Dr. Zachary Klaassen:
Hi, I'm Zach Klaassen. I'm a urological oncologist in Augusta, Georgia. And I'm pleased to be joined today by Male Health Advocate, Pat Kresnak. We're at the AUA 2024 in San Antonio, Texas. Pat, thanks so much for joining us today.
Pat Kresnak:
Thank you. Thanks for inviting me.
Dr. Zachary Klaassen:
We're going to talk about a very important topic. Want to know, as dear to your heart, as well as mine in terms of mental health and prostate cancer. And I think just for our listeners, what was the genesis in your getting into this and really forming an interest in this topic?
Pat Kresnak:
Well, a few years ago, I became aware of the amount of mental health illness in the United States.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
There's some stats that say it's greater than 50%.
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
Most of it may be undiagnosed or untreated, which was long before I started having any kind of men's health issues or anything like that.
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
I was diagnosed with a pretty significant issue.
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
I started working with a support group, and along with myself, a lot of the men in that support group were struggling with the same kind of thing.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
Just the depression, the anxiety, the fear of the unknown, not knowing who to trust or not who to trust necessarily, but what to trust and the information you're getting.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
I started looking into it a little bit, and actually sought some mental health providers myself, and it was difficult, right?
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
I mean, I actually was connected with a social worker who was working more on women's issues than with men's issues.
Dr. Zachary Klaassen:
Yeah. Would you say post-pandemic, do you think this is worse than it was maybe even 10, 15 years ago, maybe we're just more aware of it now?
Pat Kresnak:
Mental health crisis in general?
Dr. Zachary Klaassen:
Just in general.
Pat Kresnak:
Well, I learned about the crisis prior to COVID.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
And I think post-pandemic, yes. I think CDC put out a report, especially in the age range of men who are susceptible or get diagnosed with prostate cancer.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
Older than 50, there's a really high level of fear and anxiety, depression, all the other mental health aspects in the population in general. But I think in the US population in general, I think we're seeing a lot more with the younger generation, young adults in particular, and kids.
Dr. Zachary Klaassen:
Absolutely. Just for by way of background, for our listeners, maybe you can share some of the statistics among prostate cancer patients, depression, anxiety, what are some of the statistics you've come across in terms of the prevalence of this?
Pat Kresnak:
In the US, there's 6 million many year diagnosed, or not diagnosed, but suffering with some form of mental health.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
Much of it is undiagnosed, but they do surveys or whatever. With regard to prostate cancer patients, depression is, well, about 17% of cancer patients experience some form of depression prior to treatment, 15 to 20% during treatment. And the number actually goes much a little bit higher after treatment because they're concerned about a recurrence.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
After patients have been treated, even if their cancer is non-detectable, there's still this fear of recurrence. There's still this fear that it could be spreading or it may spread between your blood draws and stuff like that. And that number's somewhere around 26 - 27%.
Dr. Zachary Klaassen:
Yeah. One in three, one in four of these men are having clinical depression. As you mentioned before, a lot of this is probably undiagnosed as well.
Pat Kresnak:
Yeah, yeah.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
Yeah, for sure. I mean, with the lack of resources in mental health and particular in prostate cancer treatment plans or men's health illness treatment plans, these cases may go undiagnosed because mental health is not part of the team.
Dr. Zachary Klaassen:
Yeah, absolutely. You wrote an excellent article a couple of weeks ago, and I know you're going to speak to it at the AOA and the patient summit regarding no laughing matter, mental health awareness and prostate cancer. Perhaps you can just summarize your key points from that article for our listeners.
Pat Kresnak:
Well, the one thing I have learned working with the support group and some other patients one-on-one myself, is that a lot of men make jokes about things, whether it's their health condition, whether it's their personal life, whatever it may be.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
Men are good at making jokes and making fun of themselves, which is healthy in itself, right? But for some patients, and maybe in those percentages we were talking about, that laughter and that joy and that humor may be masking some deeper issues, right? There's a number of studies out there. I cite a study out of-
Dr. Zachary Klaassen:
European Urology.
Pat Kresnak:
Yes, thank you. Which I think was around somewhere from the Nordic states, but Sweden in particular, I think it was. But anyways, their findings were that men that are at high risk suffer from severe depression, severe anxiety, the same triggers that triggers suicide.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
Most men with prostate cancer do not commit suicide. But those same symptoms or those same signs and diagnosis are there.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
And the conclusion on that article, and from some others that were cited, is that there's a need for mental health screening for prostate cancer patients.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
There's a need for mental health screening and for some patients treatment to make sure that they have the right mindset going into the treatment that they have. And a lot of that is driven by a lack of information.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
Patients, they're relying on their doctors for the information.
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
Men don't talk.
Dr. Zachary Klaassen:
Right.
Pat Kresnak:
When they're interacting with their doctors, they may not ask the right questions. In fact, most doctors will say, please bring your wife along so she can take notes and ask questions-
Dr. Zachary Klaassen:
Get the real answers.
Pat Kresnak:
Because a guy hears cancer and it's just lights out, right?
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
But men don't talk about it, so they don't ask questions. And there's really a lack of information, right?
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
I've been fortunate to partner with Artera AI and their prostate cancer tests. I've reviewed some their language with regard to making it easy for patients to understand, because patients armed with knowledge make better patients, and they make better choices. Instead of just relying on your treating team to say, we're going to follow this pathway on cancer and a guy thinking, well, okay, you're a doctor. That must be it.
Dr. Zachary Klaassen:
Yep.
Pat Kresnak:
I don't know myself whether or not it's the right way, but that's all I know.
Dr. Zachary Klaassen:
That's right.
Pat Kresnak:
But then if you have information like the prostate cancer report, you can see what the data says with regard to prognosis, long-term, short-term prognosis of the different types of treatments that are available for treating prostate cancer. That's key. Communication is key.
Dr. Zachary Klaassen:
Yep.
Pat Kresnak:
The amount of resources that we have available in the mental health field itself, whether it's for cancer patients or whether it's for young adults or whatever the social issue is, there's a shortage of that, right?
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
And so I think that one thing I talk about in my presentation related to the article is strengthening the core, right? To get more people qualified to be mental health professionals. Now, not everyone's going to be a psychiatrist or a psychologist, but social workers, patient navigators, those types of things. Removing those pathways or removing those barriers and developing clear pathways for students to follow. And having just have a recent college grad with me on this trip, this generation that is in school right now, they want quick results. They want quick pathways. That's important. But I think also what's really important is tapping into some of the minority groups that we're not tapping into.
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
The underserved students and removing those barriers and tapping into them, recruiting them and saying, hey, you could have a future here in all these different fields of mental health. And by the way, since we're talking about prostate cancer, you could specialize in this area-
Dr. Zachary Klaassen:
That's right.
Pat Kresnak:
And have a career. And then the main driver though is economics, right? Paying the bill for mental health services. A lot of insurance companies, they have higher deductible, higher out-of-pocket costs for patients. Some don't cover a lot of mental health services related to treating physical ailments, even our public healthcare services, right? Our government funded healthcare services are a little bit lax when it comes to funding and reimbursement and making sure that the patient is not experiencing an undue financial burden.
Dr. Zachary Klaassen:
Yeah. It's a great summary. I think I want to come back to the Artera AI prostate test a little bit because I think when I talk to patients in the clinic, a new patient, I tell them, there's two things we've got to accomplish. We need to decrease anxiety and we need to have a plan. And usually those go hand-in-hand. And I think to your point, a test like that where you can have a prognostic or predictive biomarker that then gives you more clarity helps with both of those things, right?
Pat Kresnak:
Mm-hmm.
Dr. Zachary Klaassen:
I think that's an important aspect of having better tests to then decrease anxiety because I think anxiety's probably even higher than depression when we talk about these patients.
Pat Kresnak:
Yeah.
Dr. Zachary Klaassen:
Great summary. I think I want to focus a little bit on, you mentioned barriers and some of the aspects of how do we make this better? And I think those are great points. Is it patient barriers? Is it physician barriers? A little bit combination of both? Why are we not better as a patient and a physician team at treating and even recognizing mental health?
Pat Kresnak:
Yeah. I think it's a bit of both, right?
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
You've got patients who don't know what to ask. You've got patients who, I mean, their life is just clicking along and they've got everything they have. Everything's working right, presumably. Their personal life, their work life, etc. Or even if they're retired and they're looking at their golden years, and then all of a sudden they get a devastating diagnosis of a serious men's illness, right? And so that has a big impact on the patient.
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
And the patient, without information, without knowledge, they do internet searches, etc. They're afraid, right? And it raises that anxiety, how am I going to pay for this? What are my friends going to think?
Dr. Zachary Klaassen:
Sure.
Pat Kresnak:
I don't want to burden my wife. I don't want to burden my kids with my problems. On the patient end, you have that aspect. And on the clinical end, I think by treating physicians, we're great.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
Okay.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
What I hear is a lot of times that the treatment teams are not good communicators in themselves, right?
Dr. Zachary Klaassen:
Mm-hmm.
Pat Kresnak:
They're not listening, or maybe they're listening, but they don't know what to listen for in terms of signs of mental distress, right? And so there's that. I think, I don't know in your practice what the clinical setting is when you have these discussions with patients, but sometimes in some of the treatment facilities, having these conversations in a treatment room, which is not the most comfortable place to have discussions about what your diagnosis is, what it means, and what your treatment plan should be.
Dr. Zachary Klaassen:
Yeah. Great answer. As we wrap things up, thank you for your time for being an advocate and for doing this. But I'd like to have you summarize a couple of take home points, maybe from the patient side, what patients should be listening for, and also from the clinician side.
Pat Kresnak:
Well, from the patient side, listen from both on the communication. And so from the treating team and from the patient, listening is key, right? Don't just listen for what you want to hear, right? Listen to what the people are saying. If you're a doctor, listen to what the patient is saying. If you're a patient, listen to what your doctor is saying and have some faith in them.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
And then I think, again, in order to address the mental health crisis universally throughout the United States and applying some of those resources to men's health issues, we really do need to strengthen the core. We need to start recruiting and start educating and start removing some of the barriers for perspective mental health professionals in the future.
Dr. Zachary Klaassen:
Yeah.
Pat Kresnak:
And then dealing with the economics. I mean, it's so complex. There's so many different factors. I think there's political factors because we're talking about the politics of government insurance policies. You're talking about the politics of private insurance policy, you're talking about access, right? I mean, a lot of patients don't have access to healthcare, much less mental healthcare. There's access and then there's the cost. What is the business model that you can build to say that there is a payoff for treating mental health issues for prostate cancer or for other men's health issues? There is a payoff, there is a payback in terms of financially, but most importantly for the patient himself.
Dr. Zachary Klaassen:
Yeah, it's great points. And I think as part of a survivorship care plan, there's no question mental health needs to be at the pinpoint, at the top of that pyramid. Thank you again, phenomenal discussion, and I appreciate your time.
Pat Kresnak:
I appreciate you. Thank you.