Learning more about prostate and testicular cancers

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LOUISVILLE, Ky. (WHAS11) -- Dr. Arash Rezazadeh Kalebasty is a medical oncologist specializing in genitourinary cancers, which include kidney cancer, bladder cancer, prostate cancer and testicular cancer. Dr. Rezazadeh is involved in every stage of a patient’s cancer treatment from time of diagnosis, advising patients on different types of treatment, the side effects and efficacy of each treatment and how to balance these factors while choosing the treatment option best suited for each patient.

I sat down with Dr. Rezazadeh to better understand what men face when it comes to prostate and testicular cancers, from detecting early symptoms to choosing from a variety of treatment options.

The following has been edited for clarity.

Will Weible: When do you start looking for prostate and testicular cancers in men, and how do you detect them?

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Dr. Rezazadeh: Well generally the diagnosis is made by a urologist. Primary care physicians are the ones who normally screen the patients for prostate cancer, and when they find out about possibility of prostate cancer, which is mainly done by a rectal exam and a blood test called PSA [Prostate Specific Antigen]—if those are suggestive of prostate cancer then [the patient] will see a urologist and a biopsy is, most of the time, mandatory to establish the diagnosis of prostate cancer. And after diagnosis is made I’m involved with making decisions of which way a patient should go, but it is mainly in consultation with a urologist.

WW: Even before seeing their primary care physician, what are some of the possible symptoms of prostate and testicular cancer men should be aware of, and what can they do on their own to stay on top of their health?

DR: Starting with testicular health, a monthly exam, normally after taking a warm bath when the testicles are lower in the scrotum. Men should start checking themselves once a month at least, and if there is any lump or bump or any tenderness, or any change in the size of the testicle, they have to talk to their physician. It could be both ways--sometimes the testicle actually shrinks, and that [could still be] testicular cancer. It doesn’t have to be enlargement of the testicle.

WW: And prostate cancer?

DR: For example, if they have hesitancy and they cannot start urination right away, if there is blood in the urine, if there’s fullness or pain in the pelvis, if there’s blood in the sperm. You know these are early signs when the cancer is in the prostate itself. When it leaves the prostate, it could be other things like bone pain or fatigue and tiredness—things like that.

It’s a much more detailed discussion as far as the screening for prostate cancer, but definitely if men have any symptoms, they have to see their primary care physician as soon as possible.

WW: Once a patient is diagnosed, what are some of the ways these cancers are treated?

DR: For prostate cancer specifically, when the cancer is limited to the pelvis and has not spread, surgery is one--what we call radical prostatectomy, to remove the prostate gland. The other way to treat is radiation therapy. Through the radiation sessions we try to radiate the prostate as a whole and sometimes the lymph nodes around it in the pelvis. There are other ways that sometimes we use in certain patients, things like so-called “microwaving” the prostate, or “burning” the prostate—a technique called [High-Intensity Focused Ultrasound, or] HIFU.

WW: What are some of the new treatment options that weren’t available, say, 10 years ago?

DR: In prostate cancer, the first immunotherapy was approved, it’s called Provenge. This is an autologous, so-called vaccine that we use for treatment of prostate cancer. We have multiple hormonal therapies that are in the form of tablets that [the patient] can take by mouth. We have chemotherapies. We have so-called bone-targeted therapy that makes the bones stronger so these patients have less risk of fracturing their bones and being bed-ridden because of that. There are radiotherapies. We have radiopharmaceuticals in injectable form that we can actually put in the vein and it treats the bone involved with prostate cancer. So there are several class of drugs that we actually started to use and there’s more to come, actually, in the research field.

WW: What factors come into play when deciding on treatment paths for patients?

DR: One of the factors is age. The other factor is the aggressiveness of the disease because, really, prostate cancer is a spectrum of the multiple diseases that we call prostate cancer. From a very indolent disease that may not progress for many years, to a point that a very aggressive disease can really lead to death in a very short period of time from time of diagnosis. So, factors are age and aggressiveness of the disease and there are a lot of pathological factors. In the meantime, we have to look into how much the disease has spread. Is there a chance for a cure, or is it going to be something that we have to control and not be able to cure definitely?

WW: What would you like to communicate to the public that you think is important for them to understand about these diseases?

DR: I really think that the most important point that I want to make as a medical oncologist, really dealing mainly with metastatic, or spread, cancer throughout the body, is we have a lot of options nowadays to treat prostate cancer compared to many years ago. The options are very much tolerable at times for the population that we deal with. A lot of elderly men that have the disease, they can tolerate these treatments—treatments really have been tailored for elderly patients to maintain quality of life and enjoy the benefit from the treatment at times. I think this is one of the most important points that people should be aware of, that it’s not necessarily very tough chemotherapy to put them in bad shape or have a lot of side effects.

The other thing is there are a lot of clinical trials going on and those are very important to have those available in the community to be offered to our patients. And we can talk about details when they come in here to tell them what else, other than the standard care, is available. So, there’s a lot going on in the field.

Testicular cancer is a very highly-curable cancer. On average, we can cure most patients, it depends on the stage. One of the messages that I really wanted to send out to young people, young men, is if you feel anything different in your testicle you have to talk to somebody. Just simply waiting on things is not a good option. A lot of times I see patients that have waited on things for a year, year-and-a-half, and you know for a highly-curable cancer sometimes it’s very difficult to lose a patient that has waited a long time on it, on a cancer, and not talked to anybody about it.

WW: So, time is of the essence.

DR: Yes, absolutely. I encourage patients to talk to their healthcare providers as soon as they feel something different or unusual with their urinary system, with their habits of urination, getting up at night, going to the bathroom too often—and we can really cure a lot of prostate cancer if we catch it in time.

WW: If these cancers are in your family history are you more at risk?

DR: Absolutely, absolutely.

WW: And is that common with other cancers?

DR: Prostate cancer, particularly, has something to do with the family history. You know some cancers do and some cancers don’t, so we strongly recommend to screen patients with family history of prostate cancer.

WW: So talking amongst your family is important, too.

DR: Yes, absolutely.

Next week, I sit down with Dr. Greg Steinbock, a urologist and co-director of research at First Urology, to discuss what’s new in prostate cancer research and how research is helping today’s patients.

If you would like to donate to WHAS11’s Movember fundraising effort to fight prostate and testicular cancers, or join our fundraising team, you can do so at moteam.co/whas11.

For more information on these cancers and the Movember initiative, click here.