IBX: The Cover Story – No-Shave November

Peter Panageas:

If you’re looking for timely, relevant conversations about the most important topics in health coverage, you’ve come to the right pod. This is IBX: The Cover Story from Independence Blue Cross hosted by me, Peter Panageas. So by day, I oversee all of our national commercial business here at IBX. I’m also a caregiver and a patient. We always say that healthcare is personal, and it is. So my guests and I are exploring how the big picture and the big issues affect our everyday lives and the wellbeing of those we all care about together. We’ve got this covered, so let’s get started.

Peter Panageas:

Hello everyone. This is Peter Panageas. Welcome to episode eight of IBX: The Cover Story. This month’s episode sheds light on a topic that is very, very personal and very important to me. Every November, two incredible organizations spread awareness and support of men’s health in a really creative way, by encouraging men to grow their facial hair.

Peter Panageas:

The Movember Foundation encourages men to grow a mustache and or beard, and have other support them by donating money towards projects for mental health, prostate and testicular cancers. No-Shave November asks men to donate the money they would typically spend on shaving and grooming to educate others about cancer prevention, to helping save lives and aid those fighting the battle. And I’ll tell you, it works. I actually grew a beard this year in honor of my father, who unfortunately passed away in July from prostate cancer. For those of you who know me, I don’t sport a beard, never really have. But as I was growing out, everyone was asking me about it. And everyone got the story about prevention and the reasons why it is so important to get tested. As I’ve mentioned in previous podcasts, I was diagnosed with stage four Merkel cell carcinoma, a rare form of skin cancer, after a preventive visit with my family doctor.

Peter Panageas:

Prevention’s so important. And as men, we’re not necessarily on top of much as we should be. My father was a great example of that. A hard working man, an immigrant from Greece. Did all the right things, worked hard, did everything the right way. Believed in doctors, admired doctors and physicians. Wasn’t necessarily scared of them. But truthfully, he didn’t do the prevention. I remember when my father returned from Florida, he was down in Florida with my mom visiting my sister. And I remember picking him at the airport and I saw him and he had lost so much weight and he was limping and he was a little bit of pain. When I got him home, I looked at his legs and they were swollen and I knew something was wrong. And so we brought him to the hospital and on my way there, I’m asking him all sorts of questions as any son or daughter would do with their parent, asking him about, “Hey, when’s the last time he went to the doctor? Have you gotten your blood work done?”

Peter Panageas:

And he yessed me to death until we got to the hospital and then the truth came out. And I’ll never forget it, when the doctor was asking, “When’s the last time you went to see your primary? When’s the last time you got your blood work.” And it had been a long time. And unfortunately, as a result of him not being proactive while he lived the last six years with prostate cancer, there’s no question in my mind and in the mind of my sister, had my dad done the things that he probably should have done from a preventative perspective and got appropriate tests, my father would still be with us here today. So I share that story with everyone here today, because I think it’s so important as men. Whether you had Merkel cell cancer, whether you have, as I spoke about last month, breast cancer, testicular cancer or prostate cancer, I think it’s critically important as men that we got to take control and making sure that we do all the preventative things necessary in order to manage this. Prostate cancer is very preventable if you are ahead of it.

Peter Panageas:

And I think it’s so important and Dr. Gomella is going to talk to us in a few minutes about some of the things that we can do and should be doing as we’re going down that journey. So in honor of this important month and to help educate us about prostate cancer and prevention, joining me today is in internationally recognized urologist, Dr. Leonard Gomella from Jefferson Health. Dr. Gomella is the Bernard W. Godwin Professor of Prostate Cancer at the Sidney Kimmel Medical Center. He’s the chairman of Jefferson’s Department of Urology. He’s a Senior Director of Clinical Affairs for the Sidney Kimmel Cancer Center and enterprise EVP of urology at the Jefferson Health System. So Dr. Gomella, thank you so much for being with us today.

Dr. Leonard Gomella:

Great to be here, Peter. Thank you for the invitation.

Peter Panageas:

Maybe we just dive right into it and I’d love to get your insight. What increases a man’s risk for prostate cancer?

Dr. Leonard Gomella:

So Peter, the things we know that increases a man’s risk are age, it tends to occur in older men over the age of 60, African Americans. For some reason, we still don’t understand why are at increased risk of developing prostate cancer. And also, family history is important. If you’ve had a relative, such as your experience, with prostate cancer, that does increase your risk. But the other thing that we found the last four or five years is things such as breast cancer or ovarian cancer or pancreatic cancer in the family, can increase a man’s risk of having prostate cancer. Exactly what causes prostate cancer? We don’t know. But these certain related cancers can increase a man’s risk of developing cancer.

Peter Panageas:

As we talk about prevention and taking all the steps, as a man, to making sure that we do the things necessary, if I were to ask you how often should men see their primary care doctor for a prostate cancer screening, what would your counsel be?

Dr. Leonard Gomella:

That’s a very good question. And unfortunately, we do have some controversy about whether or not every man should be screened for prostate cancer. We have different organizations, the American Cancer Society, the American Urologic Association, the American College of Family Medicine all have slightly different recommendations. But a few things we should really stress, in general, the younger a man is the more likely he is to benefit from screening for prostate cancer.

Dr. Leonard Gomella:

So in general, if you don’t have a family history of prostate cancer, we recommend, for most organizations, doing screening between the ages of 50 and 70. However, if you have a family street or if you’re African American, most organizations suggest starting screening earlier, perhaps as earlier as 40 or 45 years of age. But again, the screening is controversial. And the key message in screening for prostate cancer is talk to your provider. Talk about the risk and benefits of screening for prostate cancer. Because while we do recognize that screening for prostate cancer can detect a cancer at early stages, there is also times when detecting cancer really does not have an impact on a man’s life. So it really needs to be an individual discussion with your provider about, “Should I be screened for prostate a cancer? What are my risk factors?” And how often does your primary care provider recommend your screening activity?

Peter Panageas:

Dr. Gomella, what would be some of the symptoms of prostate cancer men should be made aware of?

Dr. Leonard Gomella:

So one of our mantras that we have in the field is in the earliest and most treatable stages of prostate cancer, prostate cancer actually has no symptoms. The PSA blood test has allowed us, in many cases, to detect this cancer very early, before a man experiences any significant symptoms. Most men, as they get a little bit older, have some urinary difficulty and immediately assume, “Oh my goodness, I probably have prostate cancer.” More likely if you have urinary difficulty, it’s not related to prostate cancer, it’s related to simple enlargement of the prostate. However, the things we really worry about if a man has bone pain, weight loss, swelling in his legs, has, let’s say, a lot of blood in the urine, we then tend to worry that he might have a little bit more advanced cases of prostate cancer, certainly things we don’t want to see. And those symptoms may not all be related to prostate cancer. But again, in its earliest and most treatable stages, prostate cancer really does not have any specific symptoms.

Peter Panageas:

You talk about the swelling of lower extremities, bone pain, back pain, things of that nature. I will share, with my father, as I’d mentioned in our opening, a very proud man, old school, from Greece, loved physicians, respected them, but didn’t necessarily always see his physician on a routine basis. And I’ll never forget it when he came home from Florida, because he had been in Florida with my mom and visiting my sister for the winter. When he came home, I picked him up at the airport and he was limping and his back was hurting and his legs were hurting and his legs were really swollen. And we brought him to the emergency room and they ultimately diagnosed him with prostate cancer. And it was unfortunately very late in the game. It was really way before anything could have been corrected at that point or at least seen ahead of time.

Peter Panageas:

And so all the things that you just talked about, you spoke of, my father had, from swelling to pain. And just wish, in retrospect, that he had taken the steps earlier on, years ahead, from any type of screenings and or the PSA test and things of that nature, where we could have potentially caught it. And I share that with you, Dr. Gomella and also our audience here that prevention’s so important, right? And the symptoms are there. But unfortunately, I think once the symptoms are there, it’s pretty late in the game. Right?

Dr. Leonard Gomella:

I think that’s true, Peter. Again, if we find a patient with prostate cancer, we certainly like to find it early, before it spreads, because while we’ve had many advances in prostate cancer, once it’s gotten out of the prostate, we can’t cure it. We can control it, we can slow it down, but we actually can’t cure prostate cancer outside the prostate just yet.

Peter Panageas:

So if we were to talk about obviously prevention and making sure that we’re all looking out for, what would be some of the tests that are typically done to determine if a man has prostate cancer.

Dr. Leonard Gomella:

So one of the biggest breakthroughs was a blood test known as the PSA blood test, prostate specific antigen, that has been with us since the late 1980s. And this is a very, very important test. Now, with any test, it’s not perfect. Sometimes it misses some of the very aggressive cancers and sometimes it causes us to put men through biopsies when the number’s high, but it doesn’t always mean a man has prostate cancer. So if a PSA comes back elevated, one of the first things that we do is repeat it because sometimes it could be a laboratory error. Sometimes the PSA can be up because of inflammation or an infection. But once the PSA is elevated, normally we have a discussion with the patient about what does this mean?

Dr. Leonard Gomella:

A PSA that rises very slowly over very many years is often not associated with prostate cancer. It’s associated with a simple, benign swelling or enlargement of a prostate that happens to many men over the age of 50 to 60. But if there is a certain characteristic increase in the PSA or if extraordinarily high, your doctor may recommend a biopsy of the prostate. Because while the PSA is sort of like a smoke detector in your upstairs bedroom, it draws your attention to the prostate. It doesn’t diagnose prostate cancer. The only way today we have to diagnose prostate cancer is through a biopsy of the prostate and looking at the prostate tissue under a microscope.

Peter Panageas:

So Dr. Gomella, it’s interesting, you talked earlier about those who might be prone to it, should be made aware of it and things of that nature. And prevention’s so critically important. Six years ago, when my father was diagnosed, I shared that news with my primary care physician. And as part of now of my annual physical that I see him with that he actually prescribes a PSA blood test for me as well, just to monitor it because obviously it runs in my family with my father.

Peter Panageas:

And I share that with our audience here, that if you have a family member who has either prostate cancer or as Dr. Gomella said earlier, breast cancer that might run in a family, it’s something that you definitely take advantage of and making sure that you’re taking all the preventative measures that you should be taking. And the blood draw is a very simple procedure and a very simple test to get done as a measure to help determine whether or not you’re tracking towards prostate cancer or not. So Dr. Gomella, let me offer this, that as I watched my father go through his treatments and it’s amazing the advancements I think that have come the last 20 to 30 years in regards to treating prostate cancer, if a man’s diagnosed with prostate cancer, what would be the treatment options that are out there for someone?

Dr. Leonard Gomella:

So what we have to look at Peter is what stage is the cancer? Has the cancer localized only in the prostate or has it gotten out to other parts of the body? And that’s an important break point. So let’s talk about the ideal situation. We like to find to cancer early, when they’re contained in the prostate. How do we determine that? Well, we do special things like CAT scans and MRI and other things like bone scans to determine how far has the cancer are spread.

Dr. Leonard Gomella:

If the cancer is located only within the prostate, we then have certain options. The three main options are active surveillance, radical prostatectomy or radiation. The first one, active surveillance, is actually pretty new. We have been doing now for about 15 years or so. What is active surveillance? That’s men who don’t have aggressive cancer. There are many men who develop spots of cancer in their prostate that is never going to harm them in their lifetime. So one of the newer approaches is if you’ve got one of these non-life threatening prostate cancers, just watch it. You don’t necessarily have to treat it. So that’s called active surveillance. You check a man every year, every two years, to see if the cancer’s changing. And if it changes, you can go ahead and generally safely treat him. And it turns out today, Peter, surprisingly, probably over half the men that we’re finding prostate cancer today, we are recommending this active surveillance approach. Because many men, another term we have in our field, is die with prostate cancer, rather than of prostate cancer.

Dr. Leonard Gomella:

But if we determine that the cancer is a little bit more aggressive type, even though it’s still in the prostate, we may recommend surgery, known as radical prostatectomy, meaning that the whole prostate is taken out, or radiation therapy. And again, there’s many different types of radiation out there where you just focus the radiation on the prostate. When it comes to surgery today, in the United States, I would say that the robotic prostatectomy, removing the prostate using five or six small incisions in the lower abdomen, limits the man’s recovery and helps him get back up on his feet quicker. So when we talk about radical prostatectomy, all that means is the entire prostate is taken out. So those are for early cases of prostate cancer, active surveillance, surgery, or radiation.

Dr. Leonard Gomella:

Now, if we run into the unfortunate situation where the cancer has spread to other areas in the prostate, the general approach is to lower a man’s testosterone by giving him shots to basically turn off testosterone. Why is that important? Testosterone is a fertilizer for advanced prostate cancer. So that’s the first thing that we do, is lower a man’s testosterone level. And then today we tend to add other medications on top of it. We tend to do what’s called multi-modality therapy. We a whole variety of both chemotherapy and pills that men can take to help slow down the progression of prostate cancer.

Dr. Leonard Gomella:

And that gives you sort of a general overview. Certainly, every patient is an individual and each patient needs to be looked at as an individual. And in fact, at our center, we have what’s known as a multidisciplinary clinic where patients with newly diagnosed prostate cancer come in and they meet with all the specialists, with medical oncologists, radiation oncologists, surgical oncologists. We even have genetic counselors at our Sidney Kimmel Cancer Center, multidisciplinary clinic, where a patient can sort of do almost once stop shopping, see all the specialists at the same time and we give them our best recommendation.

Dr. Leonard Gomella:

And lastly, there’s always experimental therapies across the whole spectrum of prostate cancer. And when you go to a NCI designated cancer center, they will usually also offer you a variety of potentially experimental options. But again, each patient needs to be treated as an individual and with their desires and their stage of their cancer, all put into one comprehensive package.

Peter Panageas:

During my father’s journey, he was part of, if you will, the second round of treatment that you just walked through, lowering the testosterone and treated him with chemo and radiation. And he was very comfortable. It was a process. He lived a normal life. He was driving. He would get tired periodically, but it was a process that he was able to live with for a number of years. Again, had he caught it earlier, I think the outcome probably would’ve been a little bit different for him. And again, I’m urging all of our listeners just to make sure that we’re staying ahead of it. You’re doing all the things that you can to be preventive because there is such advancements that have been made in the treatment and managing of this cancer that not only could one beat it, but at least live a relatively normal life at that end stage.

Dr. Leonard Gomella:

And I think to your point, Peter, it’s important to understand we still really do not know what causes prostate cancer. So to your comment about prevention, we believe that what’s good for your heart is good for your prostate. We believe that a low fat diet, green leafy vegetables, exercise, don’t smoke, limit alcohol, all those sort of things are healthy for both your heart and for your prostate as well. But early detection and a conversation with your provider about should or should I not have a PSA test are probably our most powerful tools while we’re doing so much better with prostate cancer today than ever before.

Peter Panageas:

Very well said. So Dr. Gomella, as I do with all of our guests, if I were to ask you to share one last thing with our listeners today, what would it be?

Dr. Leonard Gomella:

We have had amazing improvements, as you mentioned Peter, in the management of prostate cancer over the last 20 to 30 years. From the PSA test to detect it early from amazing improvements in radiation and surgery that have had dramatically improved outcomes. And in the last 11 years, we have brought forth almost 10 different medications to treat advanced prostate cancer. So tremendous progress is what I’d like to share with the listeners. We’ve done so much better with prostate cancer than I would’ve ever imagined when I was a resident, way back in the last century. So I think there’s a lot of positive news for prostate cancer and encourage everybody to keep their eyes open for the next big advance in this field. So thank you.

Peter Panageas:

Dr. Gomella, on behalf of all of us here at Independence, can’t thank you enough for taking the time out of your very busy schedule to share some insights on a very, very personal topic for me and obviously a big issue for us nationally. So thank you so, so much.

Dr. Leonard Gomella:

But Peter, thank you for sharing your family’s personal journey and your journey as well. I think it makes it much more tangible when you can really talk to someone who’s seen it from the family patient side of this disease, which again is the most common solid tumor in men. But again, something that we’re finding great hope with early diagnosis and advances in treatment. So thank you Peter, for this opportunity.

Peter Panageas:

You’re very welcome. Dr. Gomella, healthy, happy holiday season to you and your family.

Dr. Leonard Gomella:

And Peter, the same wishes to you and the audience who’s with us today. Thank you.

Peter Panageas:

And listeners, thank you. I hope you’ve enjoyed our discussion. Be sure to check out the show notes at insights.ibx.com, that’s insights.ibx.com, for more information. Also, I hope you share this episode with family members and friends to increase awareness about prostate cancer and the importance of early detection. We’re going to take a break for the month of December and we’ll be back in the new year with more episodes. I want to personally wish you and your families a healthy and happy holiday season. And thank you so much for joining us.