Joey (Host): It's common, but treatable if caught early. So we're discussing prostate cancer screening and treatment. Our guest is Dr. Rex Kiley. He's a radiation oncologist with Novat Health. This is Meaningful Medicine, a Novat Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions.

Our physicians offer tips to navigate medical decisions and build a healthier future. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Kiley. Welcome.

Rex Kiteley, MD: Thank you very much. Happy to be here.

Joey (Host): Great to have you board. We appreciate the time. So first, just wondering, how did healthcare and radiation oncology specifically first become a passion of yours?

Rex Kiteley, MD: you know, it's interesting. My, my undergrad degree is in mechanical engineering, so I've always liked the technical aspects of medicine and radiation oncology is probably one of the more. Technical fields along with radiology that really allows me to use that background and appreciate the math, science side of, my job.

But it's really nice 'cause it combines patient care so that I still have a, relationship with patients unlike, you know, not to pick on my colleagues, but unlike radiology you tend to just see images. I get to deal with patients all day long and establish relationships with them, which is probably the best part of the job.

Joey (Host): Gotcha. And you're actually the second doctor I've interviewed lately that said that engineering led to them practicing medicine. So interesting indeed. Now, as you well know, a. Out one in eight men, big number will be diagnosed with prostate cancer sometime during their lifetime. So what are the demographic groups there that are at highest risk?

Rex Kiteley, MD: So the age is the most important thing, and men over 65 tend to be more likely to be diagnosed with prostate cancer. But there's also racial difference. African American men tend to be more likely to be diagnosed with prostate cancer, and then of course, family history. If you have a first degree relative, a father or brother that.

Has had prostate cancer, you're at higher risk as well.

Joey (Host): Now in terms of screening, talk to us please about how important it is for prostate cancer. What screening is there? Because if you're a younger person, you may not be aware of it just yet. And what are the latest screening guidelines? Because they've changed of late, right?

Rex Kiteley, MD: Absolutely. So there's been a bit of a moving target. the main screening tool for prostate cancer is the prostate specific antigen or PSA blood test, which your primary care doctor can take for you. The current American Cancer Society guidelines say. At a certain age, depending on your risk group, whether that be 40, 45 or 50, and I'll go into that in a second.

But if you're in that age range, you should have a conversation with your doctor about it. So they don't come out and recommend the PSA for everyone. Because in the past there was some controversy that the wrong men are tested. For PSA, we might. Diagnose some men that don't really need treatment.

And I think those of us that are oncologists don't really believe that. We think that the tool is an important test. That should be, if you're 50 and you have a reasonable life expectancy, you should get it. tested. Uh, You should have the PSA test. If you're 45 and you have a first degree family relative, or you're African American, you probably should get the PSA test.

And if you're 40 and you have a couple of relatives, first degree relatives, a brother or father that have had prostate cancer, you should probably go ahead and get tested.

Joey (Host): remind us, please, both what PSA stands for and then what exactly is that measuring.

Rex Kiteley, MD: so the PSA is the prostate specific antigen, and we all men have it in their bodies because the prostate gland secretes this antigen into the blood. So you can draw a patient's blood and look for the level PSA in the blood, and it's, measured in very small quantities, and then as long as that is in a, acceptable normal range, typically zero to four for most men then you're probably okay.

As it starts to rise above that, then you may need a, biopsy or, testing.

Joey (Host): Now, correct me if I'm wrong, but one of the issues with prostate cancer is that it's often symptom free to the average person. Right? So are there any things that pop up that might tell a lay person they could have it or no?

Rex Kiteley, MD: Well, for most patients if they do have symptoms, they're pretty advanced and that's why screening is so important. But if you start to have urinary frequency that's unexplained or obstructive type symptoms where you don't feel like you're emptying your bladder all of the way pelvic pain, even worse bone pain if it's spread.

But a lot of those symptoms are for more advanced cancer. So really the PSA screening tool is, is important so that we can catch patients at a curable stage.

Joey (Host): But definitely if you're experiencing any of those symptoms you just mentioned time to see a doctor. Right.

Rex Kiteley, MD: Absolutely.

Joey (Host): Okay. Now, regarding treatment, if caught early, as we alluded to earlier, how much more likely is it that prostate cancer can be treated and cured?

Rex Kiteley, MD: So it's very curable. I've caught before it's spread outside of the prostate gland in the nineties, high nineties for many patients long-term survival rates. So most men will be cured if they're caught early enough.

Joey (Host): if it's not caught early, what kind of treatment options would be discussed for prostate cancer?

Rex Kiteley, MD: So if the cancer is caught after to spread outside of the prostate gland, then we're looking at systemic therapies. Therapies that go. throughout the entire body. So androgen deprivation therapies is the mainstay, but there's also newer targeted therapies. There's new radiopharmaceuticals that are available and sometimes there's localized therapies with radiation that can be used in addition to some of the systemic options.

Joey (Host): when we talk about newer treatments, there's a modality you are offering called pto. So how does that work and what patients may be candidates for that?

Rex Kiteley, MD: Right. So it's pretty exciting new treatment. And the candidates, let's start with that. The patients that are good candidates have metastatic prostate cancer, so it has spread. They are no longer responding well to the hormonal type therapies or a DT therapies. So they have what we call castration resistant prostate cancer.

They have A-P-S-M-A PET scan, which is relatively new. PET scan as well that shows uptake of cancer in different areas of their body. All those are requirements. And then lastly, they have had to have been treated with some of the antigen receptor inhibitor type drugs, which many of your viewers won't know of, but a abiraterone and is one of 'em.

There's a, list of them. So those are the patients that are, good candidates for it. How it works, it's injected into the patient's bloodstream and it's a two-part molecule. Lutetium 1 77 is the radioactive isotope that's attached to another molecule that will seek out a prostate specific membrane antigen, PSMA, which is on prostate cancer cells.

So it brings the radiation directly to the prostate cancer cell, avoiding other cells. Once it gets to that cell, it attaches. Goes into the, molecule and the little tiny radiation particle is emitted with a very short range. So it only affects that cell damages that cell's DNA and that cell dies.

So very novel, very interesting. Method.

Joey (Host): Sounds pretty amazing, huh?

Rex Kiteley, MD: Yeah. Yeah. It's very, very much so.

Joey (Host): A couple of other things. While that's not a cure, if the cancer is spread naturally, how can some patients benefit from that and what kind of side effects could they experience as well?

Rex Kiteley, MD: Right. So it has been shown to prolong patients PSA free or, you know, meaningful survival. But it also the side effect profile's pretty good. Some patients experience nausea, decreased appetite, their blood counts can be affected. And there is a risk for some patients for long-term kidney and or liver damage that we, we.

keep on the lookout for and of course decreased blood cell counts. Those are the main things that patients might experience.

Joey (Host): Lemme go back to the PSA test. We hear so much about it nowadays. It seems years ago you heard practically nothing about it in the general public, but now it's really being pushed, promoted, the importance of it, and of course, that's great. Is that foolproof? If you have a PSA blood test and the number is within the normal range, especially toward the lower end of that spectrum, does that pretty much guarantee that you don't have prostate cancer or is there still a possibility?

And if so, should you be doing something further for screening?

Rex Kiteley, MD: Right. So, for the vast majority of patients, yes, if your PSA is in a normal range and not changing, so sometimes it can be normal, but it's jumped up a good bit. From the prior year. So your, PSA velocity or that change is greater. There's a small subset of patients that have very aggressive prostate cancers that do not secrete PSA.

They're so unlike the prostate cancer that they come from certain neuroendocrine cancers that no longer even secrete PSA. So it is possible but not very common. So I think you're gonna get. 99 plus percent of the prostate cancer cases with screening.

Joey (Host): And in summary here, doctor, any common misconceptions about prostate cancer or its treatment that you can clear up for? Us for instance. I know that patients of course, are often very concerned about side effects of different kinds of ways of attacking this, and that's a big thing that often needs to be weighed, right?

So are there any misconceptions about that? Well, if I have it treated and a certain way, then that could cause me other issues. I don't know if I should do that, if you know what I'm saying.

Rex Kiteley, MD: absolutely. So patients have preconceived notions when it comes to cancer itself. And then treatments, I would say that, the best thing you can do is educate yourself. Obviously if you're found out prostate cancer, you're gonna be. Seen by urologists, radiation oncologist to hear about your options. And each treatment modality does have various risks that you're going to have to weigh with whether or not you want treatment.

So I think it's individualized as the bottom line.

Joey (Host): And is there a certain misconception or myth, if you will, that people tend to have about all this?

Rex Kiteley, MD: would say that in general, patients that have stage four or metastatic cancer tend to think that it's a death sentence and with prostate cancer. With some of the new modalities that are available, men are living long, healthy lives minus prostate cancer. For. Years as opposed to what used to maybe months.

And so I, I think that make sure patients are aware that there's still hope if you're diagnosed at a late stage. And certainly if you're diagnosed at an early stage, if you're good about your screening, which is the really, the take home message I think is that you're most likely going to be cured.

And the side effect profile they're usually pretty favorable.

Joey (Host): And it seems like that side effect profile has really improved in recent years. Right.

Rex Kiteley, MD: It has, it really has, especially from a radiation oncology standpoint. The therapies get more targeted and the technology has improved to the point that we're able to spare the normal organs very well. And so we see a lot of the side effects than we did, 30 years ago, 20 years ago.

Joey (Host): Absolutely. And I'm sure for those joining us, that's comforting to hear, to say the very least. Well, folks, we trust you're now more familiar with pro. Prostate cancer screening and treatment. Dr. Kite, we such a crucial message that can't be delivered enough. Keep up all your great work and thanks so much again.

Rex Kiteley, MD: Thank you very much for having me. Have a great day.

Joey (Host): Absolutely same to you. And for more information, please visit novant health.org/healthy headwinds. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for being part of Meaningful Medicine, a Novant Health Podcast.