Pinning Down Prostate Cancer


Well i of course. Our hosts quadruple board. Certified doctor of internal medicine pulmonary disease critical care and neuro critical care and still fighting on the frontlines over the war on. Covid my very good friend. Dr steven tae back. How you doing steve. I'm well thank you as you've heard joining us from johns hopkins medicine. Doctor kenneth pinta. He's the director of research for the james buchanan. Brady urological institute. He's the co director prostate cancer research program for the sidney kimmel cancer center. He's a professor of urology. He's a professor of oncology. he's a professor of pharmacology and molecular sciences. Welcome dr to. What do you do with all your spare time can. This is not meant to be a softball question. But it's going to sound that way. I'm trying to understand from your inside. Perspective. what is it about the environment you work in a johns hopkins that produces these kind of outcomes. These ratings and the international recognition part of it is tradition. Johns hopkins was founded as the first research university in the united states and we've always placed the tripartite mention of patient care education to students and research on equal footing. So that we're always seamlessly combining those and the other piece of tradition is johns hopkins hospital in the medical school itself. We defined american medicine at johns hopkins with william oastler. Starting out saying we're gonna do medicine differently. Use the term. Medical residents started at johns hopkins. Because ostler made. The doctors live in the hospital to be trained in. So that's where the term came from. You know we have this dome at the hospital. With with the wings of the building and medicine rounds what referred to the fact that they would go round and round the dome to the different wards. And you know we carry that sort of tradition with pride and people love to work there and we've always attracted really smart people who love madison in love taking care of people and really love combining that with the research that powers the next generation of medicines. Forward dr parton. Your department chair talked about. While other hospitals use reports for urological surgery hopkins actually makes their own. Robots isn't making davinci robot. No we use a commercial robots like everyone else but what we are doing is creating the next generation of robots to work with mri machines. We have danced in. Our department is making a special robot that does that. The hopkins whiting school of engineering is developing the next generation of robots to integrate imaging with robotic surgery. A lot of that is not just hardware. it's software we're living in a pretty high tech era. We've come a long way in medicine but still so many men die of prostate cancer. What are we messing up here in. We have to do to fix this. So you know in this time of covid and so many people dying of kobe. You know it's an infectious disease. We gotta do better and we tend to forget about these other illnesses that are plaguing the planet you know if you look around the world. Ten million people a year are dying of cancer in the us. Six hundred thousand people are dying of cancer. Thirty thousand men die of prostate cancer. Every year and cancer of all kinds including prostate cancer is curable if you find it in time because we can do surgery or radiation in jewelry you but unfortunately in about fifty thousand men per year we find the cancer too late. We find the cancer. After it is escape the prostate and metastatic cancer virtually of all kinds is incurable and prostate cancer. Unfortunately metastasized spreads to the bones as first sight and it causes a lot of problems for guys in the bones including pain and eventually kills them and we can talk about how that happens but essentially we fail because we don't cure people because we don't find the cancer in time. Let me ask you a question about that. Actually because i've been quoted by colleagues that if you're fifty years old you have a fifty percent chance that you actually have prostate cancer and at sixty sixty percent chance that you've probably already have prostate cancer and so on and so forth and it would beg the question. Would it not make sense to prophylactically. Remove the prostate. And then obviously the the major impediment to that is the major side effects. What does the thought process about that in. Where are we in terms technologically of mitigating the terrible side effects of impotence and incontinence. So i think there's two aspects to that question steve that we just need to touch on because the other thing you hear. All the time is that oh prostate cancer. You don't have to worry about it. You're going to die with it not from it. You know we do see that. Eighty percent man age eighty if you look in their prostates. If they've gotten killed by a car accident you'll see prostate cancer. So essentially prostate cancer exists in two forms one form. Is this indolent slow growing low grade cancer. That probably shouldn't even be called the cancer. But it still is in we find it by screening and and those are the guys that can be treated with active surveillance. We don't need to treat their cancers where a lot smarter about that now than we were even a few years ago. The other kind of cancer is the aggressive prostate cancer. That is not the kind you find on all types whereas the kind that's growing quickly that we have to get out before it spreads so prostate cancer is definitely has a hereditary component. If you have a father or an uncle who had prostate cancer your your risk of developing prostate cancer is double if you have to family members. It's quadruples you had three family members. You're gonna get it so it is familial. There are some genetic drivers. Like vr rca to that lead to a higher incidence of prostate cancer. And we definitely say if you've have family history us should start screening sooner.

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