27If you have questions,
30:29the address is canceranswers@yale.edu
30:30and past editions of the program
30:32are available in audio and written
30:33form at yalecancercenter.org.
30:35We hope you'll join us next week
30:37to learn more about the fight against cancer.
30:40Here on Connecticut public radio.