Cognitive Decline and Prostate Cancer

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
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00:09 --> 00:13More information at astrazeneca-us.com.
00:13 --> 00:15Welcome to Yale Cancer Answers with
00:15 --> 00:17your host doctor Anees Chagpar.
00:17 --> 00:19Yale Cancer Answers features the
00:19 --> 00:21latest information on cancer care by
00:21 --> 00:23welcoming oncologists and specialists
00:23 --> 00:25who are on the forefront of the
00:25 --> 00:27battle to fight cancer. This week
00:27 --> 00:29it's a conversation about
00:29 --> 00:30cognitive decline after prostate
00:30 --> 00:32cancer with doctor Herta Chao.
00:32 --> 00:34Doctor Chao is the deputy director
00:34 --> 00:36at the VA Comprehensive Cancer
00:36 --> 00:38Center and an associate professor
00:38 --> 00:40of Medicine and medical oncology
00:40 --> 00:42at the Yale School of Medicine,
00:42 --> 00:44where doctor Chagpar is a
00:44 --> 00:47professor of surgical on oncology.
00:47 --> 00:50I hear you work at the VA.
00:50 --> 00:53Tell us a little bit about the
00:53 --> 00:55VA and about cancer services
00:55 --> 00:58at the VA?
00:58 --> 01:01I feel very fortunate to work at the West Haven VA
01:01 --> 01:03Cancer Center because it's so closely
01:03 --> 01:06affiliated with Yale Cancer Center,
01:06 --> 01:08we basically can take advantage of a
01:08 --> 01:11lot of the knowledge and expertise and
01:11 --> 01:14resources that are available at your
01:14 --> 01:17Cancer Center as well.
01:17 --> 01:20A particularly important thing for the
01:20 --> 01:23VA is that we're a tertiary center,
01:23 --> 01:26and many resources are available
01:26 --> 01:28that are not necessarily
01:28 --> 01:31available in the private sector.
01:31 --> 01:32For instance,
01:32 --> 01:34if veterans need transportation,
01:34 --> 01:38we can actually ask our social worker
01:38 --> 01:42to help. If a veteran needs additional
01:42 --> 01:43support and therapy,
01:43 --> 01:46we can actually ask the physical
01:46 --> 01:49therapist to meet them in the Cancer Center,
01:49 --> 01:50so it's
01:50 --> 01:52very tailored to veterans.
01:52 --> 01:55Tell us a little bit about,
01:55 --> 01:57you know when we think about cancer
01:57 --> 02:00we kind of think of it ubiquitously
02:00 --> 02:03but tell us about the prevalence of
02:03 --> 02:05cancer in the veteran population and
02:05 --> 02:08whether the the incidence of cancers
02:08 --> 02:10and particular kinds of cancers are
02:10 --> 02:13different in the veteran population as
02:13 --> 02:16opposed to the general population?
02:16 --> 02:18That's a very very important point.
02:21 --> 02:24I think we continue to
02:24 --> 02:26learn. For many decades
02:26 --> 02:29it was actually debated whether certain
02:29 --> 02:32cancers are really related to an herbaside,
02:32 --> 02:34like Agent Orange.
02:34 --> 02:37We know it was widely used
02:37 --> 02:41during the Vietnam War and many veterans
02:41 --> 02:44develop cancers
02:44 --> 02:46that are unusually aggressive,
02:46 --> 02:48unusually early in their lifetime,
02:48 --> 02:52and it took many decades before it was
02:52 --> 02:56recognized that Agent Orange is a carcinogen.
02:56 --> 02:58For instance,
02:58 --> 03:00I think soft tissue sarcoma,
03:00 --> 03:03which is a connective tissue cancer,
03:03 --> 03:06occurs early in our lifetime.
03:06 --> 03:09It was recognized earlier that this is
03:09 --> 03:12probably related to Agent Orange.
03:12 --> 03:14Exposure has increased the risks of
03:14 --> 03:17these veterans to develop these cancers.
03:17 --> 03:19Prostate cancer, for instance,
03:19 --> 03:22is so common among men and is
03:22 --> 03:25the most frequent cancer among veterans.
03:25 --> 03:29But for the many decades it was actually not
03:29 --> 03:32acknowledged to be Agent Orange related.
03:32 --> 03:36Not until 2008 there was a very
03:36 --> 03:38important study done by Doctor Karen
03:38 --> 03:41Shami at UCLA that actually proved
03:41 --> 03:44that the
03:44 --> 03:47rate of prostate cancer and
03:47 --> 03:50aggressiveness of prostate cancer was much,
03:50 --> 03:53much higher in the veterans that were
03:53 --> 03:56exposed to Agent Orange compared to
03:56 --> 04:00veterans during the same era but not
04:00 --> 04:03exposed to Agent Orange, so we know
04:03 --> 04:06more and more that veterans may be
04:06 --> 04:09at risk due to service related
04:09 --> 04:12exposures to certain type of cancer,
04:12 --> 04:13including lung cancer,
04:13 --> 04:15prostate cancer, leukemia
04:15 --> 04:17and lymphomas.
04:17 --> 04:20These days for men and women
04:20 --> 04:24who are in combat al ot of times
04:24 --> 04:27we don't think about
04:27 --> 04:29people using a particular agent
04:29 --> 04:32like Agent Orange in combat,
04:32 --> 04:35but more it's artillery,
04:35 --> 04:38there's more
04:38 --> 04:40roadside bombs and so on.
04:40 --> 04:43Are those also associated
04:43 --> 04:46with a higher risk of cancers?
04:46 --> 04:52I think we will find out very soon.
04:52 --> 04:56Unfortunately my colleagues
04:56 --> 05:00and myself have been
05:00 --> 05:03unpleasantly surprised about how many
05:03 --> 05:07aggressive cases of cancer we see in very
05:07 --> 05:11young veterans like in the 40s and 50s,
05:11 --> 05:13and a whole variety of
05:13 --> 05:15different type of cancer,
05:15 --> 05:20not just one specific cancer and the
05:20 --> 05:24common thread of the story is really
05:24 --> 05:27they were exposed to the burn pits,
05:27 --> 05:30where apparently many things were burned,
05:30 --> 05:31including
05:31 --> 05:39what I was told was equipment that
05:39 --> 05:41they wanted to be destroyed,
05:41 --> 05:43and so there were many
05:43 --> 05:45toxic exposures and I fear,
05:45 --> 05:48and I believe it will be true
05:48 --> 05:51that we will see many other risk
05:51 --> 05:53factors for different types of
05:53 --> 05:56malignancies.
05:56 --> 05:59I mean I don't know whether we still
05:59 --> 06:01see veterans who were exposed to Hiroshima
06:01 --> 06:04and Nagasaki, but radiation
06:04 --> 06:07also can expose you to a variety
06:07 --> 06:08of malignancies too, right?
06:08 --> 06:10Absolutely, in fact
06:10 --> 06:13I can talk about this because
06:13 --> 06:17one of my veterans really wanted
06:17 --> 06:21to raise more awareness and he and
06:21 --> 06:24his wife really wanted want to
06:24 --> 06:28publicly speak more about it.
06:28 --> 06:31He was actually exposed,
06:34 --> 06:36in regular service to radiation in
06:36 --> 06:39the nuclear powered submarines,
06:39 --> 06:39and unfortunately,
06:39 --> 06:41he was in very close proximity
06:41 --> 06:44to it and unfortunately now deals
06:44 --> 06:46with a very aggressive cancer.
06:46 --> 06:48They were fortunately able
06:48 --> 06:50to control it with chemotherapy,
06:50 --> 06:53but it does look like he will
06:53 --> 06:54be on chemotherapy
06:54 --> 06:57probably for rest of his life.
06:57 --> 06:59What about other agents?
06:59 --> 06:59Do we have any idea
06:59 --> 07:03about the carcinogenic
07:03 --> 07:05potential of things like tear gas,
07:05 --> 07:08which is commonly used both
07:08 --> 07:11I guess in combat and in
07:11 --> 07:13civilian crowd control?
07:13 --> 07:15I'm not
07:15 --> 07:17an expert in this regard,
07:17 --> 07:20so I have to apologize that I can't
07:20 --> 07:23answer this question correctly.
07:23 --> 07:26But I do think that we have
07:26 --> 07:30to be aware about all the herbicides
07:30 --> 07:32we are using still commercially and
07:32 --> 07:35also in the private sector that I
07:35 --> 07:37believe is under recognized
07:39 --> 07:42so certainly there are
07:42 --> 07:45a whole host of exposures that
07:45 --> 07:47are unique to veterans and our
07:47 --> 07:50military families and we have to
07:50 --> 07:52remember that. And
07:52 --> 07:55cancer is not uncommon
07:55 --> 07:57even in the general public.
07:57 --> 08:00And so when you are seeing patients
08:00 --> 08:02at the VA, you're seeing people
08:02 --> 08:04who may be at increased risk
08:04 --> 08:06because of their military service.
08:06 --> 08:09But you're also seeing people who
08:09 --> 08:11are just diagnosed with cancers
08:11 --> 08:13that they would get as part of
08:13 --> 08:15the general population as well.
08:17 --> 08:20We serve all veterans,
08:20 --> 08:23whether they've been in combat or not
08:23 --> 08:26and if they fulfill the criteria
08:26 --> 08:29to receive care at the VA,
08:29 --> 08:32we will absolutely see all veterans
08:32 --> 08:35that are eligible for VA health care.
08:37 --> 08:40We will also see the cancers
08:40 --> 08:43that are not related to service
08:43 --> 08:46connection and we will treat
08:46 --> 08:50these veterans, as much as we can do,
08:50 --> 08:54and one of the benefits for me to
08:54 --> 08:57be an oncologist at the VA,
08:57 --> 09:00is that we have many other people
09:00 --> 09:02helping me with their care.
09:02 --> 09:06One of the things that I do not miss is
09:06 --> 09:10the billing issues and medication issues.
09:10 --> 09:12I mean, as you know,
09:12 --> 09:15there so many
09:15 --> 09:17very very expensive
09:17 --> 09:18cancer medications, in fact,
09:18 --> 09:21we see a stream of
09:21 --> 09:24new patients into the VA because
09:24 --> 09:26of the very very expensive drug
09:26 --> 09:29prices and any veteran that finds
09:29 --> 09:32out that they can probably get
09:32 --> 09:34these medications for $9 copay
09:34 --> 09:37at the VA a month will come to
09:37 --> 09:39the VA.
09:40 --> 09:43For those who may or may not know, if you are
09:43 --> 09:46a veteran, you can get coverage
09:46 --> 09:48through the VA for your family,
09:48 --> 09:51your spouse, and your children?
09:51 --> 09:55That's a very interesting question.
09:55 --> 09:58I ask the social worker all the
09:58 --> 10:02time and it turns out that spouses
10:02 --> 10:05of 100% service connected veterans
10:05 --> 10:10are eligible to get care at the VA
10:10 --> 10:12until the immediate Medicare age.
10:12 --> 10:15I believe that the children
10:15 --> 10:16are not necessarily,
10:16 --> 10:19but I think there might
10:19 --> 10:22be mechanisms to take care of
10:22 --> 10:23the children of veterans,
10:23 --> 10:27but the spouses of 100% service connected
10:27 --> 10:30veteran are eligible for care here at the VA.
10:30 --> 10:33What does 100% service connection mean?
10:33 --> 10:36It means that these veterans have
10:36 --> 10:38a condition that disables them and
10:38 --> 10:41it originated during the time of
10:41 --> 10:42the military service.
10:42 --> 10:45And you see
10:45 --> 10:47patients with all kinds of cancers,
10:47 --> 10:51and you treat them at the VA.
10:51 --> 10:53Are there particular things that
10:53 --> 10:56you're thinking about in terms of
10:56 --> 10:58their treatment in terms of side
10:58 --> 11:02effects and so on that may be of
11:02 --> 11:03particular concern to veterans?
11:04 --> 11:08I think there's several
11:08 --> 11:11things that we do have to consider,
11:11 --> 11:14and that is, for instance, service
11:14 --> 11:17connected post traumatic stress disorder.
11:17 --> 11:20We unfortunately take care of a fair
11:20 --> 11:23number of veterans that suffer from
11:23 --> 11:25post traumatic stress disorder,
11:25 --> 11:29and one of the things that
11:29 --> 11:33we have to be aware of is
11:33 --> 11:37sometimes when the cancer treatment itself
11:37 --> 11:37causes stress,
11:37 --> 11:40some of the PTSD
11:40 --> 11:43symptoms can
11:43 --> 11:46flare up and that is the reason why
11:46 --> 11:49we really right from the beginning
11:49 --> 11:52even before we start treatment,
11:52 --> 11:54we actually frequently have palliative
11:54 --> 11:57care and the health psychology team,
11:57 --> 11:59in addition to psychiatry, if necessary,
11:59 --> 12:01be involved in the
12:01 --> 12:04management of the patient.
12:04 --> 12:05For instance, when
12:05 --> 12:07our veterans
12:07 --> 12:10have to undergo complicated cancer surgery
12:10 --> 12:12there is actually a service for
12:12 --> 12:15elderly veterans called
12:15 --> 12:17Champions where the geriatrician
12:17 --> 12:20and the psychologists are involved
12:20 --> 12:23before even the surgery and really
12:23 --> 12:26prepare the patients for the surgery
12:26 --> 12:28and follows them all along through
12:28 --> 12:31the hospitalization and after discharge.
12:31 --> 12:34Yeah, because I can imagine
12:34 --> 12:37that for any patient cancer is
12:37 --> 12:40a big diagnosis, it's a scary diagnosis,
12:40 --> 12:42but for veterans it may be even
12:42 --> 12:46more so that it kind of adds to the
12:46 --> 12:49stress that they've already gone
12:49 --> 12:50through.
12:50 --> 12:53And that is one of the things where
12:53 --> 12:56we are incredibly grateful for at
12:56 --> 12:58the VA in Connecticut, we actually
12:58 --> 13:00over the years we have developed
13:00 --> 13:03a cancer care coordination
13:03 --> 13:05system where the cancer
13:05 --> 13:07care coordinator actually
13:07 --> 13:09tracks patients that may
13:09 --> 13:11develop cancer,
13:11 --> 13:14but it's still in the work up
13:14 --> 13:16and the primary care physician or
13:16 --> 13:19any provider can council the cancer
13:19 --> 13:22care coordination team to try to
13:22 --> 13:25expedite the work up and navigate
13:25 --> 13:27for the patients
13:27 --> 13:29going through the treatment.
13:29 --> 13:30Yeah, that's so important.
13:30 --> 13:33We're going to talk a lot more
13:33 --> 13:36about cancer treatment and the
13:36 --> 13:38side effects in our veterans
13:38 --> 13:39right after we take a short
13:39 --> 13:40break for a medical minute.
13:41 --> 13:44Support for Yale Cancer Answers
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13:55 --> 13:57This is a medical minute
13:57 --> 13:58about smoking cessation.
13:58 --> 14:00There are many obstacles to
14:00 --> 14:02face when quitting smoking.
14:02 --> 14:05As smoking involves the potent drug nicotine.
14:05 --> 14:08But it's a very important lifestyle change,
14:08 --> 14:09especially for patients
14:09 --> 14:10undergoing cancer treatment.
14:10 --> 14:13Quitting smoking has been shown to
14:13 --> 14:15positively impact response to treatments,
14:15 --> 14:17decrease the likelihood that patients
14:17 --> 14:19will develop second malignancies
14:19 --> 14:21and increase rates of survival.
14:21 --> 14:22Tobacco treatment programs are
14:22 --> 14:25currently being offered at federally
14:25 --> 14:26designated comprehensive cancer centers
14:26 --> 14:28and operate on the principles
14:28 --> 14:31of the US Public Health Service
14:31 --> 14:32clinical practice guidelines.
14:32 --> 14:34All treatment components are evidence
14:34 --> 14:37based and therefore all patients are
14:37 --> 14:39treated with FDA approved first line
14:39 --> 14:41medications for smoking cessation as
14:41 --> 14:44well as smoking cessation counseling
14:44 --> 14:46that stresses appropriate coping skills.
14:46 --> 14:48More information is available at
14:48 --> 14:50yalecancercenter.org. You're listening
14:50 --> 14:51to Connecticut public radio.
14:52 --> 14:55Welcome back to Yale Cancer Answers.
14:55 --> 14:57This is doctor Anees Chagpar
14:57 --> 14:59and I'm joined tonight by
14:59 --> 15:02my guest doctor Herta Chao.
15:02 --> 15:04We're talking about cancer,
15:04 --> 15:05particularly in veterans and
15:05 --> 15:07right before the break you
15:07 --> 15:09were telling me about
15:09 --> 15:11the really fabulous
15:11 --> 15:13services that the VA offers
15:13 --> 15:16veterans who are diagnosed with cancer.
15:16 --> 15:18It is really a comprehensive approach
15:18 --> 15:20a multidisciplinary approach with
15:20 --> 15:22social work, with geriatricians, with
15:22 --> 15:24psychologists and psychiatrists to
15:24 --> 15:26really provide the best treatment
15:26 --> 15:28to veterans facing cancer.
15:28 --> 15:31Because many of these veterans may
15:31 --> 15:34face an increased risk of cancer
15:34 --> 15:36due to military based exposure.
15:36 --> 15:40The other thing that I think a lot
15:40 --> 15:43of people may not know about the VA
15:43 --> 15:47is that the VA actually supports
15:47 --> 15:51a lot of research in the area of cancer.
15:51 --> 15:55Can you talk a little bit about the DoD,
15:55 --> 15:57the Department of Defense,
15:57 --> 16:00and the support that it provides for
16:00 --> 16:03research into cancer?
16:03 --> 16:06Yes, they had several mechanisms at the
16:06 --> 16:09VA to apply for funding for research
16:09 --> 16:10in veterans,
16:10 --> 16:12including veterans with cancer.
16:12 --> 16:15One is the DoD Department of Defense
16:15 --> 16:17has several grant mechanisms
16:17 --> 16:19in many different cancers,
16:19 --> 16:21including prostate cancer,
16:21 --> 16:23lung cancer, breast cancer,
16:23 --> 16:25there's another mechanism
16:25 --> 16:27that's called VA Merit
16:27 --> 16:30which is internally
16:30 --> 16:34within the VA you can apply
16:34 --> 16:37for funding to conduct research,
16:37 --> 16:39an obviously there are others
16:39 --> 16:40like the National Institutes of Health
16:43 --> 16:44sponsored grants that
16:44 --> 16:47physicians and researchers at the
16:47 --> 16:50VA can apply to so I certainly
16:50 --> 16:53benefited from these grant mechanisms.
16:53 --> 16:56One of my research interests,
16:57 --> 16:59in addition to conducting clinical
16:59 --> 17:02trials at the VA and making clinical
17:02 --> 17:05trials accessible for veterans,
17:05 --> 17:08is to look at the potential cognitive
17:08 --> 17:11side effects and toxicity of prostate
17:11 --> 17:14cancer treatment with hormonal therapy.
17:14 --> 17:17And this actually was not
17:17 --> 17:20something that I thought about,
17:20 --> 17:24this was prompted by one of my patients
17:24 --> 17:28who is a decorated Vietnam War veteran,
17:28 --> 17:31and he developed aggressive prostate
17:31 --> 17:34cancer at a fairly young age.
17:34 --> 17:38He was just in his early 60s when
17:38 --> 17:41he was diagnosed with metastatic
17:41 --> 17:45gleason 8 prostate cancer and
17:45 --> 17:47he was diagnosed in the private
17:47 --> 17:50sector and then found out that it
17:50 --> 17:52was eligible for the VA benefits.
17:52 --> 17:55He came to the VA and participated
17:55 --> 17:56in several studies.
17:56 --> 17:57Finally,
17:57 --> 17:59after three years taking care
17:59 --> 18:02of him and his prostate
18:02 --> 18:04cancer it was beautiful controlled.
18:04 --> 18:07He finally told me,
18:07 --> 18:09I don't want to be ungrateful,
18:09 --> 18:12but I think these hormone shots
18:12 --> 18:14are frying my brain.
18:14 --> 18:18And I asked him, what do you mean?
18:18 --> 18:19And he said well,
18:19 --> 18:21you know I've been busy all
18:21 --> 18:23my life I can multitask,
18:23 --> 18:25I can do so many things.
18:25 --> 18:28But since I started the hormone shot,
18:28 --> 18:31I have to write down the
18:31 --> 18:3410 things I want to do within the next hour.
18:34 --> 18:35And that's not me.
18:35 --> 18:38I usually can think of multiple
18:38 --> 18:41things and I can get everything done,
18:41 --> 18:43but now I feel like I have to
18:43 --> 18:45write down and remind myself
18:45 --> 18:48what I want to do.
18:48 --> 18:50So then I thought,
18:50 --> 18:51oh, that's easy.
18:51 --> 18:55I'll refer you for
18:55 --> 18:57neurocognitive testing and it turns
18:57 --> 19:00out that he scored beautifully.
19:00 --> 19:03There was no deficit that we could
19:03 --> 19:06find on regular neurocognitive testing.
19:06 --> 19:09And then I started looking into
19:09 --> 19:13it and it's
19:13 --> 19:15still not well understood
19:15 --> 19:18what hormone therapy for prostate
19:18 --> 19:22cancer can do the to the brain.
19:22 --> 19:26I think that the breast cancer
19:26 --> 19:28experts are way ahead.
19:28 --> 19:31I mean the recognition that
19:31 --> 19:34chemotherapy or hormonal therapy
19:34 --> 19:37for breast cancer has been for
19:37 --> 19:39many years already
19:39 --> 19:41suspected and many
19:41 --> 19:43studies actually support
19:43 --> 19:47the suspicion that chemotherapy and
19:47 --> 19:50hormonal therapy for breast cancer
19:50 --> 19:54can cause chemo fog, or chemo brain.
19:54 --> 19:58It's not as well understood in prostate
19:59 --> 20:03cancer so around 2009
20:03 --> 20:07I started looking into that.
20:07 --> 20:09And the interesting part is
20:09 --> 20:11that it's not very easy
20:11 --> 20:14to characterize these impact of hormone shots
20:14 --> 20:17for prostate cancer, effects on the brain.
20:17 --> 20:19If you do regular testing,
20:19 --> 20:21neurocognitive testing,
20:21 --> 20:24whether it's a paper and pencil or
20:24 --> 20:26whether it's on a computer,
20:26 --> 20:29we have to be aware that there's a
20:29 --> 20:31certain amount of practice effect.
20:31 --> 20:35So if you do it every three months,
20:35 --> 20:38if you do it every six months,
20:38 --> 20:41you know what to expect to do in the test,
20:41 --> 20:45so your test score may actually hold hold up
20:45 --> 20:47despite the fact there might be a deficit.
20:47 --> 20:53And that is probably true for many,
20:53 --> 20:54many patients.
20:54 --> 20:59That is what prompted me to think
20:59 --> 21:03about what do other people do to study
21:03 --> 21:08effects of anything in the brain,
21:08 --> 21:10whether it's depression,
21:10 --> 21:11whether it's dementia,
21:11 --> 21:14whether it's psychiatric illnesses.
21:14 --> 21:17So that's the reason why I approached
21:17 --> 21:20my colleagues at the Yale Medical School
21:20 --> 21:22in psychiatry that are involved in
21:22 --> 21:25functional brain imaging to see whether
21:25 --> 21:27or not hormone therapy can affect
21:27 --> 21:30functional brain imaging.
21:30 --> 21:31Just to clarify,
21:31 --> 21:32what are
21:32 --> 21:34these hormone shots that you're
21:34 --> 21:35giving for prostate cancer?
21:35 --> 21:37What exactly is that?
21:37 --> 21:39Because when we talk about
21:39 --> 21:41hormonal therapy or endocrine
21:41 --> 21:43therapy in breast cancer,
21:43 --> 21:44that's often a pill.
21:44 --> 21:47Is it the same kind of thing?
21:47 --> 21:52It's not exactly the same because we know
21:52 --> 21:58that if we just use a pill form like
21:58 --> 22:02something called by Bicalutamide which is a
22:02 --> 22:04testosterone receptor blocker,
22:04 --> 22:08it usually is not sufficient to suppress
22:08 --> 22:13the effects on the prostate cancer cells.
22:13 --> 22:18So usually men with both prostate cancer
22:18 --> 22:21need to get something called Leuprolide,
22:21 --> 22:25which is, I'm going to use
22:25 --> 22:30the technical term LHRH
22:30 --> 22:36agonist, that can shut down the testosterone
22:36 --> 22:39production in a patients body
22:39 --> 22:43and we use these shots to cause the
22:43 --> 22:46testicles and also the remainder
22:46 --> 22:50of the body to turn off testosterone
22:50 --> 22:53production.
22:53 --> 22:56So the key point being that the pills
22:56 --> 23:00that many breast cancer patients take for
23:00 --> 23:04five or ten years is different than these
23:04 --> 23:07shots that men get for prostate cancer,
23:07 --> 23:09especially advanced prostate cancer.
23:09 --> 23:11They work through different mechanisms.
23:11 --> 23:14They have different targets as it were.
23:14 --> 23:18And so the side effects are pretty different,
23:18 --> 23:21so many women, while it's true that
23:21 --> 23:23with chemotherapy they certainly
23:23 --> 23:25can get chemo brain or chemo fog,
23:25 --> 23:28it's a little less common for
23:28 --> 23:30women taking endocrine therapy,
23:30 --> 23:32something like tamoxifen or some
23:32 --> 23:34of the aromatase inhibitors.
23:34 --> 23:37So how common is it that people can
23:37 --> 23:40get this chemo brain or chemo fog
23:40 --> 23:43or this cognitive decline when taking
23:43 --> 23:46an LHRH agonist for prostate cancer?
23:46 --> 23:49I think that's a very hot topic right
23:49 --> 23:53now in prostate cancer research.
23:53 --> 23:56I think for the longest time,
23:56 --> 23:59and I would say like
23:59 --> 24:0410 years ago I was equally guilty.
24:04 --> 24:06We recognized the potential effect
24:06 --> 24:10on the brain and we really just
24:10 --> 24:13focus on like how to control cancer.
24:13 --> 24:15Because as Oncologists,
24:15 --> 24:18we want to control cancer.
24:18 --> 24:20Now I think we have to recognize
24:20 --> 24:23there so many different treatments,
24:23 --> 24:25and that's the exciting part about
24:25 --> 24:27being a cancer doctor nowadays.
24:27 --> 24:29There's so many different treatments
24:29 --> 24:32and you can treat cancer so many
24:32 --> 24:34different ways that I think
24:34 --> 24:37it's actually very important to
24:37 --> 24:39know what each treatment could
24:39 --> 24:41cause in terms of side effects,
24:41 --> 24:44whether it's inside the body
24:44 --> 24:46or whether it's inside the
24:46 --> 24:49brain.
24:49 --> 24:52And what did you find with the
24:52 --> 24:55functional imaging study that you
24:55 --> 24:56did?
24:56 --> 24:59It's still a very active,
24:59 --> 25:00ongoing study.
25:00 --> 25:03We're trying to right now look at the
25:03 --> 25:06effect of lowering the testosterone
25:06 --> 25:09level what we call androgen deprivation,
25:09 --> 25:12what it does over two years.
25:12 --> 25:15My original pilot study only
25:15 --> 25:18investigated effects in 30 veterans.
25:18 --> 25:2115 leuprolide injection and
25:21 --> 25:2615 as a control that underwent
25:26 --> 25:30surgery or just radiation alone.
25:30 --> 25:32It actually showed that the newer
25:32 --> 25:35cognitive testing was the same.
25:35 --> 25:37People scored the same,
25:37 --> 25:40but when you look at the functional
25:40 --> 25:43brain imaging just six months
25:43 --> 25:45of hormone therapy for prostate
25:45 --> 25:48cancer completely changed the way
25:48 --> 25:51the brain shows activation.
25:51 --> 25:53What does this mean?
25:53 --> 25:57That's something I think I need to find out,
25:57 --> 26:01but it was very striking
26:01 --> 26:05and to be honest I was a bit surprised
26:05 --> 26:08because I initially thought if the
26:08 --> 26:11newer cognitive test scores are the same,
26:11 --> 26:15why should the brain MRI be different?
26:15 --> 26:18And so I was educated that it can be
26:18 --> 26:21different and apparently in other disease
26:21 --> 26:24processes it can be different too.
26:24 --> 26:27Thanks to the support
26:27 --> 26:30of pilot studies through the Yale Cancer
26:30 --> 26:33Center through Dr. Herbst,
26:33 --> 26:36who supported this project,
26:36 --> 26:39we were able to do an additional study
26:39 --> 26:43of these 30 patients.
26:43 --> 26:46It actually turns out that certain
26:46 --> 26:48circuits that are connecting
26:48 --> 26:50different brain areas to process
26:50 --> 26:53things seem to be affected by
26:53 --> 26:56hormone therapy for prostate cancer,
26:56 --> 27:00so I suspect that the longer we give
27:00 --> 27:04somebody hormone therapy for prostate cancer,
27:04 --> 27:08the more effects we can see.
27:08 --> 27:09Now that being said,
27:09 --> 27:13I don't want to create any fear among
27:13 --> 27:15patients to get hormone therapy.
27:15 --> 27:18I think it's a very,
27:18 --> 27:20very important treatment for prostate cancer,
27:21 --> 27:23especially for stage four prostate cancer,
27:23 --> 27:26and I think this is actually
27:26 --> 27:28part of the cognitive
27:28 --> 27:31side effects of hormone therapy.
27:31 --> 27:34That's something we need to study,
27:34 --> 27:36and I believe not everybody
27:36 --> 27:39is vulnerable to it.
27:39 --> 27:41There are certain individual vulnerability
27:41 --> 27:43that we have to identify and study.
27:43 --> 27:45That was going
27:45 --> 27:48to be one of my questions.
27:48 --> 27:50Was that in that functional MRI
27:50 --> 27:52study where you had some
27:52 --> 27:55patients who had the LHRH agonist
27:55 --> 27:57therapy and some patients who didn't,
27:57 --> 28:00and you found that there was a
28:00 --> 28:02difference in the functional brain
28:02 --> 28:04imaging between the two groups
28:04 --> 28:07were all of the patients who had the
28:07 --> 28:09LHRH agoinst therapy still thinking that
28:09 --> 28:11the hormones were frying their brain
28:11 --> 28:13or were some of them quite functional?
28:14 --> 28:17I would say some of them
28:17 --> 28:19were quite functional and
28:19 --> 28:21that is the reason why I was
28:21 --> 28:25surprised to find on the brain imaging
28:25 --> 28:27study that they're still changes.
28:27 --> 28:29And some were
28:29 --> 28:31complaining of maybe hot flashes.
28:31 --> 28:34So I think frequently we say,
28:34 --> 28:37maybe you feel more fatigued
28:37 --> 28:40because of hot flashes that you
28:40 --> 28:43can get with those LHRH agonist,
28:43 --> 28:45or whether there could be
28:45 --> 28:47some component of depression
28:47 --> 28:49affecting your cognitive out,
28:49 --> 28:53but I think that's the reason why it's
28:53 --> 28:56actually important to have something
28:56 --> 28:59that's not just subjective,
28:59 --> 29:02it's actually fairly objective for the
29:03 --> 29:06patients to see actually on brain imaging,
29:06 --> 29:09there are changes and
29:09 --> 29:12while this is all still
29:12 --> 29:15very much a topic of research,
29:15 --> 29:17for my patient,
29:17 --> 29:19who was the original one to actually
29:19 --> 29:22complain to me about it, was very,
29:22 --> 29:23very comforted actually,
29:23 --> 29:27to know that it's not just in his mind.
29:27 --> 29:29It is actually something that
29:29 --> 29:30we can see.
29:30 --> 29:33Dr. Herta Chao is the deputy
29:33 --> 29:35director at the VA comprehensive Cancer
29:35 --> 29:37Center and an associate professor
29:37 --> 29:39of Medicine and medical oncology
29:39 --> 29:42at the Yale School of Medicine.
29:42 --> 29:43If you have questions,
29:43 --> 29:45the address is canceranswers@yale.edu.
29:45 --> 29:47And past editions of the program
29:47 --> 29:49are available in audio and written
29:49 --> 29:50form at Yalecancercenter.org.
29:50 --> 29:53We hope you'll join us next week to
29:53 --> 29:55learn more about the fight against
29:55 --> 29:58cancer here on Connecticut public radio.

Information

Cognitive Decline and Prostate Cancer with guest Dr. Herta Chao June 21, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095