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Melanie Cole (Host):  Welcome. Today, we’re talking about cancers of the urinary tract and my guest is Dr. Madhumitha Reddy. She’s a Urologic Oncologist and a member of the medical staff at Temecula Valley Hospital. Dr. Reddy, I’m so glad to have you joining us. Please tell us what constitutes urinary tract cancers?

Madhumitha Reddy, DO (Guest):  Thanks for having me Melanie. And thank you for to Temecula Valley Hospital for giving us a forum to talk about these cancers. So, cancers of the urinary tract, it’s a wide list. The most common being prostate cancers, bladder cancers, and kidney cancers. There’s also other less common cancers like testicular, urothelial carcinoma and a bunch of different cancers but the three that I mentioned are the most common.

Host:  So, how common are they? Are these pretty prevalent? Tell us a little bit about the incidence of them.

Dr. Reddy:  Yeah, they are very prevalent. Prostate cancer by itself it’s the second leading cause of cancer death among men. It’s also the most common cancer in men in America. There’s about 31,000 cases of death due to prostate cancer every year. So, it’s very common and 170,000 cases that we diagnose every year of prostate cancer. Now kidney and bladder are less common. Maybe 80 to 90,000 cases per year but prostate cancer is very prevalent.

Host:  Well then let’s talk a little bit about prostate cancer. So, tell us a little bit about screening and what the current recommendations are at what age. What are the screening tests so that we can determine if a man has prostate cancer?

Dr. Reddy:  Definitely. So, screening for prostate cancer had been a little bit controversial but right now, we have very good guidelines. And the guidelines are based on primary care physicians and urologists coming together to come up with the set of guidelines. So, the recommendations currently are patients who are from 55 to 70 years of age; should get a PSA and a prostate exam. A PSA is a blood test. And a prostate exam by their primary physician every two years. Now these are patients who don’t have family history of prostate cancer or African Americans because those subset of patients were never included in the testing that we do.

Less than 55 years old, it’s an individual decision between the patient and their doctor. And over 70 years, it’s no recommended to screen for prostate cancer.

Host:  When people think of screening, then they also think of symptoms for cancer Dr. Reddy. What are some signs and symptoms that might suggest a urinary tract cancers? We’ve all heard about urinary infections and things that might go along with that. But what about cancer? Are there some signs and symptoms?

Dr. Reddy:  So, if we are talking generally about broad list of cancers of the urinary tract; yeah there are a few signs and symptoms. But individually looking at the cancer itself, for prostate cancer; there are really no signs or symptoms. The symptoms happen when it becomes metastatic or stage 4. So, it’s very important to screen for prostate cancer.

Now bladder cancer, the most common symptom is blood in the urine. Kidney cancer also more commonly found on CT scans done for other reasons. So, it’s not really found with any symptoms, the majority of the time with kidney cancer.

Host:  Well thank you for clarifying that and as long as we are talking about different urinary tract cancers and not just focusing on one; tell us about some of the exciting things that are going on in your field right now as far as treatment options if someone is diagnosed with a urinary tract cancer, whether it be kidney, or bladder, or prostate. And I understand that there are different treatments but whether it’s watchful waiting in the case of prostate cancer or radiation, hormone therapy, chemo. Please tell us a little bit about what’s exciting in your field right now.

Dr. Reddy:  I think the exciting thing which has probably happened in the last ten years or so, surgically the exciting thing is definitely the robotic surgery. It has quite revolutionized how patients recover and how well they tolerate these surgeries. It give us a better technical way of doing the surgeries and gives patients a quicker recovery. So, surgically, that’s one aspect. The second aspect that has been a way revolutionized recently has been the change in how we treat advanced cancers in the urinary tract. Before, all we had was chemotherapy and people unfortunately did not survive long. Now we have a bunch of immune therapy medications, a bunch of targeted therapy medications and we are seeing that patients even with really aggressive cancers are able to survive longer than they ever did.

And this shift happened around 2005 and that’s been a very drastic change.

Host:  And what about things we’re hearing about like immunotherapy and hormone therapy and targeted therapy. As these being used for urologic cancers and if so, how?

Dr. Reddy:  Yes, the hormone therapy is the mainstay of treatment for advanced prostate cancer, cancer that has already spread out of the prostate. There are a bout six or seven new medications that have come out and right now the average lifespan we are seeing up to sometimes 10, 15, 18 years in this cancer that had a poor outlook before. Also, in kidney cancer, we are seeing more targeted therapies and immunotherapies, sunitinib being one of them. There are a bunch of PD1 inhibitors that we are seeing. And all these are also progressing and improving quality of life in advanced cancers where it has spread out of the kidney.

The same thing we are seeing in bladder too. So, it has been quite a revolution for these cancers.

Host:  Well it certainly would seem to be an exciting time to be in your field. One of the things with urologic cancers specifically, and prostate cancer are the side effects from some of the treatments whether it’s erectile dysfunction, incontinence, self-esteem, in prostate cancer. Tell us some of the side effects that you see and how those are managed both psychologically and physiologically.

Dr. Reddy:  There are some side effects and we are specifically talking about prostate cancer, somebody who has gone through prostate surgery or radiation is prone to have erectile dysfunction afterwards. They can also has urinary leakage issues afterwards because the sphincter that controls their urinary system is right next to the prostate. And these issues can be managed, some of which is technical on part of the surgeon. Also technical on part of the radiation oncologist about how they do the radiation. Some of which the patient can actually control and improve on. We have penile rehab programs that we do in my department. We also do pelvic floor therapy to improve continence. We also have a bunch of support groups for patients and I typically all of my patients get referred to all these three because it’s very – even psychologically, it’s very challenging if you are going through this thinking that feeling like you are the only one going through it; it’s important to have that support and talk to other people who have gone through similar treatments and see what has helped them and how they have coped with these treatments.

So, yeah, there are a lot of rehab programs and support groups that we have that will help patients come through these side effects that can happen.

Host:  What a good point you’ve made about support groups. So, along those lines, how do you follow a patient and evaluate how well their treatment is working? Speak to the listeners a little bit about your team and how you work with patients.

Dr. Reddy:  Yes. We have a pretty comprehensive team here. After my year and a half of being in this community, I’ve been able to establish a pelvic floor therapist that works with me. I was able to establish a relationship with radiation oncologist to work with us and medical oncologist too. So, we are able to provide very comprehensive team. We also have access to support groups as I mentioned. And I do follow patients very closely after these treatments.

The treatment doesn’t mean that the – just because you had surgery doesn’t mean that your follow up is done and you don’t need to see the doctor anymore. We do need to watch for a recurrence of the cancer, the cancer coming back. And also, we need to watch for all these side effects that can happen and if we do see the patient at that time, we are able to come up with programs for the patient to help them cope with the side effects and also make the side effects better. So, we do have a pretty comprehensive team at this point for prostate, kidney and all of the cancers.

Host:  Very multidisciplinary. As we wrap up, Dr. Reddy, questions that you would like listeners to ask their doctor as there are so many forms of therapy today and surgical options. Please tell the listeners what you’d like them to know about these types of cancers, questions they should be asking and what you would like them to know.

Dr. Reddy:  I think the biggest advice I would give and I’m just going to talk about it as I was talking to some of my family members who got the diagnosis. One of the main things is as soon as patients get diagnosis, it’s essentially like being in shell shock. Most people do not hear a lot about what the doctor is saying, and it is hard to process what the doctor is saying. I’m sure that the doctor is talking in medical language, not in the common terms. So, it’s very difficult during that initial visit to figure out what the next step is and what to do.

I think it’s important to talk to people who have been through these cancers. And especially I have had a lot of my patients talk to their family members and they just find out someone else had prostate cancer or someone else had kidney cancer and they find out how to deal with it and what the other person did. And that’s important. Also important, to go to a well-known website. Not everything on Google, but very well-known websites like WebMD, like American Urologic Association and sometimes the Society of Urologic Oncology. These websites have good data and good information to read about the cancers.

And then always, I think the first visit is always difficult. Getting the diagnosis is very challenging. But I think it’s important for patients to be very – an active participant in their care. And to ask questions of their doctor. What about this, what about this treatment, what about proton beam, what about minimally invasive surgery like robotic surgery. Those are all important to ask of your doctor and be a very active participant. Learn about the cancer. Definitely attend support groups because I have seen a great difference in the way patient’s outlook changes when they talk to other people who have had similar situations. So, that would be my overall general advice.

Host:  Well, it’s great advice Dr. Reddy and certainly important to be your own best health advocate and to bring family members along so they can listen as well. Thank you so much for coming on and sharing your expertise. And that wraps up this episode of TVH Health Chat with Temecula Valley Hospital. To learn more about general TVH surgical services, head on over to our website at www.temeculacalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media, share with your friends and family that way we can all learn from the experts at Temecula Valley Hospital together. And be sure not to miss all the other interesting podcasts in our library.

Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Until next time. This is Melanie Cole.