Video: Prostate Expert, Przemyslaw Twardowski, MD, Discusses Hormone Therapy | 2019 PCRI Conference

2019 PCRI Conference Interviews | Transcription

So I'm Przemyslaw Twardowski and I'm a medical oncologist specializing in urinary tract malignancies including prostate, bladder, kidney cancer and testes cancer, and I work at John Wayne Cancer Institute which is part of St. John's Providence system in Santa Monica, California. So that's where I practice. 

So, I was talking about the specific subset of patients with prostate cancer who have evidence of early relapsing disease after surgery or radiation therapy based on just the blood test elevation. So, the subject was how to identify/stratify these patients into various risk groups and how to manage them. What's the therapy? What are the therapy options?

What do you think about the new 2nd generation hormone therapies? 

They are definitely transforming the field. It seems like the data suggests that the earlier in the setting of the disease you use them, the more benefit you get. The question is, how early are you gonna see it? It started, initially, in very advanced disease after chemotherapy, you know, failure of hormone therapy. Now we're moving it into pre-chemotherapy and in combination with early hormone therapy treatments. So, and there's actually several agents now, so today that's one of the hot areas in prostate cancer. It's very intriguing how, even though the whole concept of hormone therapy is so old (it actually goes back to the 30s and 40s of 20th century) we're still finding a way to refine it with these better drugs that still address the same pathway of growth of this disease.

Do you find that patients are usually aware of these newer therapies? 

Yeah, it's quite variable, you know, where I practice patients tend to be very well-educated, but not always, you know, there are some patients that don't know about these new drugs so it's really you have to gauge it initially when you meet the patient and, you know, sometimes the patients know the literature so well and quote me the articles that I barely know about, and then on the other side of the spectrum patients are just kind of more relying on physician's recommendations. So it's, but I would say that in a majority of cases, they do know, yeah.

What are the first steps for someone diagnosed with a rising PSA after treatment? 

Well, I think I did mention that first of all, maybe it's as easy as it is for me to say, "Don't panic." I mean, I quoted some numbers indicating that it's not any imminently life-threatening circumstance and usually you have a lot of time to think about it, so that's, I think, one of the important points. Don't rush into any decisions. That situation, typically, is not associated with any threat for years to come, so you certainly don't have to make any decision in a month or two. You can' take your time, gather opinions from various subspecialties, you know, pick a doctor that you trust, get a second or maybe even a third opinion. I think that's probably, honestly, the point that I wanted to get across because obviously, it creates a lot of anxiety. It may indicate that the disease hasn't been cured, but it's a relatively unique subset that is definitely well-managed by some, what I call, tincture of time. Sometimes it's good to just watch it for a while and see what's the pattern of PSA, how quickly it's going up and make a decision after these few months of follow up.