ADT in Prostate Cancer: Managing Cardiovascular Risk - Episode 1
Susan F. Slovin, M.D., Ph.D.: Hello everyone. I’m Dr. Susan Slovin from Memorial Sloan Kettering Cancer Center. I’m here today with a guest, Mr. Andrew Rochester, who is a prostate cancer survivor. We are here on behalf of Cure Connections® to talk about cardiovascular risk and androgen deprivation therapy. In particular, to determine the best way of managing cardiovascular events that occur for people who are on androgen deprivation therapy.
So, Andrew, thank you so much for being here today, we really appreciate your help with this. It would be very helpful I think to everyone to hear about your diagnosis, and what was your life like before diagnosis? How was your health? Were you being followed by a variety of different doctors, or was there anything unusual that in the retrospective scope, as they say, should have been different if you go and think about it?
Andy Rochester: Yes, definitely would love to use the retrospect scope that you have. Before my diagnosis we were an active family. We would do hiking and out with the kids and those types of things. I probably wasn’t very careful with my weight. My weight was slowly creeping up, and I don’t think my diet was the best either. So I would eat fried foods and drink Mountain Dews, things that I have learned a little bit about since then.
What came about though is that my weight got to the point where my blood pressure was beginning to rise as well. I just was beginning to become aware of the fact that my health was less than ideal. So when the situation presented itself, my physician retired and I saw a new physician. And I said, “So are you going to run the battery of tests, let’s see what’s going on.” Because to be honest with you, I’d been so healthy that I really hadn’t had anything in 30 years.
Susan F. Slovin, M.D., Ph.D.: And you’d never had a PSA [prostate specific antigen test] or cardiovascular profile?
Andy Rochester: I had one. The outgoing physician had done a lipid profile on me and also had done a PSA test at 50, and it met the criteria.
Susan F. Slovin, M.D., Ph.D.: Meaning that it was within acceptable….
Andy Rochester: Yes.
Susan F. Slovin, M.D., Ph.D.: Nothing that was suspicious for prostate cancer.
Andy Rochester: Exactly. But the thing is that because of my apparent good health, I wasn’t doing an annual physical. And so then got the new physician and I remember quite distinctly in the fall of 2016, I was paying bills one night, opened one of the bills and it was my laboratory report. And my lab report, I looked at the lipid profile and I thought, this is not ideal, I need to talk to my new doctor about this, and we need to deal with it. My dad died of a heart attack at 61, and at the time I was about 60. So the next thing that crept up, I turned the paper over, what’s on the other side—PSA. And I’m reading down through there and I go, 42, so….
Susan F. Slovin, M.D., Ph.D.: Do you remember what it had been previously?
Andy Rochester: One.
Susan F. Slovin, M.D., Ph.D.: One. And this is in the course of…?
Andy Rochester: Nine years.
Susan F. Slovin, M.D., Ph.D.: Nine years.
Andy Rochester: So I clicked Google just to confirm my suspicions, and became very alarmed immediately. And so in the morning I saw my corporate physician, and because we were very fortunate, at Corning there’s a corporate physician who’s about 200 feet from my desk. So I went to visit him and I said, “I’ve got a problem.” And he was on the phone right away to my new family doctor. And later that day I was seeing a urologist.
Susan F. Slovin, M.D., Ph.D.: Now, Andy, let me interrupt you and ask, had you any symptoms at that time?
Andy Rochester: None.
Susan F. Slovin, M.D., Ph.D.: Had you noticed increase in urination, change in sexual functions, thinning of semen, pain on ejaculation, anything that was atypical in your lifestyle?
Andy Rochester: No getting up in the night, nothing, absolutely no symptoms. And that’s one of the amazing things that we’ll touch on again, but through this entire process I’ve never had a symptom.
Susan F. Slovin, M.D., Ph.D.: And so you saw the urologist and…?
Andy Rochester: Saw the urologist and at that point I was just beginning to be positive. On the DRE test, the digital rectal exam, he subsequently did scans and did the biopsy, and my biopsy came back and put me in Gleason 10. And so at that point Corning Inc., where I work, had put together a program of referral to Memorial Sloan Kettering. So I was immediately referred to go to Sloan Kettering and then they made all the arrangements for me to come in and see you and your other teams.
Susan F. Slovin, M.D., Ph.D.: Now, we had imaging studies done. Were you the typical patient would you say? Because your presentation….
Andy Rochester: The imaging studies were equivocal. They were not showing, other than in the prostate area. The prostate area definitely went along with a biopsy. The area though of concern was the metastasis. So there was a potential from metastasis, some loss of the lamina, etcetera, in the spine. And so … they would not commit. So we brought the same scans down here, and we’ll get to that when we talk a little bit about the various teams, but I’ve got some follow-up on where that went.
Susan F. Slovin, M.D., Ph.D.: So in general, you were not a patient with localized disease. You already had what looked like metastatic disease to bone and possibly lymph nodes.
Andy Rochester: Right.
Susan F. Slovin, M.D., Ph.D.: Completely asymptomatic.
Andy Rochester: Yes.
Susan F. Slovin, M.D., Ph.D.: I guess what would be considered to be sort of unique about you is the fact that you were, or are, a young man, relatively speaking. You had no symptoms and you had been screened at some point, but then here you are presenting.
Andy Rochester: I neglected to follow up.
Susan F. Slovin, M.D., Ph.D.: Correct, but that happens. But the point is you had metastatic disease at presentation.
Andy Rochester: Yes.
Susan F. Slovin, M.D., Ph.D.: So for a while we didn’t see that. We would see people with just localized disease who were young, but do you think that’s a problem with screening? Do you think that somehow we’re not taking screening seriously? Because that’s a whole other hour discussion for everyone. There are pros and the cons.
Andy Rochester: I think that I was at the end of the backlash from the problem, in the zeroes, where the PSA test was more popular. And please correct me if I’m in the wrong vein, but I think that there was a lot of screening that led to a lot of treatments. And so I think when I came along there might have been a backlash where the screening was being actually de-emphasized a bit when I came along, when I was 50.
I’ve talked to some of the other physicians and they said, “Well, you know, we started holding back,” in terms of how often they would screen. Whereas my belief is that I’m very much in favor of screening because so many people can have no symptoms at all, it’s just silently there, and in my particular case I was so fortunate. If it had been much longer I don’t think I would be in as good a place.
Susan F. Slovin, M.D., Ph.D.: You mentioned a family history of coronary artery disease.
Andy Rochester: Yes.
Susan F. Slovin, M.D., Ph.D.: Your father passed of a heart attack, and what about you? When you had the screening were you at a higher than average cardiovascular risk? Do you have high triglycerides or cholesterol that the doctor needed to put you on medication?
Andy Rochester: Over 300 with triglycerides, upper 200s for cholesterol, and my HDL [high-density lipoprotein] was down in the low 30s. But the thing that was pointed out to me by a couple of different physicians, they said, “Well you know the side effects are actually probably going to be worse than the benefits that you’re going to receive.” So I took that at face value. And when I saw the new physician, when he saw the preliminary, he said, “Yes, we have some work to do.” Subsequently, when I got to meet the cardiologist at Sloan Kettering, then we addressed it. We can talk about that when you’re ready.
Susan F. Slovin, M.D., Ph.D.: But I would say that you bring to light something very important, which is that it’s not just treating the prostate cancer, this is about a multidisciplinary team including a cardiologist, possibly a urologist, in addition to medical oncologists, and whomever else is needed to really adjudicate all the abnormalities. You’re the captain of the team, but that doesn’t mean that all of us shouldn’t be in continued correspondence with one another to really work together as a team.
Andy Rochester: I’m so much in favor of that. The thing that would have happened with me is that if we had these different diverse specialists working together, it would have been picked up, discussed and so forth, and it would have been picked up quicker in terms of the cardiology.
Transcript Edited for Clarity