Dealing with Salvage Radiation Side Effects for Prostate Cancer- One Mans Extraordinary Journey

NBA superstar Grant Hill, also an Atlanta Hawks co-owner, and African American health advocate, has teamed up with  Dendreon to combat the prostate cancer racial disparities experienced by African American men.  He discusses, along with Cancer ABCs CEO Joel Nowak, how men, particularly African American men, can combat the disparities.  

They focus on how a man can develop their own playbook to beat prostate cancer,  what role a man should play with his doctor and the importance of becoming an educated patient.   

Mr. Hill shared a program he has started with Dendreon called Start Strong.  Start Strong (www.startstrong.us)  is focused on raising awareness of the racial disparities in prostate cancer incidence and the importance of talking to your doctor about the best treatment options.

Please note that during the interview, Mr. Hill provided the wrong web address for the Start Strong Program.  The correct address is www.startstrong.us. 

Overall survival and cancer-specific survival for those with node-positive prostate cancer treated with surgery lived longer than those who elected radiation treatment. 

Men diagnosed with node positive prostate cancer need to decide if they want to include a targeted treatment to their prostate gland along with a systemic treatment like hormonal therapy. 

Most men who elect to include a targeted therapy will choose between either surgery or radiation.  A retrospective observational study concluded that men who did elect to use surgery as opposed to radiation lived longe.

Read the study at;
https://onlinelibrary.wiley.com/doi/10.1002/pros.24317

Cancer ABCs would like to thank:
Foundation Medicine
Myovant
 Bayer
 Dendreon 
for their continued support of our podcast program. 

https://ard.bmj.com/content/early/2021/08/22/annrheumdis-2021-220597

 As per the link above, individuals taking the drug methotrexate experience an up to 62% reduced rate of an immunological response when given a mRNA Covid-19 vaccination like to Pfizer and Moderna vaccines.  This finding suggests that patients on methotrexate may need alternate vaccination strategies such as additional doses of vaccine, dose modification of methotrexate or even a temporary discontinuation of this drug.

In this podcast, Joel Nowak from Cancer ABCs, who is taking methotrexate, after having is booster shot of the Moderna vaccine was informed by his doctor that he should have not received the injection without having made a modification in his methotrexate.   Joel talks about his frustration and anger that he was not informed about this complication when the research was first published, three months prior to his receiving his Covid-19 booster shot.  

 Joel shared his current plan to discontinue taking methotrexate and hope that the booster will still create some antigen effect.  He will follow up in a few weeks and check his antigen level (blood test) and then if he hasn't received an adequate result go on a campaign to obtain an additional Covid vaccination booster while still remaining off methotrexate.

Joel’s story should serve as a warning to anyone taking methotrexate that they need to discuss this issue with their doctors prior to having a mRNA Covid-19 vaccination.  


Cancer ABCs would like to thank its podcast sponsors for their support of this podcast program.  Our sponsors include:

• Myovant/Pfizer
• Foundation Medicine
• Bayer 
• Dendreon

When you are first diagnosed with cancer, when the doctor says to you have cancer, you are likely to have many different responses. Among these first possible responses are fear, apprehension, disbelief, sadness, anger, dread, or even denial. Any and all of these reactions are reasonable and normal.

The question is how do you chose to deal with these feelings?  

Everyone's cancer is different and how we as individuals deal with our cancer is also different. However, developing a specific mindset, taking personal responsibility for yourself and your medical care, learning about your disease and  deciding on how you are going to come to grips with your reality will immediately influence you today and tomorrow. 

We all have choices to make, the choice we eventually make will have repercussions from today until the day we die.  Making better choices is hard, but so much of our future is dependent on the choices and decisions we make from today and on. 

In this podcast, Joel Nowak shares some lessons he has learned about being diagnosed with cancer.  Joel has been told he has cancer on six different occasions.  He has been diagnosed with 5 different cancers (thyroid, renal (kidney), melanoma, prostate and appendiceal (appendix cancer) as well as a prostate cancer recurrence five years after his primary treatment. 

Cancer ABCs would like to thank its podcast sponsors for their support of this podcast program.  Our sponsors include:

• Myovant/Pfizer
• Foundation Medicine
• Bayer 
• Dendreon

Joel Nowak and Shane Norris discuss his unusual Covid Pandemic Journey with a new prostate cancer diagnosis.  Shane, a well-respected music producer and gig worker, joined with other New Orleans artists to raise funds for out-of-work musicians.  As he began to create a fund raising vehicle he was diagnosed with prostate cancer.  

Shane shares the experience he had navigating the Covid pandemic as he searched for the prostate cancer treatment that he felt best suited his needs.  With financial support raised from a GO-Fund-Me project as well as help and guidance from a number of resources, including medical professionals, family and friends, Shane decided to become the first man in Louisiana to treat his prostate cancer with high intensity focused ultrasound – or HIFU. 

Despite Shane having to learn about prostate cancer and potential treatments and their possible side effects, in the middle of a pandemic, he and his colleagues managed to raise and distribute $400,000 to out-of-work New Orleans artists.   

Some Important Additional Information:
 1-  High Intensity Focal Ultrasound (HIFU) currently has a CPT code, and is covered by Medicare, with a deductible. HIFU is also covered by some private insurance carriers for both initial treatment and as a salvage therapy.  Please check with your insurance carrier (Medicare and private carriers) to confirm your specific coverages.  With the CPT code urology practices can now submit claims to private insurers which are evaluated for reimbursement on a case by case basis. 

2-  Shane's personal experience with side effects from his HIFU treatment does not guarantee that others having HIFU will have the same experience.  Following HIFU patients may be required to have a catheter inserted for 3 to 7 days.  The risk of having the more common side effects of urinary incontinence and sexual dysfunction seen in treating the entire gland are minimized due to HIFU's targeted nature of  tumor ablation. 

Cancer ABCs would like to thank its podcast sponsors for their support of this podcast program.  Our sponsors include:

• Myovant/Pfizer
• Foundation Medicine
• Bayer 
• Dendreon

Radiopharmaceutical scans (PETS) are a vital tool in our fight against cancer. 

These special PET scans allow us to make earlier cancer diagnoses while a cancer is still contained in the original organ.   With an earlier diagnosis, treatments can still stop the cancer before it is able to move to other parts of the body, or become metastatic.  

These special scans also are our best tools to evaluate whether our treatments are working, or if we have developed resistance to the treatments.  FDA approved treatments are limited, so we have  to take full advantage of them while they work.  Since most treatments will eventually stop working, we need to also have an immediate and accurate way to measure whether we are still benefiting from our treatments, or have developed resistance to them.

Sadly, the future of these scans is in jeopardy.  The current insurance reimbursement schedule only supports the use of these scans for three years, after which reimbursement rates might not cover the costs, making these very important scans unavailable despite having been approved by the FDA.  Currently these scans could be looking  at a 3 year life, after which adequate reimbursement might disappear (as will the availability of the scan to patients). 

Cancer ABCs is working to change the law so that reimbursement of these scans will keep them affordable and available as we need them.  Join us and help us preserve the availability of these scans.  To learn more about this issue,  and to lend your support, reach out to us at info@CancerABCs.org

Cancer ABCs would like to thank its podcast sponsors for their support of this podcast program.  Our sponsors include:

• Myovant/Pfizer
• Foundation Medicine
• Bayer 
• Dendreon

Joel T Nowak from Cancer ABCs discusses with Dr. Rana McKay, Associate Professor of Medicine at the Moores Cancer Center at the University of California in San Diego,  her recently published article that analysizes real world data that demonstrates that Provenge (sipuleucel-T), an immune therapy for castrate  resistant metastatic prostate cancer (mCRPC), can reduce the risk of death over and above the newer  hormone treatments that have been FDA approved . 

Dr, McKay evaluated a large medicare data base and determined that despite the addition of the many second generation hormone treatments like Zytiga and Xtandi,  Provenge continues to lower the risk of death for men with mCRPC.  

Dr. Mckay also shared a peek into the future of additional immune therapies for prostate cancer as well as sharing information about the newly FDA approved part inhibitors.  

Cancer ABCs would like to thank its podcast sponsors for their support of this podcast program.  Our sponsors include:

• Myovant/Pfizer
• Foundation Medicine
• Bayer 
• Dendreon

One of the most common question men with prostate cancer ask us at Cancer ABCs is if they can stop their hormone therapy (ADT) when they go on a second generation hormone treatment like abiraterone (Zytiga).

A recent analysis of the SPARE Trial points us in the direction that it might be possible to halt ADT when you are taking Zytiga.  SPARE was a small trial which needs to be replicated by a larger trial before we can gain confidence in this conclusion. 

SPARE did not evaluate what, if any change. stopping ADT  when you are on Zytiga might have on survival, economic costs and the quality of life.  

Men who have a local prostate cancer recurrence, or their PSA starts increasing, after having prostate cancer surgery (a radical prostatectomy), the treatment of choice is considered salvage radiotherapy (SRT). In the post prostatectomy setting, SRT may impose significant risks and complications.

Potential complications or side effects can include incontinence, bladder neck contracture, bladder and bowel symptoms, needing secondary procedures, as well as secondary malignancies. Radiation should never be considered non-invasive, but it can halt the progression of the cancer. Therefore, reserving radiotherapy for those who will most benefit is of great concern.

In this podcast Joel Nowak speaks with Mr. John Harrison who had salvage radiation and has experienced many of these side effects.  On two occasions John has used Hyperbaric Oxygen Treatment which he describes as well as having a colostomy to allow his colon to  rest and hopefully heal.  

In addition to having deal with radiation toxicities, he still has to be treated for his progressing prostate cancer.  John has just completed a Phase II Clinical Trial as well as using Lupron, aka Hormone Therapy (ADT). 

To date, John has had limited relief from his symptoms, but his cancer is under control. 

John shares his journey and experiences treating his side effects from both the surgery and the salvage radiation. Despite all of his symptoms he maintains a positive attitude and reminds us that his experiences are his and do not reflect what others might experience.

John considers himself an outlier. As an outlier he offers some sage advice for all of us who are being treated for prostate cancer.  

Genetic testing plays a major role in identifying an individual's risk for developing cancer as well as the management of many different cancers, including prostate cancer.  It's important that we patients know the limits of a key federal privacy law that is supposed to protect us when we do have a genetic test.

In June, 2020, there was a  new set of recommendations on the use of genetic testing published by the International Philadelphia Prostate Cancer Consensus Conference that strongly endorses the testing of all men with metastatic prostate cancer to aid with treatment decisions and to assess eligibility for clinical trials.

 It is important that we understand that there are significant limits to the Genetic Information Nondiscrimination Act (GINA) of 2008, which was written to protect against discrimination in employment and medical insurance for people with known genetic risk factors for diseases, including cancer.