madman
Super Moderator
In this episode, we challenge the terminology: Should Gleason 6 prostate conditions honestly be labeled as "cancer"? Many experts, including our esteemed guest, Dr. Adam Kibble - Chair of Urology at Harvard Medical School and Dana-Farber - believe the answer is a resounding "no." Delve deep into the nuances of a Gleason 6 diagnosis and why it might be more manageable than it sounds.
Dr. Kibble, an alumnus of Cornell University with a residency from Harvard and a fellowship from Johns Hopkins, has dedicated his practice to the minimally invasive treatment of urologic cancers. With over 400 peer-reviewed papers to his name and substantial grant support from the National Cancer Institute, his insights are invaluable.
Chapters
00:00 Lifestyle Medicine In High-Risk Prostate Cancer with Adam Kibel, MD
05:53 What have you seen that's really unusual in the space of prostate cancer?
07:06 The definition of high-risk prostate cancer Gleason Pattern.
08:32 Explain the difference [ between Adjuvant and Neoadjuvant Chemotherapy]
11:45 Second opinion: do they know the Gleason score the first pathologist scored?
14:15 We need to understand where the cancer is before we can focally ablate it.
17:15 Grade predicts whether the patient will fail therapy.
24:34 I've heard four things that I can do. How do I come up with a decision?
27:56 We're over-treating patients who have Gleason 6.
29:03 Gleason 4 plus 3.
29:49 About 1 percent of Gleason 6s. Can develop an aggressive disease.
30:31 Between 40 and 60 percent of patients who are put on active surveillance fail to show up for their follow-up.
33:55 How often do you order these genomic tests like Oncotype DX?
37:13 MRI really helps me... not only around the diagnosis but around the management strategy.
38:33 Lifestyle changes have been shown to decrease a patient's risk of cardiovascular mortality
40:11 If you have a prostate [and] you live long enough. You're going to get prostate cancer. I care about the aggressive type.
42:28 Forest Bathing.
46:34 Anna Pli, Epidemiologist at Harvard T.H. Chan School of Public Health
47:37 We've identified a "Polygenic Risk Score,"...who's at increased risk for cancer.
49:36 For Those with a family history of prostate cancer or low-risk disease, this is an opportunity.
55:07 70 years old. He's been eating poorly his whole life. Diagnosed with fairly significant prostate cancer...He says I want to change my diet.
57:41 People are eating too much... Let's eat less.
58:28 Men on ADT need protein.
59:26 Genetics is only gonna work if we can then change the environment and influence the genetics or influence the outcome.
01:01 Prostate Cancer patients who visit emergency rooms on weekends - 20% increased risk of morbidity compared to those who seek care during weekdays.
