A practicing radiation oncologist who oversees one of the largest radiation oncology departments in the country, Dr. Louis Potters serves as Chairperson of Radiation Medicine at Northwell Health, and Professor at the Zucker School of Medicine at Hofstra/Northwell. He’s also deputy physician in chief in the Marilyn and Barry Rubenstein Chair in Cancer Research for the Northwell Health Cancer Institute. Together with his colleagues at Northwell Health, Dr. Potters pursues a team approach to treating prostate cancer geared to deliver the best outcomes for patients.
- Dr. Louis Potters’ bio
- Dr. Louis Potters on Twitter
- Prostate cancer care at Northwell Health Cancer Institute
- Prostate cancer radiation therapy at Northwell Health Cancer Institute
Welcome to Stay in the Game: Conversations about prostate Cancer with Ed Randall. Here we’ll chat with doctors, researchers, medical professionals, survivors, and others to share and connect. This show was produced and shared by Fans for the Cure, a non-profit dedicated to serving men on their journeys through prostate cancer.
The Stay in the Game podcast is sponsored by Cancer Health – online at cancerhealth.com.
Cancer Health empowers people living with prostate cancer and other cancers to actively manage and advocate for their care and improve their overall health. Launched in 2017, cancerhealth.com provides accessible information about treatment and quality of life for people with cancer and their loved ones, along with information about cancer prevention and health policy.
Ed Randall: Hi, everybody. I’m Ed Randall, the founder and Chief Advocacy Officer of Fans for the Cure, and welcome back to our Stay in the Game podcast. Our special guest for the bonus podcast we’ve scheduled for Men’s Health Month is a practicing radiation oncologist who oversees one of the largest radiation oncology departments in the country that provides both superior patient care and highest quality education to the next generation of oncologists. These are his twin missions as chairperson of the Department of Radiation Medicine at Northwell Health and professor at the Zucker School of Medicine at Hofstra/Northwell. He’s also deputy physician in chief in the Marilyn and Barry Rubenstein chair in cancer research for the Northwell Health Cancer Institute. With a list of titles and accomplishments, it would take us three podcasts to complete. Let’s just be clear that he’s one of the most knowledgeable people around when it comes to the diagnosis, management treatment of prostate cancer. It’s indeed our pleasure and honor to welcome Dr. Louis Potters to the Stay in the game podcast.
Dr. Louis Potters: Thank you so much for inviting me and it’s a pleasure to be here and to spend some time with you and the listeners, to talk about something as important as prostate cancer.
Ed Randall: Dr. Potters, you’ve been significant and measurable strides in dealing with prostate cancer since I myself was diagnosed back in 1999. You had prostate cancer ranks behind only lung cancer as the primary cause of death for men among all cancer types according to the American Cancer Society. What do you believe needs to be done to reduce these unacceptable mortality numbers?
Dr. Louis Potters: The first question they ask I think is a really important one. And I think the way to understand it is, you know, lung cancer is the number one killing cancer in the United States, and it kills around 70,000 men a year. Prostate Cancer is the number two killing cancer in men at an unacceptably high rate of somewhere between 30,000 and 35,000 men a year.
I think it’s important to understand and frame that number because the incidence or prevalence of prostate cancer in men is the number one cancer. And somewhere around 260,000 to 290,0009 men a year are diagnosed with prostate cancer, and yet only about 30,000, 35,000 are dying from it.
So it’s important to recognize that the natural history of the disease for most men with prostate cancer is not that aggressive and most men are going to survive with the disease. So it’s an important primary thing to acknowledge and recognize. But your point is real. A good number of men are dying from prostate cancer each year, and those numbers are falling at what I would consider a frustratingly slow rate. But nonetheless, they are falling.
Over the number of years that I’ve been in practice, the death rate from prostate cancer is going down. I think there’s early discovery and treatment of meaningful disease, which we’ll talk about, impacting and decreasing the death rate, and there are newer and advanced medications and treatments that are available for men that have high risk or metastatic prostate cancer and a number of things that are in the pipeline.
So I’m optimistic that we’re going to be able to impact the mortality numbers. But you’re right in pointing them outright from the get-go. This is still cancer. It’s an important disease that men need to recognize in terms of the opportunity for early diagnosis and intervention as a means of keeping them from dying from it.
Ed Randall: Doctor, I just want to follow up on something that you just said. To quote you, “The numbers are going down at a frustratingly slow rate.” Tell us about that frustration.
Dr. Louis Potters: The good news is, is that the mortality rates from all cancers in generals are going down, even breast cancer, and lung cancer, and prostate cancer. And we’ve seen strides over the last 30 years or so since the President Nixon’s initiation on a war against cancer. Those numbers are in the single low, single digits. But year over year you’re chipping away at it, and you’re making improvements.
Obviously, when somewhere between 30,000 and 35,000 men are dying each year from prostate cancer, you know, you’d like to see the numbers drop significantly more than just a couple of percent a year. Let me just add. One of the things that we are concerned about, and it’s important for the listeners to recognize is that during COVID, a lot of men, a lot of patients in general neglected routine, medical care. One of those would be the screening for cancers.
So there is concern in the research community that the delay in diagnosis as a result of our hibernating for the last year or so with COVID is going to have a reverse impact on mortality and perhaps have patients present with higher risk, higher grade cancers. So I would just emphasize to the listeners the importance of getting back into the routine of screening, not just for prostate cancer, but just general medical conditions in general now that we’re coming out with the vaccinations and the lower COVID rates in our communities.
Ed Randall: I’m going to pick up on that because I was going to ask you about that a little bit later in the podcast. I’ll ask it now. According to the American Cancer Society stats for 2021, the number of projected new cases is up significantly over both 2020 and 2019. Is it because so many men miss their regular screenings during the lockdown in 2020, and are you seeing a higher percentage of later stage disease due to the missed screenings?
Dr. Louis Potters: It’s a great question, and it’s one that’s going to evolve over time. So we’re not going to have a direct answer on that probably for another five to seven years in the context of looking back. Again, the natural history of prostate cancer is that it is a very slow-growing cancer. And we’re only just now coming out of COVID and societies just only now starting to wake up and get back to a more normal state.
It’s going to take time to see whether or not the incidence of cancer actually does go up, and that there’s a migration toward higher risk more advanced cancers as a result of the delays. There’s speculation on both sides that, yes, it’s going to be a cause of concern over the next couple of years. But there are others who suggest that it’s not going to be quite as bad. So we’re just going to have to wait and see.
I can tell you, in my clinic, that there hasn’t been any appreciable change in terms of any migration toward more advanced disease so far. But again, it’s really, really early. I mean, we’re only just coming out of it right now.
Ed Randall: Two Fans for the Cure’s primary missions, Doctor, are education and awareness. Beside the importance of “get a PSA screening, please go to the doctor,” what are the educational gaps you often see when it comes to men and their knowledge of prostate cancer?
Dr. Louis Potters: I think it’s important to recognize a number of things with prostate cancer. And this is sort of the flip side of the first question in terms of mortality and concern associated with mortality. But with prostate cancer, it really, for a lot of men, is almost an indolent type of disease. And although there was some politics in understanding the value of PSA screening for a number of years, we do recognize now the importance that PSA holds from a screening perspective in the context of early diagnosis.
And I say that because our thinking has evolved over the years that in men who present with very low-risk disease that no initial treatment is indicated until the disease migrates into a more aggressive phase, which may or may not happen over time. And we call that active surveillance. So many either present with meaningless disease in the context of being a candidate for active surveillance or a meaningful disease where the role of surgery or radiation will be important in terms of controlling the disease and ultimately impacting, as we were talking about earlier those mortality numbers.
It’s better to have that information up front and to have the honest discussion about how best to manage men. But from my perspective, it’s better to know than not know. And so PSA screening, followed by MRI, followed by biopsy, if positive, having that discussion, is this an active surveillance opportunity, or do you need treatment.
And for those men who have meaningful disease in the context of requiring treatment, that early intervention could be significant in terms of either less intense radiation course or an overall improved prognosis long term for them. So I would recommend that men get back into the game, so to speak, of having their PSAs checked and to follow through accordingly.
Ed Randall: I want to pick up on treatment. One of the themes/complaints in our men’s online support groups, which we host every other Thursday night at 7 p.m. Eastern Time, among men who have undergone treatment is the flawed process of deciding on a treatment path. Options and yet more options can be both, Doctor, From what we’re hearing a blessing and a curse.
Dr. Louis Potters: Yes, that is absolutely true. Sometimes you just want to be told “this is what you got to do. And here is your path. You go from point A to point B to point C, and D, and you’re done.” I think the good news for prostate cancer, despite the fact that it is a potentially anxiety-producing, the fact that there are options available to men, I think is something that’s really fantastic.
Just within radiation, which is an option that is a non-surgical approach that I routinely perform on men, there are about five or six different ways that we can do radiation treatment for prostate cancer. And then obviously, a good number of men have the option of surgery. And so it’s a double-edged sword.
So the first is it’s important that men receive consultation and have a discussion with both the urologist, the surgeon, and the radiation oncologist for the non-surgical options in a manner that creates a personalized pathway for those men. And not everybody is the same, not everybody’s prostate cancer is the same, not everybody’s anatomy is the same, not everybody’s comorbidities or other medical problems that they may have are the same. And so there is no real cookie-cutter aspect to this.
So there’s an opportunity to personalize a treatment pathway. And even if that pathway then still retains options like surgery versus radiation, there are pros and cons to both. It’s important that patients understand what those pros and cons are.
There are men whose approach is, “If I have cancer, cut it out, and I live with it.” And that’s just perfectly okay for those men. There are other men who either may have other medical conditions that make surgery dangerous or just prefer not to have surgery and prefer radiation option. And then there are those that have a hard time deciding.
It’s important to recognize the fact that having a decision implies an equal outcome. So the patients at the end of the day can’t make a wrong decision. They just have to make the decision that’s right for them. And listen, I agree with you the process can be quite daunting for these guys, and it sort of weighs on them.
What I’ve learned over time is to have them think of it in the context of the regret, so that while the majority of men are going to be treated successfully, are you going to regret that you didn’t have surgery, or are you going to regret that you didn’t have radiation or vice versa? And sort of start to weigh it in that context.
But once a patient—and they’re usually working with their spouse or family members, sometimes their friends in terms of discussions—once they get to the point where they make a decision, assuming they have options, that really is helpful for them in terms of lowering their anxiety level and the concern. But I admit it can be an issue for a lot of men as they’re going through this process.
Ed Randall: And to make it even more daunting, the men that we hear from, Doctor, complained that they were essentially pitched by specialists. Surgeons recommend surgery, radiologists pushing radiation, seemingly without colleagues at the same health care centers communicating with one another.
Dr. Louis Potters: Yeah. There’s competition in the healthcare environment, there is competition with car dealers. And I get that. Men are not necessarily being told the wrong things, they’re just being only shown one side of the equation. One of the things that we participate in and I think is really helpful is what we call a multidisciplinary clinic, where for men who do have options—and I participate in some of my other colleagues, both urologic and radiation oncologist participate—where we sit down with the patient, their spouse, and or family at one time, one sitting, and we sort of go back and forth in terms of discussing the pros and cons of radiation and surgery in one sitting. And that’s very helpful for the patients.
Ironically, by doing that, there are a lot of times where my urologic surgeon colleague and I walk into the room and in a matter of a few seconds or so we can really size up, you know, this guy is going to be much happier with surgery. And so we have this cadence down where it’s pretty straightforward where this guy is really not interested in surgery. But still having the two of us together in the room decreases some of that bias and affords the opportunity for them to ask questions to both of us at the same time.
I think it’s the right way for men to think about the decision process. But if those types of clinics aren’t available, they really should take the time to see both urologist and a radiation oncologist as a means of having independent discussions so that they understand the risk-benefit potential outcomes of each of the modalities.
Ed Randall: Increasingly, men have shared with us that they chose a given hospital based on the level of multidisciplinary communication, with Sloan Kettering and Northwell coming in for praise among our guys. Can you speak about Northwell’s multidisciplinary approach to presenting men with the best treatment options for their specific case?
Dr. Louis Potters: We have developed a multidisciplinary program to address two aspects of prostate cancer. The first is rapid diagnosis programs. We were one of the pioneering institutions doing a lot of research over the last 10 to 15 years on the role of MRI and now on the role of what’s called transperineal biopsy. So one avenue for patients coming in is in the pre-diagnosis phase and really wanting to do the workup sequentially correctly to get the most amount of information that will help to drive the best decision option for patients.
I believe the standard of care has evolved toward getting an MRI in advance of biopsy as a means of assessing the extent of the disease, which can be distorted if you get the MRI after the biopsy, and not give you as clean information. And so that’s one approach that we’ve taken is really trying to do the best and most accurate workup for men presenting with pre-diagnosis elevated PSA.
And then for men who actually have prostate cancer, we do the multidisciplinary program where the urologist radiation oncologists meet together with the patient. And as a result, it provides us an opportunity to get their feedback together and to present an appropriate option for them. There are times where we’ll walk in and we’ll say, “We’re sorry, we can’t do surgery because of your heart and kidney conditions.” But there are other times where we’ll sit down and really map out the pros and cons, allowing the patients and their spouse to come up with what they think would be the best approach for them.
But again, it’s important to recognize that this idea of personalized treatment support and coming up with a personalized treatment plan is something that is important for men with prostate cancer. There’s no one program where everybody fits into one aspect of care.
And it’s important that the patients understand the risk of disease that they have, whether it’s low, intermediate, or high risk, and now we’re into favorable and unfavorable high-risk disease. There’s the whole budding area of genomics and understanding genetic risk associated with decision support. Having all of that information in one setting with the two physicians, I think is really key for the men to come up with a decision that’s appropriate for them, and then to feel satisfied that they’ve really picked the tires appropriately in coming up with that decision.
Ed Randall: With Dr. Louis Potter’ on our Stay in the Game podcast, he is the chairman of the Department of Radiation Medicine at Northwell Health. You and your department are recognized as pioneers for high quality and safe cancer care, which Northwell has formalized through a smarter radiation oncology initiative. Described for us, Doctor, what the smarter radiation oncology initiative is all about and what that brings to the table for men who are weighing radiation as a treatment option.
Dr. Louis Potters: Thanks for raising this issue. I think it’s an important one. When you go to receive care someplace, you put your trust in the quality of the care that’s provided. Radiation therapy is one of those types of services where there are a good number of handoffs between the physician and some of the staff within our department in terms of the planning and the implementation of that plan for each of the patients.
We have a group of physicists and what we call dosimetrist. They’re our sort of treatment designers so to speak. And it’s important to recognize that during those handoffs and during the planning phase that there are different levels of quality that leads to what I would call the best plan and the implementation of that plan for the patient. Think of radiation as sort of like a spotlight aimed at the prostate. We have the opportunity to design that beam in a way that conforms to the prostate or the prostate in the seminal vesicles, and be accurate within just a couple of millimeters or so.
So about 12 to 14 years ago at Northwell, we came up with a program where we really wanted to lower the risk of errors and wanted to enhance the quality of our planning. So one of the things that we do is all of our physicians share each other’s plans together before the patient started treatment. So if you think about it, we have 21 faculty in the Department of Radiation Medicine, and every day we’re rounding on all of the new patients that will be starting care. And we’re all providing input on each other’s work.
Think of it as the entire Department of Surgery being in the oar with your surgeon at the same time that the procedure is being done as a means of consensus and validating the work that each of us do. It’s a phenomenal backstop, because it… You know, listen, everybody has an opportunity to provide some input and we identify and make some minor tweaks and changes. When you’re treating with an accuracy of a millimeter or less, everything counts. And if there’s an opportunity for improvement, then we take advantage of that.
This is a program that we’ve put together. We’ve published on it, we’ve done research on it, and it’s been picked up by a number of other institutions around the country and it’s one that we think is unique and special to the care that we provide to the patients in the Northwell system.
Ed Randall: Within the category of radiation therapy treatment, there are several subcategories. Stereotactic body radiotherapy (SBRT) is one of them. Walk us through, if you will, the difference between SBRT and conventional radiotherapy.
Dr. Louis Potters: Great. It’s one of these confusing areas. The history of radiation treatment for prostate cancer involved two parallel tracks over the last 30, 35 years or so. And one of those was the concept of using the linear accelerator with external beam radiation. The standard of care has evolved as the technology has improved, allowing us to focus the radiation more safely to the prostate with less collateral effects to, say, the bladder and the bow and the rectum, which are in proximity to the prostate.
And we use all sorts of techniques called intensity-modulated radiation, we use image guidance to make sure that the beams are aimed accurately each day of treatment. Over the years, the standard of care has been to treat to a very high dose of radiation. And we’re capable of doing that safely. And until a number of years ago, that was about 44, 45 treatments, almost nine weeks of care.
The parallel track has been using seed implants or Brachytherapy where we inject radioactive seeds into the prostate. And in a one treatment setting, as a minor procedure similar to the biopsy, we inject little radioactive pellets smaller than a grain of rice into the prostate, which then from the radiation decays and over time treats the prostate.
Brachytherapy continues to be an option for men with prostate cancer provided their prostate is not too large and that the men do not have a lot of urinary issues upfront. And we continue at Northwell to provide that option to a good number of men.
The external beam approach—and I’m sorry for the long-winded answer, but it’s an important concept for men to understand—is that a) we don’t have to treat over nine weeks anymore. We’ve done a number of studies to shorten the standard of care down to about five weeks of external beam radiation. We call that hypofractionation. It’s a shorter course of care. And we’ve demonstrated that there’s no increase in the complication rate and the outcomes are equally as successful as the longer course. So that’s good news for men in terms of the amount of time that they would need to set aside for treatments.
The concept of stereotactic body radiation therapy, as you note, is this unique opportunity where we can actually concentrate all radiation treatments into five or less sessions. Again, because the technology allows us to focus the radiation very accurately to the prostate, we don’t have to worry as much about some of the collateral effects that such high daily doses of radiation would potentially cause. And so the data suggests that stereotactic treatment in some men might be a viable option over the five-week course of traditional radiation or the seed implant option.
So it’s important as I was saying earlier in the discussion today to understand the risks and benefits of each one of these options. So if you think about radiation treatments, generically, we now have stereotactic, five treatments, we have a standard hypofractionation of five weeks of conventional radiation therapy, and we have seed implants.
And again, we would want to personalize for each man what might or might not be the best. And there might be options for men, depending upon the risk of disease, the size of the prostate, the type of urinary symptoms they present with. Remember prostate cancer is a disease of older men who tend to have difficulty urinating. So it’s important to put all of that together to sort of shake it up and come out with what might be the best option. So one size doesn’t fit all, as I’ve already said, but understanding that there are options within the house of radiation oncology is important.
Ed Randall: It’s also something of interest to the guys in our support groups. Would a man be able to get repeat treatments of SBRT should he experience a recurrence of prostate cancer after his initial treatment cycle?
Dr. Louis Potters: So that’s a great question, and it’s one that we’re investigating more and more so. It doesn’t necessarily have to be SBRT on top of SBRT. It could be seed implant on top of SBRT or it could be SBRT on top of the seed implant. One of the advantages of radiation over surgery is that you retain the anatomy—the prostate, the plumbing, and everything is still intact so that if a man is to experience a recurrence of prostate cancer, it creates a multiple opportunity of how best to treat.
Again, it’s important for the listeners to recognize most men, the vast majority of men who need to be treated are treated successfully. Again, whether it’s radiation or surgery, in the mid to high 80% into the 90% depending upon risk category. So we’re talking about a minority of patients who may have a failure or recurrence of the cancer. And then the question is what’s really the best approach?
What we’re in the process of learning is that, yes, we can consider in some men retreating the prostate with radiation. Sometimes, instead of using radiation, men may want to think about cryotherapy or freezing of the prostate as a means of treating a recurrence. There are some other things that are potentially coming down the pike as a means of treating men who have recurrent disease.
One of the most exciting areas in prostate cancer is understanding how best to treat men who develop metastatic disease. Metastatic disease is when the prostate cancer spreads, and it either recurs or men present with advanced disease that has already spread beyond the prostate. So there’s a whole approach now in men who have metastatic disease but not a lot of it, just a couple of pinpoints here or there, a lymph node here or there or even a solitary bone lesion, which in the past we would have written off and just put men on hormone treatment. Now we can do stereotactic radiation to those particular lesions and potentially avoid the use of hormone therapy and treat them successfully. So continuing to do research in that area. But it’s a really exciting area for men who have either recurrence or advanced or metastatic disease.
Ed Randall: Dr. Lewis potters is the chairperson of the Department of radiation medicine at Northwell Health. Doctor, we are nothing if not hyper aware of the issue of overtreating interim cases, that is, cases that would never clinically impact a man’s health during his lifetime. The side effects of any surgery or radiation regimen can be brutal and life-changing. What are your ideas and improving treatment strategies to get them more proportionate to the velocity of a man-specific disease?
Dr. Louis Potters: That’s a great question. Listen, five to seven years or so ago, the sort of the watercooler discussion was, you know, it’s very hard to convince somebody who’s been told they have cancer that they don’t need to be treated. I know that for a good number of years there was—and it continues to today—but there’s overtreatment of men who perhaps initially do not need therapy for their prostate cancer.
And what that means is that they’re presenting with very low risk or low volume cancer, a clean MRI, Gleason 6 tumors that can be observed over time in a program called active surveillance. And I touched upon that a little bit earlier. But it’s important to recognize that active surveillance is probably an option for almost 20% to 25% of men diagnosed with prostate cancer. And it’s something that they need to talk with their urologist and radiation oncologist about.
Again, it’s one of those areas where having a multidisciplinary clinic, when a patient comes in thinking they’re going to need to be treated to have both doctors at the same time say to them, “No, we’re going to observe this and see what happens.” The data shows that about 60%, so greater than even odds of men over the course of five to seven years will not need treatment at all. And only about 40% of men will migrate into a phase where either the PSA elevates or repeat biopsy shows more advanced disease, and then those men get treated. And what we’ve learned is, is that delay in treatment doesn’t impact prognosis. And then for those 60% of men who don’t need treatment, it’s just a great thing.
So every physician learns how to have that conversation with the patient and how to gauge the patient’s anxiety, the spouse’s anxiety of a cancer diagnosis, and then being told you don’t need anything. I like to say prostate cancer is in those types of men is like a small c cancer, not a capital C Cancer. And that my role as treating or observing physician in the active surveillance is to not compromise their opportunities of success, should they need treatment down the line.
So follow-up is important and repeat biopsies and MRIs are important. But I can tell you, the quality of life aspect of avoiding treatment is phenomenal. It’s gotten to the point sometimes where you turn around and a patient is clearly having a problem and we now need to evolve into the discussion of treatment, and they’re so happy with active surveillance that then they’re like, “Can we just wait a little bit longer?” And then you have the reverse difficult conversation of trying to tell them, no, it’s time to be treated. But I have a good number of men out, you know, 7, 10, 12, 14 years, no treatment at all and they’re happy as clams.
Ed Randall: Doctor, you’ve talked about progress. Fill us in on a few of the exciting new technological advances and testing methods we can expect to positively impact the processes of diagnosing of treating prostate cancer over the next five years.
Dr. Louis Potters: It’s a great question. I’ve been doing this for 32 years, and there’s clearly been progress over that time period. But we’re really sitting at the threshold of two aspects of improvements and our understanding of prostate cancer. So the first is really in understanding how to fingerprint from a genetic perspective the individual patient’s prostate cancer.
The traditional way of assessing risk of prostate cancer is the Gleason score, which is an assessment of the pathology looking at the architecture of the slides. But we’re now advancing our understanding of the real genetics underlying prostate cancer as a means of trying to further personalize the best treatment approach or perhaps validating active surveillance in men. So a lot of work that’s being done in that area that is going to be very promising over the next couple of years.
Both of these are game-changers. But secondly, another big game-changer is in what’s called PET scan, Positron Emission Tomography scanning, where we inject patients with an isotope that is attracted to what it is we’re trying to find. And while PET scanning is done for a lot of different cancers over the years, the agents that we’ve used for prostate cancer really don’t pick up prostate cancer well. But that’s changing.
The FDA just recently approved what’s called PSMA scanning, and that’s a prostate membrane antigen-specific isotope that looks for prostate cancer. And we know from the studies that got the approval and the European studies that have looked at this over the years that it’s really quite sensitive and specific for looking at any spread of the cancer beyond the prostate as a means of further identifying what might be the best treatment approach for men.
So PSMA scanning is really going to be a game-changer. I see that as a bigger game-changer than the genetic screening and profiling. But both of those are going to be really important. PSMA is going to be really helpful in men who either had surgery or radiation and were concerned about a recurrence of the cancer in the context of identifying where it might be as a means of either using some stereotactic radiation in terms of like spot welding or defining which type of systemic treatment might be best for them. So, really an exciting time for both of those modalities. And I see a fairly significant evolution over the next couple of years in how we manage prostate cancer as a result of these.
Ed Randall: Up until the last few years, Fans for the Cure had focused solely on the importance of early detection in our messaging. Now we try to engage in assessment at all phases of their prostate cancer journeys, screening, diagnosis, treatment, and in a perfect world, many years of survivorship. From a doctor’s point of view, what do your patients need most along the way that a charity might be able to provide?
Dr. Louis Potters: That’s a great question. There’s safety in numbers as they say and the opportunity to, first of all, recognize that there are many, many prostate cancer survivors out there. A lot of men feel alone about it. And I think the opportunity to hear podcasts like this and to just participate in the community of prostate cancer awareness and survivorship is important.
And then being able to have other survivors or other men with prostate cancer along their cancer journey phase to speak with and to relate to I think is something that’s particularly helpful. There are a lot of times where I’ll sit down with… we didn’t really talk about it today, but I’ll sit down with a man who had surgery, thought they were cured, but then need radiation, and they feel like they made the wrong decision, and “why do I need radiation now?”
It’s important for me to say to them, listen, you’re not alone. I mean, this is something that happens frequently. Fortunately, not in the majority of men, but it happens frequently. And it’s important for them to understand it’s not a rare occurrence. Having support groups and listening to other podcasts about the disease I think is very helpful.
There’s a lot of things that men look for in terms of sexual health, in terms of nutrition, in terms of exercise that I think these types of groups like yours is really helpful in providing that information to them. Men with prostate cancer, you know, we started out talking about mortality, but there’s more cancer survivors than there are men who die from prostate cancer. And they’re living now a long, long time. And we want their quality of life to be as good and strong as everybody else. So I think you guys have a lot of input in making that happen for these men.
Ed Randall: Northwell Health along with its educational research components is one of the largest if not the largest healthcare employer on the east coast. Your resources, both financial and human, are second to almost none in the industry. How did these ideas and resources doctor translate into innovation and advancement in the treatment of prostate cancer?
Dr. Louis Potters: It’s great working for this organization. And what I find appealing is the opportunity for our department and the Department of Urology to have an impact in the New York metropolitan area, and more than just one geographic area. So we’re in Westchester in Staten Island and east side of Long Island, and then obviously, in Nassau County.
The opportunity that we offer patients with cancer is that we are a cancer program within a health system that allows us to integrate not only cancer care but health care within cancer care. We talked about the multidisciplinary aspect of decision-making with the urologist and radiation oncologist upfront in a man that has prostate cancer. But for somebody whose healthcare is within the health system, it allows us to further expand that multidisciplinary aspect to the patient’s cardiologist or other health providers and to take into account the whole patient when deciding on treatment and or working together in terms of managing the patient.
So it’s one aspect of being in a large health system that I think is valuable to the patients. And then because of our size, it allows us to offer clinical trials, cutting-edge treatments, and making certain aspects of care available to patients that may not be available outside of the standard of care.
Ed Randall: [Extra innings? 00:48:25]. Anything you want to add?
Dr. Louis Potters: No. I just want to thank you guys for what you do and for being there for men with prostate cancer. I think, as I’ve been doing this for a good number of years, men are less in the closet, so to speak, with this disease. And I think a lot of that has to do with groups like yours and others that bring the awareness and the importance of these discussions to them. So just wanted to thank you for your time and the work that you guys are doing in this area.
Ed Randall: Dr. Lewis Potters with us, the chairperson of the Department of Radiation Medicine at Northwell Health. And we are so grateful to have had him on our Stay in the Game podcast. I’m Ed Randall. Thanks so much for listening.
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