Dr. Atish D. Choudhury:
Hello, everyone. My name is Atish Choudhury. I'm a medical oncologist here at Dana-Farber Cancer Institute, and I'm here with my dear patient, Mr. Josh Kraft. Josh Kraft, as you may know, is the president of the Patriots Foundation, and he was treated here at Brigham and Women's and Dana-Farber, and I'm here to talk about his experience with the diagnosis and treatment, and hopefully this is educational for the people who are going to see this segment. So Josh, thank you for being willing to do this.
Josh Kraft:
Anytime, Atish. I appreciate everything you, and Dana-Farber, and the Brigham did for me, so ...
Dr. Atish D. Choudhury:
No, you're very, very welcome. So let me go back to when you were initially diagnosed. How did it happen? How were you told? How did you feel?
Josh Kraft:
So what happened is as I was meeting with my PCP and my PSA, it wasn't out of the normal range, but the jumps within the normal range were quite big. I don't remember exact numbers, but so my PCP sent me to urologist, Quoc Trinh, who you know well, and he started to monitor it, and when it kept doing those jumps, we eventually did a biopsy. The result of the biopsy was you have cancer. I think the Gleason score was seven, and that's when I met you, and we had the decision, surgery or radiation.
Dr. Atish D. Choudhury:
Yeah, and we'll talk about all of that, but you were told you had a diagnosis of cancer. What went through your head at that time?
Josh Kraft:
I was definitely a little surprised, because I know prostate cancer, most men get it when you're older. I think I was just 50 years old at the time, and so I was a little surprised. Maybe 40, 51, or 50 at the time, and so I was a little surprised because we did the biopsy right. We did the biopsy, and I'm like, "Yeah, this'll be fine," and then when Dr. Trinh called me, Quoc called me, I was like, "Oh, okay." So I had to kind of readjust.
I'm like, "All right." On the phone call, he said, "You have cancer. I will give you ... My opinion is you should remove your prostate or you can do radiation." I think I probably said, "I have to do one or the other, correct?," and he laughed.
He said, "Yeah." I said, "Okay." So then, I kind of got a little grounded, and I'm like, I just said, "I'm all right. All right. Well, I got to figure it out." I was definitely a little surprised, but within a couple hours, I was like, "All right, I got to deal with this," so ...
Dr. Atish D. Choudhury:
So what were your worries at that time? What were you concerned about? What was going through your head?
Josh Kraft:
Well, I think when removal, I was 50 years old, a youngish guy. Obviously, sexual function scares you. Incontinence scares you. Anytime you have a surgery, you never know. You hear horror stories about people going in for a simple surgery and something bad happens.
So those are ... Not probably, they were the three things I was anxious about the most.
Dr. Atish D. Choudhury:
And you weren't so worried about the cancer itself growing or spreading?
Josh Kraft:
Well, I was worried about that, but I did feel ... I'm not a doctor, but I knew it was early enough where ... We'll get to, I guess I was a little wrong, that if we got the prostate out, I know a doctor can never say 100%, but you all felt confident that with removal, this would be something that more likely would not come back. So I felt good about that, and it was just the fears of the surgery as well, and being under the knife, so to speak, or under the robot, in this case, so to speak.
Dr. Atish D. Choudhury:
Right. Yes. The robot wields the knife while the surgeon sits a little bit to the side. It's really quite impressive.
Josh Kraft:
Yeah, and I actually remember, when I was in the pre-op room and they asked, "Do you want to get something to knock you out a little before you go in?," I said, "No, no, I want to be awake," because I wanted to look around. I remember the one thing when they wheeled me in, it was freezing in there, and I said to all the surgeons, the residents ... There's a number of people in there as you well know. I said, "Man, you guys work in here?" I think I probably said, "It's blank freezing in here," and they laughed and said, "Yeah, we prepare."
Then, they said, "Don't worry, we're going to put you on something that's warm." I said, "Okay." Then, I looked around and I said, "Oh, is that the robot in the corner?" They said, "Yeah," and I said, "Where's Quoc? Quoc Trinh, he's not in here yet?," and they go, "No. He'll be in when you're asleep," so I said, "Okay, put me to sleep," so ...
Dr. Atish D. Choudhury:
And there you go. When you first came to see us, you might remember that you were actually referred to three people. There was a urologist, who's Dr. Trinh, there was a radiation oncologist, Dr. Paul Nguyen, and you saw me as a medical oncologist, and a lot of people who see me don't really understand what the role is of the medical oncologist in that initial consultation because we're not the ones doing the surgery, we're not the ones doing the radiation, and so I tell people my role is really just to counsel people of what's going on, what this is, what this is in the range of what to expect, talk a little bit about surgery and radiation as the person who doesn't do it, but also, I would be the one to prescribe testosterone-lowering medicines if that was going to be recommended as part of the treatment plan. So what was your experience of the multidisciplinary? Did you find it helpful?
Josh Kraft:
The multidisciplinary was great. It was so helpful, because I could talk, as I just mentioned, I had fears about surgery, and then I was thinking to myself, "Is radiation better?" I did have a friend with me who works here at Dana-Farber, who works on another type of cancer. So I was able to ask all three of you, "What are your thoughts? What would you do?"
I know it's a standard question, "What would you do if you were me?" I think what was really helpful, as you said, most people, my age, my health situation, et cetera, 90% of them do removal. There is a 10% or a little bit more that would do the radiation, and then all three of you, Paul, you, and Quoc all said, "Look, you can do the radiation. The only issue is if this ever comes back, it's either going to be ..." And you would know for sure.
I don't remember specifically, "It's going to be a lot harder to remove 'cause of the scar tissue or potentially would be unable to remove it because of the scar tissue."
Dr. Atish D. Choudhury:
Right.
Josh Kraft:
So I thought, "That sort of seals the deal. Let's just remove it, and then we hopefully never have to worry about it again," but we'll get to that later.
Dr. Atish D. Choudhury:
Sure, sure. So yeah, that was definitely the discussion, is that when we have these multidisciplinary meetings, you meet with the three people, we give an overview of what's going on, and we talk about the different treatment options, and we talk about an option of surveillance as well. A lot of people come to us and ask about some more experimental type treatments, what we call focal therapies to the prostate, which are appropriate for some people, but not necessarily for everyone. So we talk through kind of the different approaches and what the risks and benefits are for each individual, and then we try to give advice based on our experience and the patient status, their health status, their motivations, what they're really most worried about, and how to accommodate that, and also thinking ahead 20, 30 years down the line, because the recommendations that we would make for you as a 50-year-old would be much different than we would make for somebody who was 70. And so did you feel like the conversation was somewhat individualized to you?
Josh Kraft:
Having the multidisciplinary approach was so helpful, because each of you are very knowledgeable about the whole gamut of the experience, radiation, surgery, alternative therapies, and then you each have your specialization areas, but just hearing the various opinions and how they meld together, and what was best for me really came through, and that's why I chose the surgery because I felt the three of you all kind of thought that was the best way, using your own experience from different patients and from different situations. So having your experience, even though you're all experts in different parts of the journey, was so helpful, and that's how I was able to make the surgery decision.
Dr. Atish D. Choudhury:
So then, you had the surgery, and then you woke up, and then there were some incisions, and there was a catheter.
Josh Kraft:
Incisions and the catheter. Frankly, it was a Friday night, and then I spent the night in the hospital. The real only discomfort I had was ... I did it early in the morning, I remember like 7:00 AM, 7:30. The only discomfort I had was probably around 9:30, 10:00 at night.
I felt, it's almost like when your stomach muscles get real tense. That's what I felt. I was like, "Ooh." I remember I got a painkiller, went away, I woke up the next day, and I really didn't have any more discomfort for the rest of the recovery. It was just that first night.
The catheter, definitely ... Let's put it like this, seven, eight days later, it was a very happy day when they removed the catheter. I understood it was part of the process, and you guys were very clear. I think I said ... I don't know if you remember this, but when we were all talking like, "Well, in the surgery, you'll have a catheter," and I think I was like, "Oh, I have a ..." I remember, I was like, "Oh."
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
In my head I was like, "Oh," swear. Okay.
Dr. Atish D. Choudhury:
Sure.
Josh Kraft:
I guess it's part of the process, but then, you were also very clear about doing kegel exercises. So I remember there was a PT person I met with who gave them to me, and I did them religiously. The catheter, it took a day or two to get used to, then I got used to it, and when they removed, it was a great day, but I think the kegels, I really had no issues with incontinence at all, post-catheter, which was great, and I think you're all referral to the PT pre everything was very helpful.
Dr. Atish D. Choudhury:
But there was a period that you needed some pads after the catheter was removed, or not at all?
Josh Kraft:
No, not at all.
Dr. Atish D. Choudhury:
Okay. Yeah.
Josh Kraft:
I'd say, if being totally frank here, I'd say one in 30 times right now, I might have a bit of an accident, but nothing major.
Dr. Atish D. Choudhury:
Okay.
Josh Kraft:
So, I never needed the pads.
Dr. Atish D. Choudhury:
Okay.
Josh Kraft:
You sent me home. They sent me home with them after the catheter, and I think within a day or two, I tossed them.
Dr. Atish D. Choudhury:
Yeah. So that's a little bit of an unusual experience to recover that quickly.
Josh Kraft:
Well, you guys tell me to do the kegels, the multidisciplinary approach.
Dr. Atish D. Choudhury:
Sure, sure. But there is a recovery process, though, for some people, it's a bit slower than others. I don't know how comfortable you are in talking about the recovery of the sexual functioning after the surgery.
Josh Kraft:
Oh, you put me on Cialis, half a pill every week, so I did that and this couple weeks, and I came back.
Dr. Atish D. Choudhury:
Yeah, so that's a pretty favorable timeframe too. So was there a time period that you were frustrated with all of this, or did you feel like everything was going pretty clockwork?
Josh Kraft:
Well, again, back to pre-surgery, I thought about it a lot. I did honestly feel like, and maybe it was stupid or naive of me, I'm like, "I trust these guys. They're going to get this out. I'm never going to have to deal with this again. No, nothing in the lymph node, no, nothing. I felt good."
So my fears were the things I spoke about, sexual function, incontinence, and then just being knocked out and on an operating table.
Dr. Atish D. Choudhury:
Sure.
Josh Kraft:
So I did, I'm not going to lie, thought about that stuff a lot, but I was like, "All right, let's just do it."
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
But I did think about that, and ironically enough, the cancer, I thought about, but I did feel really good that you all would get it out.
Dr. Atish D. Choudhury:
Yeah. So you had the surgery, the prostate was removed, the pathologist was able to examine the whole prostate and say this was a favorable intermediate cancer.
Josh Kraft:
Yeah.
Dr. Atish D. Choudhury:
Everything was contained within the prostate, the margins of the surgery were negative, and Dr. Trinh thought that this was a great result and thought that the likelihood of cure was really high.
Josh Kraft:
Yeah.
Dr. Atish D. Choudhury:
And your PSA was undetectable for, I think it was about a year and a half, and then there was a value that was just slightly detectable.
Josh Kraft:
Right.
Dr. Atish D. Choudhury:
And so what did you think at that time?
Josh Kraft:
So just slightly detectable. I talked to my PCP, and then I think I talked to Dr. Trinh, Quoc Trinh, and he was like, "Maybe it was lab error. Come back. Give it a couple weeks, and come back," so I gave it ... I came back, and it was still detectable, and they're like, "Okay, let's just stay on it." Then, not only was it detectable, but it started to creep up slowly, and then I ...
Forgive me, Atish. I forget the number where you retreat, but I had it in my head, and then every three months, it was kept creeping up. It's sort of like when I first had it, it wasn't out of the normal range, the PSA, but it was just the jumps are big, but it's coming. I was like, "Okay." I knew in my head this isn't lab error.
So then, remember I did one test and it really got up, and then I said, "You know what? Instead of waiting three months, can we just do this in six weeks?" Then, it was up again then, and that's when we decided to retreat with hormone therapy and radiation. I will tell you, those last couple tests, I started to get anxious because I was like, "Okay, if this is escaped somehow in my lymph nodes, it's not a great thing."
Dr. Atish D. Choudhury:
Sure.
Josh Kraft:
So I was very ... I'm not going to lie, that had me very scared.
Dr. Atish D. Choudhury:
Yeah, and that's totally understandable, and so we do recommend treatment relatively early when the PSA is pretty low.
Josh Kraft:
Yeah, that's why when you all said, I'm like, "All right, let's do it."
Dr. Atish D. Choudhury:
Yeah. Yeah. So it's around ... If it gets above 0.1, we say, "This is kind of suspicious enough."
Josh Kraft:
Yeah, it got to 0.1 and something, or 0.9, or 0.09, or 0.1, and then you said it, and then you connected me to Paul Nguyen as well.
Dr. Atish D. Choudhury:
Yeah. So then, you saw me and Dr. Nguyen, and so that's when I was really involved in your treatment.
Josh Kraft:
That's when you took ... Yeah, yeah, and you oversaw ... Yeah. I'd come in and see you once a month, and I'd get my shot of Lupron, and I was taking the bicalutamide. I forget how to say that.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
The pills every day, the Lupron once a month for six months.
Dr. Atish D. Choudhury:
For six months.
Josh Kraft:
Yeah.
Dr. Atish D. Choudhury:
And so you say the word hormonal treatment and Lupron, and a lot of men are very, very nervous about what that is and what that does, and you had side effects from treatments, so-
Josh Kraft:
I definitely did. When you all said, when my PSA was slowly starting to creep up again, you all said, "Well, you'd have to do radiation and hormone therapy," and I thought more about the radiation. I'm like, "Oh, that'll make me tired." I didn't think anything of the hormone. Again, my naivete, I'm like, "Oh, hormone therapy."
I didn't even know what it meant. Then, when I got it, I definitely am like, "Oh, the radiation was fine." It was 35 days, and I got to say the team here, the kids, 'cause they reminded me of my daughter's great ... There was ... I got to tell you, just as a son, they were so upbeat, and I saw who was going in there, a lot worse off than me, and kids, adults, and they're always smiling, warm, engaging, and I told them, I said, "Look, I'm the least of your problems, so you guys maintain it. It's great."
So that was experience, but the hormone therapy, yeah. This is what I tell everyone. I had no clue what ... I mean, I knew what testosterone did, for being active and sexual function, but I had no clue how my emotions got a little crazy. I'd get the hot flashes, I cried all the time.
I think one day, checking in here, I just started crying. I don't know, and yeah, I had no clue. So that took a month and a half to get used to, and then I dealt with the hot flashes and the mood swing ... I never got angry, but I got cried a lot over stuff I wouldn't cry about, which was interesting, and so I really have told people, "Look, you have no idea what testosterone does."
Dr. Atish D. Choudhury:
Right.
Josh Kraft:
It doesn't just, when you're in the gym, it's not just that, so I totally learned that. My hair, I didn't need haircuts as often. I didn't have to shave as often, which I kind of liked, but the hot flashes and the emotional things definitely impact, yeah.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
I felt the sides of that.
Dr. Atish D. Choudhury:
So some people do have side effects from radiation, like irritation of-
Josh Kraft:
Right. No, I never had that. I'm trying to think. No. No. I was pretty good.
I think the first month, I got really tired, and then it kind of leveled out. I tried ... Not tried, I worked out five to seven days a week through it all, through the radiation hormone, and then through the hormones post-radiation, but I still ... That was the other big thing. I gained, I think 25 pounds.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
I was working out every day, so I was like, "Wow." That's when I really, the testosterone, it was like, "Whoa, this is crazy."
Dr. Atish D. Choudhury:
Yeah. Some people get side effects from radiation, like urinary frequency, having to go to the bathroom at night, some people get some diarrhea, and some blood in the stool, but they tend to settle out in the few weeks after the radiation is done, but it doesn't sound like you got much of that at all.
Josh Kraft:
No, I had none, and they put the music on, and I'd take like a 12-minute nap every time.
Dr. Atish D. Choudhury:
Yeah. In a similar way with the hormonal treatments, there's just a huge range in how people do, so some people hardly experience any symptoms, and some people have really bothersome ones, and some are somewhere in between, and what people experience is highly variable kind of along that spectrum. So the things that you experienced, like the hot flashes and the moodiness, we do have medications that can help tamp down those down in a lot of people, but you did feel like you adjusted to that after a month and a half or so.
Josh Kraft:
Yeah, I didn't want to take any more medications, and I just said, "Look, I'll deal with it. It could be a lot worse."
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
So that's how I looked at it. I was like, "Things could be worse," so I didn't mind it. Then, the weight gain, it was nothing. I took it all off, but I gained it quick. It was ...
Dr. Atish D. Choudhury:
And so, I don't know if you remember what I told you at the time, which is that not everyone gains weight on hormonal treatment. Some people do, and certainly working out and eating healthy is the best way to try to prevent that, but even when you were working out and you felt like you weren't getting as much impact from it in terms of weight loss, as you were really hoping, I don't know if you remember what I told you, but just to be patient with it.
Josh Kraft:
Yeah, you said be patient, and then I stopped the ... I think in May, and then it really, the end of June, early July is when I stopped getting the hot flashes and emotions of it. Then, I just kept working out and I didn't look at my weight for till the fall, and then I noticed, I'm like, "Oh, I'm back on my normal weight." I didn't even think about it.
Dr. Atish D. Choudhury:
Right. What I said was that that exercise during the hormonal treatment primes your body so that when the testosterone comes back, it'll then kind of help you settle out in terms of the weight and allow you to gain muscle rather than just trying to prevent losing it.
Josh Kraft:
Exactly.
Dr. Atish D. Choudhury:
So how did you feel then during that recovery period?
Josh Kraft:
I felt good. Once the side effects of the hormone therapy wound down, I felt much better, and yeah, I got back pretty quick to my normal self. It took about six weeks or so, and the hot flashes stopped.
Dr. Atish D. Choudhury:
And during the hormonal treatment, did you feel like you were limited in the things you were able to do, physically or at work or in your relationship?
Josh Kraft:
No. Sexual activity decreased considerably.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
Majorly, yeah.
Dr. Atish D. Choudhury:
Majorly, yeah.
Josh Kraft:
Yeah.
Dr. Atish D. Choudhury:
And so how did you feel then about the recovery then after it was done? Did that come back relatively quickly, did it take some time?
Josh Kraft:
Yeah, it came back quick.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
It came back quick.
Dr. Atish D. Choudhury:
Yeah, yeah.
Josh Kraft:
Yeah.
Dr. Atish D. Choudhury:
So again, it's a variable experience. Some people, it takes a bit longer, and some people recover well like you, but then, how did you feel then for your first PSA result when the testosterone level recovered?
Josh Kraft:
Zero. It was good. It was more ... Yeah, that was great.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
And then you just build up, and then the zero, the zero, the zero, and now, I think we just went from three to six months.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
This last check was my last three month, and the next is six in September. So that's definitely a satisfying, validating thing, because I was ... When it was creeping up, my thought was, "Okay, I don't have a prostate anymore, so this is in my lymph nodes." In my head, I was like, "Oh, I'm screwed. This is in my lymph nodes. I'm going to have to tell my kids," blah, blah, blah, and thank God, it wasn't.
Dr. Atish D. Choudhury:
Yeah. Yeah. So we're still in monitoring stage, but everything is looking really good to this point.
Josh Kraft:
As far as we know, yeah.
Dr. Atish D. Choudhury:
So let's talk about genetics. So you started earlier screening because of a family history of prostate cancer in your family, and so how did that discussion go initially with your primary care doctor?
Josh Kraft:
Well, I talked to the PCP about it, and I said, "Look ..." It sort of goes back to our screening talk. I said, "I want to do everything just to stay on top of it," and so at the time, my PCP, Maria said, "Look, we'll do PSA, blood draws, and digital exams, and that's what we'll do."
Dr. Atish D. Choudhury:
Okay.
Josh Kraft:
"And every time you come in once a year for your physical," and that's how we started mine. I said, "Fine," and, "Let's do it."
Dr. Atish D. Choudhury:
And so you were referred to see Dr. Judy Garber. I don't know if you remember or not.
Josh Kraft:
Yup. Yes, I remember on the genetic. I think that was, I just wanted to make sure ... Probably like every family in the world, we had some history of some cancers in the family, and I just wanted to see if that was linked genetically to me, or if I had the predisposition, I don't know if that's the right word, to get that cancer or to have it. So that's why I did the work, and I was told that I was pretty clean on most of that, on all that stuff.
Dr. Atish D. Choudhury:
Sure. So before you had the blood test, was there ever any trepidation about doing the test, about what would it mean if it's-
Josh Kraft:
No. No, I wanted to know.
Dr. Atish D. Choudhury:
Okay.
Josh Kraft:
I wanted to know.
Dr. Atish D. Choudhury:
Then, when it did result and it didn't show any particular genetic alterations, what did that mean to you?
Josh Kraft:
Well, that was good. I felt relief, but I still were going to do PSA checks, and digital, and colonoscopies, and it's funny 'cause I need to do colonoscopies every five years, not every 10, because I had polyps.
Dr. Atish D. Choudhury:
Sure.
Josh Kraft:
And I don't have a problem. Do it.
Dr. Atish D. Choudhury:
Yeah. So you understood that even though the genetic test was technically negative-
Josh Kraft:
Right. You just never know.
Dr. Atish D. Choudhury:
Yeah, that because of the-
Josh Kraft:
Oh, my mother had ovarian cancer and there was no history in her family of it, and she had it bad.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
So I'm like, "You can't control it, and you never know." So whatever screenings, even not just for those two, if there's other things, I know you all are close to other cancers, we can screen, so they'll sign me up.
Dr. Atish D. Choudhury:
Sure, sure. Absolutely. So the genetic test that we do that Dr. Garber ordered was what we call a panel test. It looks at mutations in particular sets of genes that are associated with certain cancer predisposition syndromes. So for example, you might be aware that for people who have prostate cancer, it can run in similar families as women getting breast and ovarian cancer, and there are certain syndromes that are associated with mutations in genes called BRCA1, BRCA2.
Josh Kraft:
Yeah, the BRCA1 and BRCA2.
Dr. Atish D. Choudhury:
Yup, and those weren't identified for you, but at the same time, you understood that just because that test was negative, didn't mean that you didn't have an increased risk of prostate cancer.
Josh Kraft:
Right. Right, exactly. I think you might not have the genetic disposition, but why mess around? I'd still want to stay on top of things. I mean, we all hear stories about, no history of this, never smoked cigarettes in their life, and they get lung cancer.
Dr. Atish D. Choudhury:
Right.
Josh Kraft:
So as you know, a heck of a lot better than me. Sometimes it's just a random roll of the dice, so to speak.
Dr. Atish D. Choudhury:
Yeah, and so the heritability of predisposition to prostate cancer isn't always coded in the set of genes that we actually test in the panel, so patients are very confused. "Well, why are you doing this test if the genes that might predispose me to prostate cancer are not actually included?," but it turns out that there are many genes altogether that kind of increase that predisposition to prostate cancer, and the test that we do is actually to look for particular cancer syndromes that run in family that might suggest that we should do other screening for you, like for pancreas cancer, for example, if you had a BRCA alteration, but it's also really critical then to counsel family members, like siblings and daughters, about being tested themselves for these particular mutations that are linked to cancer syndromes, because then, that would affect screening for those kinds of cancers in them.
Josh Kraft:
Right.
Dr. Atish D. Choudhury:
Do you recall having a discussion about doing some genetic testing from the tumor itself to look for the genes were altered in the tumor?
Josh Kraft:
Wasn't that like ... I think before the surgery someone came and talked to me about that for a study, and would I be willing? I said, yeah.
Dr. Atish D. Choudhury:
Yep. So we're definitely doing that kind of genetic testing as part of a research, but it's not part of our standard management. There was a discussion of potentially sending your tumor for what we call onco panel testing here at Dana-Farber, which is looking for the genes that are altered within the tumor itself, but I told you at the time, that it's not part of our standard management for an intermediate risk prostate cancer because if it were to recur, then the treatment would be the radiation and hormones. It would not be altered by the genetics of the cancer itself, but if the cancer were to come back later on, then there are genetic features from the cancer that would actually influence some treatment recommendations and clinical trials down the line. So that's probably more a time that we would consider that sort of testing.
Josh Kraft:
Got it. Yeah, no. Well, little I know, I know that genetic treatment of cancers, be it prostate or any other, is, could I say the future of treatment, and prevention, and screening, correct.
Dr. Atish D. Choudhury:
Yeah.
Josh Kraft:
So if we could be early on on that ride, I think it's important for everybody to be aware of it.
Dr. Atish D. Choudhury:
Yeah, absolutely. And so you actually discussed most of the ways that we use a lot of this genetic testing. One is to identify who to screen, second is that there's some screening tests that are based on genetics. The third is really about counseling yourself and your family members around risks of different cancers, a fourth is around sort of potential treatment options that might be available, and five is sort of prognosis, like what to expect over time, and so luckily, you've done very well with the treatments that you received, and luckily, there was no inherited predisposition that we could detect for you that would influence some later management. But this was very helpful for you to talk about your experience of this for the education of our listeners.
Josh Kraft:
Great. Well, I want to be helpful because I think we all want everybody to be cancer-free for as long as possible.
Dr. Atish D. Choudhury:
Absolutely. Well, thank you again for your help. Is there any other message that you wanted to send to our-
Josh Kraft:
I think the best ... I think I said it not in this interview, but just don't be afraid to get your PSA checked. Don't be afraid to do digital exams because granted, I had to go through a second treatment, but if you get in front of this, you can get rid of it quick. Even a lot of cancers you get early, you're dealing with it for a long time, and granted, I had to deal with this a second time, but even, as I said, things could have been a lot worse, and we think we're in a great place now. We feel like we are.
So don't be afraid. Digital exam, I know men are afraid of that. It's, what, 20 seconds, if that, less, and then get your PSA checked, and so you can just stay in, 'cause if you get it, you can get rid of it pretty easily, or in one fell swoop, so ...
Dr. Atish D. Choudhury:
And did you have questions for me that you think would be helpful for the audience to hear?
Josh Kraft:
No. None that I could think of. I think we covered it all, unless there's anything else you think I should mention.
Dr. Atish D. Choudhury:
No. I mean, from our end, we certainly advocate for screening, not necessarily only for ... There was some evidence that as screening kind of declined over the population, that a number of deaths from prostate cancer had been decreasing for many years, but then, it plateaued over time as screening decreased, and the number of patients who present to us with a more advanced stage of prostate cancer has been increasing over the past several years, and so the presentation with advanced cancer has gone up by about 5% a year over the past decade or so.
Josh Kraft:
That's a lot, though.
Dr. Atish D. Choudhury:
Which is a lot. We can often cure even more advanced prostate cancers, but the process to get there is even more complicated than what you went through. Often, the period of hormonal treatment is maybe two years, instead of six months or with more intensive hormonal treatments, and if it's advanced, again, and had spread to other parts of the body, the treatments are very, very effective and can be effective for many years and years, but it usually does involve hormonal treatments ongoing. And so for a lot of quality of life reasons, despite the concerns that people have about surgery or radiation, that taking care of things at a more earlier stage does prevent some of these more long-term outcomes and long-term problems that people can develop. So we share and echo your concern about educating the population around some benefits of screening, even though there's some controversy about who benefits into what degree, and thank you again for being willing to do this interview.
Josh Kraft:
No. Thanks for treating me and making my experience here so, I don't want to say turnkey, but so smooth.
Dr. Atish D. Choudhury:
You're very, very welcome. Thanks again.
Josh Kraft:
Thank you. Thank you.
Dr. Atish D. Choudhury:
Bye.