Selected Podcast

Prostate Cancer Survivorship

The American Cancer Society estimates that one in six men will be diagnosed with prostate cancer in his lifetime.

Since prostate cancer is the most common cancer in American men after skin cancer and long-term survival is common, after diagnosis and treatment, survivors have continuing needs for follow-up care to manage treatment side effects. They may also need tests to see if the cancer has come back, and treat other health conditions.

Here to speak with us today about prostate cancer survivorship is Dr Shubham Gupta, he is a urologist with UK HealthCare.

Learn more about prostate cancer

Learn more about skin cancer
Prostate Cancer Survivorship
Featured Speaker:
Shubham Gupta, MD
Shubham Gupta, MD received his medical degree from All India Institute of Medical Sciences in New Delhi, India. He finished his urology residency at the University of Mississippi. Subsequently, he completed an advanced fellowship in reconstructive urology and genitourinary cancer survivorship at Duke University Medical Center in North Carolina. Additionally, Gupta has completed a postdoctoral research fellowship at the University of Pittsburgh Medical Center where he worked on animal models of prostate cancer progression and treatment.

Learn more about Shubham Gupta, MD

Melanie Cole (Host): An estimated 2.8 million men in the United States are living with prostate cancer or have had it at one time, and that number is growing. Prostate cancer is the most common cancer in American men after skin cancer and long-term survival is common. But even after diagnosis and treatment; survivors have continuing needs for follow up care to manage treatment side effects, tests to see if the cancer has come back and treat other health conditions. Here to speak with us today about prostate cancer survivorship is Dr. Shubham Gupta. He is a urologist with UK Healthcare. Welcome to the show Dr. Gupta. So, who is at risk for prostate cancer? Tell us a little bit about risks and screening.

Dr. Shubham Gupta, MD (Guest): Melanie, thanks for having me on the show. Prostate cancer like you said, is the second most common cancer in American men following skin cancers and pretty much everyone is at risk for it. As men age, the prevalence and rate for – and risk for having prostate cancer increases. About one in seven men will get diagnosed with prostate cancer throughout their lifetime. There are a few pointers that may predispose men to having prostate cancer; this includes race, African American men are more predisposed to having cancer and then family history. People with a strong family history of prostate cancer in first degree relatives are at a higher risk.

Melanie: So, then if they are somebody who is at a higher risk; what are the screening tools available to them Dr. Gupta?

Dr. Gupta: The screening tools that we have for prostate cancer comprise a simple blood test called PSA as well as physical exam including a rectal exam that can be done by a primary care physician or a urologist. This combination of a PSA and a digital rectal exam can be used to potentially identify patients who have a high risk of prostate cancer. And these screening modalities can be age and risk adjusted for instance, someone who is at a high risk, we offer this screening at an earlier age and more intensively than someone who is at a lower risk for prostate cancer.

Melanie: So, then let’s speak about if somebody goes through treatment and they have been diagnosed and a lot of men, Dr. Gupta, don’t even want to go see a urologist. They certainly don’t want the digital exam, maybe they are willing to get that PSA, but if they are diagnosed with prostate cancer and all of these tools available to them now through you physicians; what does survivorship look like? What is their life like, because there are also side effects that they are concerned about, erectile dysfunction, incontinence; so speak about survivorship, just a little bit.

Dr. Gupta: That’s a very good question and point Melanie. I would myself not want to go to a urologist to have a rectal exam, to be honest with you, so I completely empathize with all these men out there. Once men do get diagnosed with prostate cancer; the next question is whether they need to have it treated. The good thing about prostate cancer is that most of the cancer is not aggressive and a lot of the times, patients can undergo active surveillance or watchful waiting. But if men do decide to have their cancer treated by a variety of treatment modalities including radiation, surgery, cryoablation, ultrasound, whatnot; then the sad truth is that a lot of these men will suffer short and sometimes even long-term side effects, like erectile dysfunction and urinary incontinence.

If they do have treatment, most of these men live for very, very long time. Of the five-year survival disease specific survival is close to 100% after prostate cancer treatment. What it also tells us is that we have this huge population of men who have had prostate cancer, who have had treatment for prostate cancer and now are in the survivorship pool and have potential side effects from those treatments.

In the U.S., approximately 3 million men, right now have had a diagnosis of prostate cancer and have been treated for it and therefore are “prostate cancer survivors.” The rate of erectile dysfunction after prostate cancer treatment either radiation or surgery is up to 70%. The rate of urinary leakage is up to 30% after surgery, long-term one to two years after surgery, a little less after radiation but that increases with time. The good thing is that we have tools to diagnose and manage these side effects and more than 90% of the time, if a person comes to us complaining of erectile dysfunction or urinary incontinence; we are able to get them to where they need to be to lead a completely normal quality of life.

Melanie: So, Dr. Gupta, where survivorship is concerned, the roles change both for the caregivers and for the physician. Maybe you dealt with the treatments and now you are dealing with those side effects and life after as are the family members and the loved ones. What do you want them to know about whether it is support or looking at their new normal or getting help for these side effects so that they can go on with life and not feel like this is all that they are about now?

Dr. Gupta: That’s a very good question, Melanie. The Institute of Medicine and the Commission on Cancer both recognize that survivorship care is as important as treating for the primary cancer. There are numerous online as well as local support groups for prostate cancer specifically. There is Live Strong Foundation, there is Us 2 Foundation, again providing information and support for prostate cancer treatment as well as survivorship.

One of the other things that has been more or less mandated and very rigorously followed is the concept of a survivorship care plan. When men have prostate cancer treated; once they are past their active treatment, then their treating physician will give them a survivorship care plan enumerating the treatment type, date and things to look out for. The good thing is that with the combination of psychological, physical and as well as medical support; most of these men can live normal or nearly normal lives. Our concept, our paradigm of saying to men and their families be grateful that your cancer is gone and now be grateful that you are just living and you have to live with the side effects; that has shifted to yes, the cancer is gone, it is taken care of, but the most important thing we need to make sure now is that your quality of life is adequate, that you continue to be a productive member of your society as well as your family. We have at UK Healthcare, we have a dedicated survivorship clinic for patients. We under the ages of this, we talk to patients and their families, talk about their specific issues, be it urinary incontinence, be it erectile dysfunction, be it frequency of urination, urgency, be it just depression or hormonal imbalances because of their hormone therapy and then based on that; we can get investigations and outline treatment options for that.

Melanie: So, then what about the new perspective on health that they should adopt after they have been diagnosed and treated or not treated with prostate cancer. What do you encourage them to do? So, wrap this all up for us about survivorship and what you want men and their loved ones to know about this new perspective on their health and the healthy things that they can now adapt to as a prostate cancer survivor?

Dr. Gupta: So, what we tell men and their families is once the cancer is past you, even if you are continuing to get regular follow-up in terms of your PSA and everything else; you are a cancer survivor and your family is a cancer survivor because you have fought cancer and you lived with the diagnosis of it and you’ve come up on top. And now is the time to go and praise and conquer all other aspects of your life. The things that are common sense healthy lifestyle things like eating well, exercising well, avoiding smoking, avoiding bad foods, those are the things that we encourage. We encourage societal participation. We encourage participation in other support groups to share patient’s and their family’s stories and if they have any issues with any bumps in the road; vis a vis specific side effects from cancer; we are there to take care of those.

Melanie: Thank you so much Dr. Gupta, it is great information for listeners to hear. This is UK HealthCast with University of Kentucky Healthcare. For more information, you can go to . That’s . I’m Melanie Cole. Thanks so much for listening.