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Prostate Cancer Prognostic Factors

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Published on October 29, 2015

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Transcript | Prostate Cancer Prognostic Factors

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:    

We know that there [are] a lot of treatment modes that we can engage in right now.  We know that there [are] a lot of treatment modes that are on the horizon.  Genetics and prognostic factors.  These are the words that are giving us that peek into customizing the care.

How does all of that work? I’m gonna start with you, Dr. Kim.  How do we start developing a customized care plan?

Dr. Kim:                 

So we are working, the clinic, and we are looking into profiling or genetically profiling tumor cells, or tumors from patients.  And by doing so, we can look at different alterations in the genes and mutations and so forth.

So we can actually target the specifically—the mutated genes or altered genes in the tumor genes so that we can individualize or personalize cancer care in our patients.  And so for prostate cancer, we are doing that more and more, and also institution-wide, we have gene profiling that we can order on different patients.

So that can also help in deciding specifically what therapy to choose for our patients.

Jeff Folloder:     

Would you like to build on that?

Dr. Subudhi:       

I just want to say that this is all experimental at this point, and so some of my patients may be asking, “How come he hasn’t done that for me yet?” And you should be asking that.  And the truth is that I try to choose carefully when to do it, and I don’t tend to do it in the very beginning of when I see a patient.

I tend to do it more in the middle once I get a better understanding of their prostate cancer.  A lot of these prognostic factors that people are talking about or that are in the literature—right now, the ones that we tend to use in clinic are, for example, my African-American patients.  No matter what, I tell them that even though things my look fine, I’m always more worried about them because they seem to have more aggressive prostate cancer than what meets the eyes.

And we just have to be more aggressive.  And so that’s, for example, one prognostic factor I may us.  Others are Gleason scores.  A lot of people are held—or think about PSA as the only thing to think about.  But the truth is, the more treatments you get for prostate cancer, the PSA becomes less reliable of a prognostic factor or a predictive factor, and you have to use other markers. 

And so the three markers I use in clinic are my patient/their caregivers telling me that, hey, he’s feeling better on this therapy, or, hey, he feels worse.  Or his pain has gotten worse.  Second is blood markers, including PSA.  But there [are] other ones that we use in prostate cancer.  You can use circulating tumor cells, prosthetic acid phosphatase, alkaline phosphatase, even measuring someone’s hemoglobin, which is a sign of anemia, that can also tell you how things are going.

And third is the radiographic scans.  CAT scans and bone scans can help us.  And to me, I tend to tell my patients that if two of three of the signals are pointing one way, then that’s—I tend to tailor my treatments for that.  And but the most important one is what the patient and the caregiver say.          

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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