A Mediaplanet Guide to Prostate & Mental Health
Men’s Health & Wellness
Brandon Marshall The former NFL wide receiver shares how a mental health diagnosis changed his life for the better
The new innovation revolutionizing prostate cancer treatment How men are avoiding cancer treatment side effects
JUNE 2021 | FUTUREOFPERSONALHEALTH.COM
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Adapting Prostate Cancer Support for the COVID-19 Era National prostate cancer support group networks transitioned from in-person to text and video-based meetings during the pandemic. The new opportunities for people challenged by distance and time were positive. Thousands of men who previously had not considered attending support groups joined and benefited from online communities. However, many hundreds of men who previously attended in-person groups do not own computers and have no interest in or sufficient money for buying one. These men lost access to their reallife support group friends and cancer mentors. Malecare’s mission Malecare tries to address this problem by asking our support group leaders to telephone group members without computers. The feedback was entirely positive. The computer-shy men received concrete and life-saving information as well as human connections that they feared COVID-19 had taken away. Indeed, all of the men who were happy for this intervention were men who lived alone and were reluctant to ask family or friends for help. Most were also men of color. Life-saving measures The computer-savvy volunteers quickly learned to not make assumptions or judgments about their computer-challenged peers. They listened and helped find the online information that men with prostate cancer need to live longer and happier lives. The volunteers learn from each other what kind of online information is helpful for quality of life, longevity, financial safety, and pain-free death. The volunteers then search, print, and mail the information to their peers. Most people who volunteer are confident that many of the men they help would not be alive today were it not for this unique intervention. Connecting men with computers with those without is an efficient and low-cost way to help those in our community, and it’s an easy way to make critical information available to all men with prostate cancer. Darryl Mitteldorf, LCSW, Executive Director, Malecare.org
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What Rising Prostate Cancer Rates Mean for You Jamie Bearse President & CEO, ZERO The End of Prostate Cancer
This Men’s Health Month, it’s important to learn your (or your loved one’s) risk of prostate cancer, since more men than ever before are expected to be diagnosed with the disease this year. Prostate cancer cases are expected to reach a historic high this year, with new diagnoses jumping an alarming 30 percent from last year, with nearly 250,000 men learning their life is about to change due to a prostate cancer diagnosis. And, sadly, there’s a 3 percent rise in prostate cancer deaths anticipated this year — deaths that may have been prevented if the cancer was caught early. When prostate cancer is caught early, survival rates are nearly 100 percent.
But, when caught late, survival rates drop to a startling 30 percent. Remaining vigilant More than a quarter of men who will pass from cancer this year will be prostate cancer patients, making it the second leading cause of cancer death among American men. Talk to your doctor about getting screened for prostate cancer, and make an informed decision on your treatment plan. It’s important to discuss your family history of prostate and other cancers, as well as other key risks such as race, military service, or chemical exposure, with your physician. You can reduce your risk of life-threatening prostate cancer by taking steps to promote
your overall health — like eating a balanced diet with an emphasis on plant-based meals, exercise, and maintaining a healthy weight. Starting the conversation This year, a man will be diagnosed with prostate cancer every two minutes, and a man will pass from the disease every 15 minutes. Talk to your physician and the other men in your life about the importance of early detection for prostate cancer. Starting the conversation can be all it takes to open the door to a lifesaving health intervention for you or someone you know and love. Learn more about prostate cancer screening and find a testing site near you at zerocancer.org. n
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Publisher Arianna DiBella Business Developer Joelle Hernandez Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Celia Hazard Lead Editor Mina Fanous Copy Editor Taylor Rice Partnership and Distribution Manager Jordan Hernandez Director of Product Faye Godfrey Cover Photo Courtesy of House of Athlete All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.
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5 Things to Know About PSMA-PET
The U.S. Food and Drug Administration (FDA) recently approved a highly sensitive new body scan.
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he test, referred to as PSMAPET, can help doctors find cancer that may have spread beyond the prostate so it can be targeted for better treatment. Here are the five things you need to know about PSMA-PET: What is PSMA-PET? PSMA stands for prostate-specific membrane antigen. PSMA is a protein found mainly on prostate cancer cells. PET stands for positron emission tomography. PET is a scan that uses a special dye with
radioactive tracers to scan the body for cancer. So, PSMA-PET is an exciting new body scan that can potentially help doctors see and track hard-to-find prostate cancer earlier than current imaging techniques. How does PSMA-PET work? During a PSMA-PET scan, doctors inject patients through a vein with a small radioactive molecule. This radioactive tracer will be attracted to PSMA on the surface of prostate cancer cells. When the scan is complete, the radioactive part will light up,
giving doctors a clear image of exactly where prostate cancer may have traveled to in a man’s body. Researchers believe PSMA-PET will be a more accurate way to find where prostate cancer may have spread in the body, even in tiny amounts (as small as a garden pea), so it can be more effectively treated. Is the radiation in PSMA-PET dangerous? The simple answer is no. The idea of having a radioactive molecule injected into your body may sound scary, but the
molecule — called Gallium-68 — is very safe. It is given in extremely small quantities, and no adverse side effects have been reported among hundreds of thousands of patients receiving PSMA radiotracers. It was recently approved by the FDA after years of clinical testing. You are exposed to some amount of radiation through any PET scan. However, the amount of radiation exposure from a PSMA-PET scan was found to be lower than with current standard-of-care imaging techniques.
Is PSMA-PET right for every prostate cancer patient? The current FDA approval is for two main groups of patients: 1. men with highrisk prostate cancer before treatment with prostatectomy or radiation therapy, and 2. men who have already been treated for localized prostate cancer who have a rising PSA level, according to Thomas Hope, M.D., a Prostate Cancer Foundation-funded researcher and one of the lead investigators in PSMA-PET. In essence, these are patients whose prostate cancer may have spread. The PSMA-PET scan is used to find out whether distant disease is present, and, if so, exactly where it is located in the body so it can be treated. Where can I get PSMA-PET? Following the FDA approval, the Gallium-68 PSMA-PET scan is only available in two centers in California: University of California, Los Angeles and University of California, San Francisco. Despite its limited availability at the moment, it’s important for patients to see this new FDA approval as a huge step forward. The approval opens so many doors for the future of PSMA-PET. Other cancer centers may be able to offer this scan in the near future, and additional imaging agents are likely to be approved shortly. In fact, by the time you read this, you may be able to check with your doctor about other options, including 18F-DCFPyL. To find out more about prostate cancer and PSMAPET, visit www.pcf.org . n
Prostate Cancer Foundation
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One of the top three cancers for men is prostate cancer, which will affect approximately 30,000 African American men this year. African American men have, by far, the highest incidence of prostate cancer compared to men of other ethnicities. One in 6 African American men will be diagnosed with prostate cancer, and they are more likely to get prostate cancer at an earlier age. They are also more likely to have aggressive tumors that grow quickly, spread, and cause death. The reason why prostate cancer is more prevalent in African American men is unclear, yet it may be due to socioeconomic, environmental, diet, or other factors. Men with a family history of prostate cancer also face a higher risk of developing the disease. A man is 2-3 times more likely to get prostate cancer if his father or brother had it. This risk increases with the number of relatives diagnosed with prostate cancer. The age when a close relative was diagnosed is also an important factor. Being proactive Staying on top of routine health checkups and screenings, especially during the COVID-19 pandemic, can be hard enough within busy day-to-day life. But African American men fall into a high-risk group for a myriad of health concerns including prostate cancer, high blood pressure, diabetes, and obesity, so it is of great value to check for these concerns on a routine basis. Download the free “Health Screenings Every African American Man Should Know” poster to learn more about basic health numbers and screenings to help African American men keep their health in check. As well as showing key timelines, this free download also reviews health numbers that can be helpful when speaking with your doctor(s) about the best health plan for you. Please download this checklist and share it with your loved ones. Knowing your risks and being proactive will help you take steps toward leading a healthier life. Brian Keith McNeil, M.D., Chief of Urology, The University Hospital of Brooklyn
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Former NFL Player Brandon Marshall Shares His Experience With Borderline Personality Disorder Brandon Marshall, former NFL wide receiver and current sports TV personality, was well into his football career when he received his diagnosis of borderline personality disorder (BPD).
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randon Marshall had played for several different NFL teams, including the Denver Broncos, the Miami Dolphins, and the Chicago Bears, but he had had trouble overcoming a reputation of being “difficult.” On July 31, 2011, he publicly announced his diagnosis of BPD while simultaneously pledging to be a mental health advocate. “It wasn’t until I was on the campus of McLean Hospital that I knew what borderline personality disorder was, or that I was experiencing any of the symptoms,” Marshall says. “I had no clue I had it, and it went undiagnosed for around four years.” Diagnosing BPD Borderline personality disorder is largely defined as a condition marked by insufficient regulation of emotions, which can lead to unpredictable mood swings, unstable emotional responses, poor self-image, and depression, among other symptoms. An estimated 1.4 percent of the United States population has BPD, but research suggests that the number could be much larger, as BPD is notoriously difficult to diagnose. Marshall says his diagnosis was the first step in changing his life for the better. “When I first received the diagnosis of borderline personality disorder, I felt like I was already 50 percent better because now I knew that there were others like me,” he says. “Being able to go to [a therapy] program for three months radically changed my life.”
Eliminating the stigma Marshall received treatment and mental health support, and with time he was able to learn how to process, cope, and manage stressors in his life. “I picked up tools and skills to self-regulate,” he says. With these tools, Marshall now is turning his focus towards advocacy. A large part of advocating for people suffering from BPD involves destigmatizing mental illness. “The most important thing we can do right now for the mental health community is to eradicate the stigma,” Marshall stresses. “Storytelling and vulnerability in this space are crucial.” Diagnosis gender gap Marshall’s story is especially crucial to tell, as men are less likely to get the mental health support that they may need. According to the National Alliance on Mental Illness (NAMI), nearly 75 percent of those diagnosed with BPD are women, but recent studies suggest that there may be just as many men suffering from the condition. However, men are more often diagnosed with PTSD or depression rather than a personality disorder. “NAMI is a great starting point for people seeking information and seeking help,” Marshall says. “They have resources and can help you navigate through what’s out there for assistance in your mental health journey.” n Lauren Hogan
PHOTO: COURTESY OF HOUSE OF ATHLETE
African American Men at Higher Risk for Many Health Issues
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The Care Saving You From Prostate Cancer Side Effects More than 248,000 men will be diagnosed with prostate cancer this year, but not all of them will need surgery or radiation. Instead, many low-risk patients can safely be monitored through active surveillance. “The term active surveillance implies that you have an untreated cancer,” says Christian Pavlovich, director of the prostate cancer active surveillance (AS) program at the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer. “AS is appropriate if the cancer is not very aggressive and if we’re concerned that the treatments are potentially more toxic than the chance that the cancer itself will spread, so we withhold treatment for those men.” With AS — now considered a standard of care in early disease states — doctors hold off on surgery or radiation because they don’t think the prostate cancer is likely to progress for a long time, if at all. The patient receives regular testing and is monitored over time. Pioneering model Johns Hopkins has been a leader in AS for over 20 years, especially because of its patient risk stratification work, which includes refining and optimizing its surveillance strategy. For example, prostate cancer patients under AS get their PSA checked every six months and MRIs done approximately
The five-year survival rate for prostate cancer patients is 97.5 percent.
every two years, as well as episodic prostate biopsies, all of which reassess whether the cancer may have progressed or gotten more aggressive. They also developed a personalized predictive model called the Johns Hopkins ActiveCare Tool, an algorithm that predicts a patient’s longitudinal suitability for surveillance. “Every time a patient enters the surveillance program, that person’s data goes into the hopper and informs the predictive model,” Pavlovich said. “The tool tells you what the chance is that there would be more aggressive cancer in the prostate; when that prediction, for example, becomes 20 percent, 30 percent, 40 percent or more,
we increasingly worry that we should pull the trigger on intervention and offer curative treatment.” Personalized precision medicine Monitoring and treatment plans are tailored to a patient’s risk level and testing results, and patients get individualized risk predictions for whether they’ll have more aggressive disease. Patients appreciate the surveillance approach because they do not have to worry about the side effects of prostate surgery and other treatments, including urinary incontinence and erectile dysfunction. However, surveillance is not for every man, as there can be anxiety in living
with a known, albeit minimally aggressive, cancer. Pavlovich, who has 20 years in the urology field, said that before surveillance existed, most localized prostate cancer patients were offered radical prostatectomy or radiation therapy. The surgeries were high risk, including blood loss that often required a blood transfusion, as well as residual high rates of scarring at the bladder outlet. These days, surgery, if needed, is more precise than ever. Pavlovich said surgeries went from an open radical retropubic approach to a laparoscopic approach, and now to a robot-assisted laparoscopic approach, with finer instrumentation at every iterative change.
Looking ahead PSA is one of the most famous biomarkers. Now, Pavlovich and his colleagues are looking to see if there are other biomarkers that could indicate prostate cancer. “The most exciting thing that I worked on in the lab the last five years is the ability to collect a patient’s urine after a prostate exam, and actually find or look to get prostate cancer cells in that urine,” he said, describing another breakthrough. Pavlovich is optimistic about prostate cancer diagnosis and care. “I think the amount of safety that’s been added to the diagnostic and therapeutic armamentarium to diagnose and treat prostate cancer has been unbelievable,” concludes Pavlovich. “We’ve reduced the number of people who need treatment, we’ve made the treatment safer, and in the last couple of years, we’ve even made biopsies safer. n Kristen Castillo
To learn more about active surveillance and precision medicine, visit hopkinsmedicine.org/ inhealth/precisionmedicine-centers/ prostate-cancer/
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Diagnosing Bladder Cancer Despite it being the sixth most common cancer in the United States, most patients never knew that bladder cancer existed before their diagnosis. There are no routine screening tests for bladder cancer. The most common clinical sign is painless gross hematuria — blood in the urine that can easily be seen. The hematuria may be occasional and short-lived, and there is likely to be no pain associated with the bleeding. This can cause patients to postpone seeking immediate medical care. In some cases, there is not enough blood for a patient to see (microscopic hematuria), and it is only detected with the help of a urine cytology test done by a physician. Other common bladder cancer warning signs, such as increased urgency and frequency of urination, can also be signs of other urologic conditions. Diagnosing To make a bladder cancer diagnosis, a urologist, the medical specialist for urinary diseases, performs a cystoscopy. A narrow tube with a lens on the end allows the urologist to see inside your urethra and bladder, so they can examine these structures for signs of disease. Many patients with the signs above are not referred to a urologist until after their doctors have treated them for possible urinary tract infections. This can lead to a delay in diagnosis. Staging Bladder cancer is “staged” based on the location of the tumor in relation to the inner lining (urothelium) of the bladder. If a tumor has not grown into the muscle wall of the bladder, it is non-muscle invasive bladder cancer. The tumor can be removed, and local treatments can be put into your bladder to reduce the risk of the cancer returning. Once it grows into the muscle wall of the bladder, because the chance of the cancer spreading to other parts of the body increases, the medical team may suggest removing the bladder (a cystectomy) to reduce the risk of disease progression. A new way for urine to leave your body, called a urinary diversion, is created. When someone is diagnosed with advanced or metastatic bladder cancer, a medical oncologist may be part of the care team. Evidence that the cancer has spread to nearby organs requires more systemic therapies like chemotherapy, immunotherapy, or even targeted therapies. To find more information, answers, and support, visit BCAN.org Stephanie Chisolm, Ph.D., Director of Education and Research, Bladder Cancer Advocacy Network
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The Value of Shared Decision-Making Although a cancer diagnosis can make you feel alone, you never are. Shared decision-making can help you make confident treatment decisions.
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or most men, prostate cancer is a slowly progressing disease with many decisions to make. Patients usually have time to gather information and take charge of those important treatment decisions. But those decisions can be complicated and stressful. Decisions might include: Should I get a PSA test? What does my PSA score mean? Should I have a biopsy? Do I need treatment? What treatment is best for me? Surgery? Radiation? Active surveillance? Which doctor would best provide the treatment I have chosen? Should I get a genetic test? What should I tell family members? These choices can be overwhelming. Fortunately, we don’t have to make the decisions alone. We can get advice and support from trusted sources, our shared decision team. Our medical team When you see your doctor, physician’s assistant, or nurse, arm yourself with questions you have thought of in advance. Question whatever answers you don’t understand. Never hesitate to get a second or even third opinion before making an important treatment decision. Our caregivers Be open and direct with your spouse, partner, or
other caregiver, and listen to their concerns. Your decisions will affect them. If possible, bring them along to your medical appointments to help ask questions and take notes. Our research The internet is full of information and advice for prostate cancer patients. Choose trusted organizations such as Us TOO and ZERO for information and decision guides that have been vetted by medical professionals. Our support group members When you attend a support group with other prostate cancer patients, you get the benefit of their real-world experience from the patient’s perspective. What worked for them? What didn’t? What would they do differently? You can find a virtual or in-person support group at https://ustoo.org/Support-Group-Near-You. Ultimately, the decisions we make about our bodies, our health, and our lives belong to us. However, by sharing our concerns with our medical team, our caregivers, and with others who have faced these same challenges, we can make informed decisions with courage and with confidence. n Marty Chakoian, Support Group Leader, Chair, Board of Directors, Us TOO International
Increasing African American Participation in Prostate Cancer Clinical Trials The participation of African American patients in prostate cancer clinical trials rarely reaches the level of statistical significance. Since this is the U.S. population with the highest incidence and mortality rates for the disease, this level of participation calls into question the results of prostate cancer clinical trials for African American men and all men in general. Within the medical community, the most widely cited reasons for this low participation are the Tuskegee experiment and the resulting lack of trust in the medical system. The Tuskegee study, where Black men were put into a syphilis experiment for 40 years and denied available treatment, was certainly horrific enough to have a lasting impact. However, are the Tuskegee after-effects
truly limiting 2021 cancer clinical trials? The Prostate Health Education Network (PHEN) focuses on raising clinical trial awareness among African American patients. PHEN’s mission is to eliminate the prostate cancer racial disparity and raise clinical trial participation to statistical significance. We conducted a survey of our network members in early 2021 for patients’ perspectives on clinical trial participation. Clinical trial awareness One hundred-and-eight men responded to the survey. 10 percent had participated in a clinical trial before, and 81 percent had not. Of those who had not, 43 percent answered that their reason for not doing so was that they had not been asked. Another 11 percent answered, “I do not know enough about clinical trials’
risks and benefits.” Only 1.8 percent cited Tuskegee as their reason for not participating. Clearly, the patients’ perspective differs dramatically from the medical community’s regarding why African American participation is so low. Increasing participation Patient responses to another survey question provide useful insights into what approaches could be effective towards increasing clinical trial participation. We asked, “What would be the most important things for you to consider participating in a clinical trial?” The leading responses were: an effective treatment or diagnostic option for myself (55 percent); minimal potential side effects (45 percent); and to contribute important information to medical science (45 per-
cent). It is certainly expected that patients are most interested in finding trials that are beneficial to them with minimal side effects. However, contrary to being distrustful of the medical community, patients indicate a strong interest in supporting medical science. I strongly believe that increasing African American patients’ clinical trial participation is achievable and that there are opportunities and paths forward. An understanding and acceptance of the real obstacles as well as discarding long-held myths are imperative. Building trusting and working relationships between the African American patient community and the organizations conducting clinical trials is a must. n Thomas A. Farrington, President, Prostate Health Education Network
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The New Game-Changing Prostate Cancer Treatment Traditional prostate cancer treatments come with a 50 percent risk of erectile dysfunction and up to a 25 percent risk for urinary incontinence. HALO Diagnostics (HALO Dx) is drastically improving those odds with laser focal therapy. “I’m a science and engineering guy. This procedure just made sense to me,” says Tom Lowell, who decided to treat his prostate cancer with laser focal therapy (LFT), also known as focal laser ablation (FLA). Lowell, like many men facing a prostate cancer diagnosis, was told he needed a radical prostatectomy — a full, surgical removal of his prostate.
Whole gland prostate cancer treatments like radical prostatectomy and radiation therapy put delicate nerves and muscles that regulate erectile function and urinary control at high risk. Damaging these structures can cause permanent impotence and urinary incontinence. In LFT, HALO Dx doctors use MRI technology and heat maps to target and destroy prostate cancer cells with a laser fiber in real time. The treatment site visualization and laser-precision afforded by LFT minimizes the risk of collateral damage. HALO Dx LFT patients have a less than 10 percent risk of erectile dysfunction, and less than a 3 percent risk
for urinary incontinence. Unlike a radical prostatectomy, LFT is performed in an outpatient setting and does not require radical surgery, general anesthesia, or hospitalization. “Planning treatment for a man with localized prostate cancer, or BPH (enlarged prostate), no matter how small or advanced, should be personalized, safe, and precise. LFT makes that possible,” says Dr. John Feller, chief medical officer for HALO Diagnostics. Dr. Feller, alongside HALO Dx chief research officer, Bernadette Greenwood, performed the very first outpatient LFT over 11 years ago. Patient results published in the peer-reviewed Journal of Urology show a 100 percent
prostate cancer specific survival rate to date. Lowell, now 5 years after laser surgery, says he has no side effects from the procedure. “Get the latest and greatest technology, zap the cancer, leave everything else alone,” says Lowell. “I’m so glad I had this option.” n Michael Uhl, Former Patient, CEO, HALO Dx
To learn more visit www.halodx.com
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