Army veteran David Atkinson shares how transitioning to VA care gave him access to advanced genetic testing, innovative treatments, and a collaborative care team after his metastatic prostate cancer diagnosis. Alongside Dr. Julie Graff, he discusses how the VA helped him navigate treatment decisions, access promising therapies, and maintain a high quality of life. David encourages fellow veterans to explore their options, ask questions, and take advantage of the specialized resources available through the VA healthcare system.
Dr. Julie Graff:
Well, David, it's amazing to be here with you today and everyone wants to hear about you understandably, but first it's about me, me, me.
David Atkinson:
Always.
Dr. Julie Graff:
So I'm Julie Graff. I get to take care of David at the VA. Well, let me start with me. I'm a medical oncologist and I focus on taking care of prostate cancer patients, which is how I met David here. I've been doing this for 16 years at the VA and at Oregon Health and Science University. David, tell us about yourself and your military experience.
David Atkinson:
So my name is David Atkinson. I was diagnosed with metastatic prostate cancer in 2018. Little bit of my background, I'm a 1987 graduate at West Point, served on active duty in the Army, original duty station, what was then West Germany for three years. And then my unit was sent to Operation Desert Storm in 1990 and '91.
After that, I came back to the States, did a few more years of active duty and then resigned my commission from active duty in 1993. Got married, had three wonderful children. When I got out of the military, I moved to Portland, Oregon. I've been here ever since and everything was going along very nicely until my diagnosis in 2018.
Dr. Julie Graff:
Thanks, David, for that and for your amazing service. It's been such a joy taking care of you. I guess we met in 2019, right?
David Atkinson:
Yes, 2019.
Dr. Julie Graff:
David, I hope you don't mind if I just kind of summarize your medical history here.
David Atkinson:
Please do.
Dr. Julie Graff:
So as I mentioned, I got to meet David in 2019 and unfortunately David was diagnosed with prostate cancer that had spread already to the bone. So we were working together and our goal was to make David's life as long as possible with a good quality of care. And David very generously agreed to do a clinical trial at OHSU. So I saw him on the academic university side first. Unfortunately, that trial didn't really help David with the cancer control.
None of it really worked out. And then we sent some of his cancer tissue, or biopsy from the cancer, for sequencing, meaning we looked at it to see if there were any changes in the DNA that we could actually do something about. And 80% of the time we don't find anything. 3% of the time we find the mutation that David has.
At OHSU tried to get the drug approved from the insurance companies. And mind you, the FDA had already approved this treatment for any cancer type that had this mutation. So it should have approved it, but it said no, that it wasn't going to approve it because there's not a lot of information in prostate cancer. And so we appealed that ruling. They said even after our conversation, they refused to pay for it.
And David and I decided that he should really apply for VA coverage. I worked at the VA as well and I felt very confident the VA could get him the drug that was appropriate. And so David applied to the VA and fortunately he knows people from his West Point days that I think facilitated his coming to the VA. Although I will say, I think for any veteran, you don't have to go to West Point to go to the VA and get excellent care.
David Atkinson:
While it does take a little time to get enrolled in the VA system for first time enrollees, it is well worth it because the care and the treatment that I received from Dr. Graff and her team here at the Portland facility has been nothing but amazing. And I say that because when I was diagnosed at the end of 2018, and Dr. Graff knows this, I was given one to five years to live with where the cancer was in my body and how far along it had gone. And as we sit here talking with this video, I'm at year eight and a half and that's the result of Dr. Graff and her research and her care team.
Dr. Julie Graff:
David, I think you're doing all the hard work. You were on a study for the drug you ended up getting and that you were receiving the placebo, as you say. And you sort of touched on something else I wanted to talk about, which was navigating the VA system. And I think it can be overwhelming for first time veterans accessing, first time patients. I want to just ask, did you get a hold of a veteran service officer or did you navigate it by yourself with the help of the person from West Point?
David Atkinson:
So it was a combination of both, but the veteran service officers are a lot of help, especially in the beginning. As I said, there's just paperwork, there's stuff you got to file and things to do and they can help you navigate through a lot of those loopholes and issues you have to do.
Dr. Julie Graff:
So David, of course, you were diagnosed with that mutation at OHSU, but the VA is very committed to testing all veterans with cancer that spread for these genetic mutations in the tumor itself. And the VA has contract with a company that checks for these mutations. We as VA providers are held to certain standards, including that we test all patients with metastatic prostate cancer for these mutations, and actually we do it better than doctors in the community and I think in some cases better than doctors at the university. So that's something unique to the VA. And we also have clinical trials for patients who have certain changes in their DNA. As your cancer journey evolved and treatment decisions became more complex, how did you and your team approach these conversations about treatment? Did you feel you had the information options you needed through the VA?
David Atkinson:
I would just call you.
Dr. Julie Graff:
Yeah.
David Atkinson:
You have been amazing in helping me with all this and through the years if there was ever an issue or in the world of prostate cancer, the main number we always look for is what's called PSA and you can tell them what PSA stands for, I always forget, but that number is supposed to be between zero and four. And as Dr. Graff knows, I've been as low as 0.5 through this journey and I've been as high as 110. So every time that number rises, I reach out to Dr. Graff. We have conversations about, what does it mean? Where is the medication I'm currently on still effective? What's next steps of treatment?
I've always had the utmost confidence in you, Dr. Graff, to give me the correct answers or what you feel is the best decisions or options based on current medications, current treatments, current conferences you've been to where you're learning more all the time, and I feel blessed to have you in my corner.
Dr. Julie Graff:
David, you're so sweet. I think you touched on something really important, which is I don't work in a vacuum. And there's a lot of VA physicians who are experts in prostate cancer and I've had to lean on them from time to time to see if there's anything special we should consider in your situation. We've had to do radiation and some other things in addition. And I think what's been the trigger for us is the rising when your PSA goes up and then we get new pictures and then we say, "Maybe you should get radiation to this spot or that spot." From my recollection, I don't think we've ever disagreed on that.
David Atkinson:
We talk about the pros and cons usually, but at the end of the day, if your recommendation is X over Y, I have the confidence and the faith in you, because I know you've done the research and you've done the homework and this is what you do for a living.
Dr. Julie Graff:
The way we first met is clinical trials, which means oftentimes working with patients who don't have great treatment options to get newer forms of treatment that aren't yet approved in that setting, but show promise. So you participated in that one trial before you ended up at the VA, but there are a lot of trials at the VA that you haven't really needed because you've been on this immunotherapy and it's been working. So yeah, that's one of the passion projects.
And I think David, you would just maybe from time to time kind of wink at me and say, "Yeah, Julie's looking for the next therapy to give me to cure this thing." And I'm definitely looking for the next therapy because as well as this has worked, it's not working forever and it's not curing your cancer, which is what we want.
So at the VA, patients have access to clinical trials, which is really critical for any cancer program that you have clinical trials available. And sometimes through these trials, patients get treatment with effective drugs like years before they're actually approved. So that's how we get patients at the VA, access to advanced care.
David Atkinson:
And I want to touch on that when you talk about advanced information or treatments as you just mentioned next week I'm going to start a secondary treatment of IV radiation, which we're really hoping will help my condition. And this is you, Dr. Graff, you worked hard to get it approved for me through the VA system and you got it approved and so we're moving forward with it. And it's just another form of treatment that you've done the research and you've come up with, so I appreciate all of that.
Dr. Julie Graff:
It always is funny to me, David, you're thanking me because I feel like you've done so much in your life that what I do is such a minimal contribution to everything that you've done. So thank you, you.
David Atkinson:
No, that's not true. And I know one thing they wanted me to touch on is quality of life. And for me, I have a quality of life because of you and your team at the VA hospital. As you know, shortly after you first met me, I was going downhill in 2020 and it was because we were trying to figure out which medications would work because the ones I was on weren't, and it was through your research ... Sorry about that. It was through your research that allowed me to get on this medication that I've been on for six and a half years and it turned around the pain I had in my body and allowed me to have a quality of life.
Dr. Julie Graff:
Right after Thanksgiving, 2020, and that I still remember you being in the exam room. You're about to start your treatment and I was waiting for the blood result to come back. You'd already gotten ... Actually, this was your second treatment because you'd already gotten one and I went to a computer in another room and your PSA came back and it was like 11. I think it went from like 110 to 11 after one treatment and running into your exam room and being able to tell you that was like all this work was totally worth it. That was amazing.
David Atkinson:
To your point, I started my first treatment with the VA and you December of 2020 and about 110 when I got there and within two months I was like 1.6. So it's amazing.
Dr. Julie Graff:
Yeah. It is really amazing.
David Atkinson:
I am absolutely certain that I would not be here if it wasn't for the work you did in testing for genetic tumors in my cancer and therefore determining which course of treatment is the best for me.
Dr. Julie Graff:
Maybe you can say something about your quality of life through all this.
David Atkinson:
Once I got on my current medication, I actually started ... I did pretty well for quite a while. One of the biggest side effects of the medication that I'm getting is, well, two things. One is fatigue and one is muscle atrophy. I've always been a very athletic person through my entire life from playing sports in high school to college, riding a bike in the summer, snow skiing in the winter. So I've always been a very active person.
You know having to deal with me all these years, I have been an avid snow skier since the time I was four years old and in 2020 I couldn't do that because of the pain and issues in my body, but the medication you found for me and got me on through the VA system allowed me to ski for another five years. Now I did have to give it up this year because you told me I had to, but it allowed me for a number of years to stay healthy, or as healthy as I can be with cancer, but to still be able to do things in my life and be active every day and still have a quality of life, which I know a lot of people sometimes don't, especially when they have advanced stage of cancer like I have.
It is getting more difficult. I will admit the cancer has taken a toll on my body. However, my quality of life has been very good over the last six to seven years with Dr. Graff's care and the treatments she has put me on, some minor treatments like radiation and other things that we've done when the issue arises. I'm happy I can still be here and smile and tell you everything is still good. I get to see Dr. Graff next week for my appointments, but my quality of life has been fantastic thanks to Dr. Graff and her team.
Dr. Julie Graff:
Well, you also became a grandfather.
David Atkinson:
And I did become a grandfather, yes. As Dr. Graff knows, I truly thought when I got my diagnosis, I truly thought I will never see that happen because at the time none of my kids were married. My two older ones are now married. One of them has a beautiful daughter. I have a granddaughter, three and a half years old, and it's just a joy to be part of her life.
Dr. Julie Graff:
As we wrap up, what would you want other veterans to know about navigating prostate cancer within the VA system?
David Atkinson:
It's a little difficult for me to answer that question only because my navigation of prostate cancer care in the VA system has been very seamless and very easy. And again, I feel a lot of that's based on you helping me originally get into the system and managing my care. But just the VA system in general, I truly believe while it takes a little time to initially get into it ... I only have the experience of the Portland VA Hospital, but the staff is amazing. I mean, people are always making sure my appointments are lined up when they need to be. I get phone calls, I get emails, I get text messages, so there's never not knowing when you have an appointment, so that's amazing.
But prostate cancer specifically, I guess the one thing I would tell any veteran is just always ask your doctor if there's options, if there's anything else on the table to help you. And that's what you and I have always done. We've always had an open dialogue on where we're at and where we're trying to get to.
Dr. Julie Graff:
David, thank you for your time today. Always such a pleasure to talk to you.
David Atkinson:
Same with you, Dr. Graff. I appreciate it.
This interview was produced with the generous support of AstraZeneca Pharmaceuticals