Advice for Multidisciplinary Management in Prostate Cancer
Advice regarding the multidisciplinary management of patients with prostate cancer.
PUBLISHED May 10, 2019
Susan F. Slovin, M.D., Ph.D.: Andy, would you share with us please your current travels, where is your disease, how are you, how is everything, how are you responding to the treatment, where is it going?
Andy Rochester: Right now I’m really in a good place. My mind is set with everything. I have no side effects from the cancer at all. I actually have never had a side effect—before, during, etcetera. We’re looking forward to the end of this month, actually a cessation of a treatment of the ADT [androgen deprivation therapy] basically. I’ll stay on the cardiac of course. I’ll be checking in with a cardiologist because that’s still critical on its own. It’s going to be very interesting. Basically we’ll be tapering off the prednisone. And then as you pointed out, we’re going to need to wait a while. At first I thought, boy, I’d like to have daily PSA [prostate specific antigen] tests and then you pointed out.
Susan F. Slovin, M.D., Ph.D.: You probably would.
Andy Rochester: Hourly. Yes, time to check again. But you know I’ve matured a lot in that too, and I realize that it’s going to take a while for my systems to re-regulate. So the end of the summer, this fall we’ll do some more testing, and I’m at the point now where basically we’ll find what we find, and then we’ll deal with it.
Susan F. Slovin, M.D., Ph.D.: How can I as a medical oncologist, or a colleague of mine who’s a urologist or radiation oncologist, really impact a patient to try to get them to understand the importance, and the relevance of everything that you’ve shared with us today? There may not even be an answer, but you seem to have it so well packaged for you that I wish I could just give you to everybody and say, “listen,” but it doesn’t seem to work that way.
Andy Rochester: No, although my urologist at Corning was using me as an example because I gave him permission. So Dr. Robert Douenias M.D. is a good guy. The catch is that you can’t know all the answers, and you need to know yourself. You need to take charge of yourself so that you only have yourself to blame. If you don’t take care of yourself, then why are you even bothering asking for this tremendous assistance from major centers?
So, you’ve got to set aside all the things that prevent you from being part of the success. Then you really need to engage with the specialist that you need for this. And as you mentioned, cardiology is showing a big part of this, and I can’t imagine why you wouldn’t want to have a cardiologist work you up and make sure that you’re in; even if they come back and say, “No, everything looks good, I’ve got a baseline, let’s do this thing and so forth.” And who knows, maybe like me they’ll say, “So I’ve got a surprise for you, but we’re going to fix it, or we’re going to work on fixing it.”
And again, with working with the urologist as part of this whole team, it’s active communication. I’m seeing much better communication than say back when I was in medicine. I was in medicine for 18 years. And what I’m seeing now is that communication is much tighter teamwork.
Susan F. Slovin, M.D., Ph.D.: Do you think the onus should be upon the specialist to make the referral to cardiology?
Andy Rochester: That’s a tough one. Who’s the captain of the team?
Susan F. Slovin, M.D., Ph.D.: Well it becomes an issue sometimes, it really does.
Andy Rochester: I think informally when I talk to my wife, pretty much we consider you the de facto captain because you will refer us. But the catch is it puts a big burden on you. I think the patients, if they come in, if we do the education and so forth, then they should be looking for that and say, “Okay, if you’re going to be going into ADT you’re going to need this, you’re going to need this,” and then some of that onus gets pulled off you because you’ve already set the expectations for you need a team approach. It’s not just one miracle doctor that’s going to take care of this.
Susan F. Slovin, M.D., Ph.D.: I’d like to take this opportunity right now to thank you, Andy, for sharing your experiences with us and your excellent advice, and I hope that patients who are watching this will really understand and accept your recommendations. As your oncologist, I feel very privileged to be part of your care, and part of the team, I should say.
Andy Rochester: It’s a team effort.
Susan F. Slovin, M.D., Ph.D.: It’s a team effort.
Andy Rochester: Clearly the patient is really part of the team.
Susan F. Slovin, M.D., Ph.D.: And if there’s one thing I think that we all can learn from today’s journey with you is the fact that the ability to take responsibility and really be proactive in your own care, is tantamount to success. So I thank you very much.