Focusing on cancers: liver and pancreas; lungs; kidney and prostate: Upstate Medical University's HealthLink on Air for Sunday. Aug. 27, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a surgeon discusses a promising treatment advance for cancer of the pancreas.

Thomas VanderMeer, MD: ... What they looked at was whether or not the immune cells in that patient were able to specifically attack those proteins that they intended to have them attack. ...

Host Amber Smith: A medical oncologist talks about improved survival rates for lung cancer.

Stephen Graziano, MD: ... Only about 20% of people are getting low-dose screening CT scans that are eligible. So I think we need to do a lot better in this area. ...

Host Amber Smith: And a urologist shares encouraging news about kidney cancer and an update on prostate cancer.

Gennady Bratslavsky, MD: ... We still have close to 80,000 new diagnoses expected this year, and there will probably be close to 200,000 people living with kidney cancer in the United States alone. ...

Host Amber Smith: All that, and a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we're exploring the 33% overall reduction in cancer deaths since 1991, according to data from the American Cancer Society and the National Center for Health Statistics. We'll go into depth with Dr. Stephen Graziano about lung cancer. Then, Dr. Gennady Bratslavsky addresses kidney cancer and prostate cancer. But first, Dr. Thomas VanderMeer talks about promising new therapy for pancreatic cancers.

From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."

Many more people are surviving cancers of all types today than 20 or even 10 years ago, thanks in part to better detection and diagnosis and improved treatment strategies. Cervical cancer has seen the most dramatic decline -- 65% from 2012 to 2019 among women in their early 20s, and experts credit the HPV (human papillomavirus) vaccine for that.

Now we're going to take a look at a cancer that seems to be on the rise and another that has been difficult to catch early with Dr. Thomas VanderMeer. He's the interim director of the Upstate Cancer Center and chief of surgical oncology with a practice specializing in cancers of the liver and pancreas.

Welcome back to "HealthLink on Air," Dr. VanderMeer.

Thomas VanderMeer, MD: Thank you, Amber. Thanks for having me.

Host Amber Smith: You specialize in the liver and the pancreas, so I'd like to talk about what is happening with cancers in each of those organs. Let's start with the liver. Liver cancer incidence has tripled since 1980. Do we know why?

Thomas VanderMeer, MD: We think that the rise in the incidence of liver cancer is primarily related to the high rate of infection from hepatitis C virus in baby boomers, and also the rise in obesity. These are both risk factors for the development of cirrhosis. There's a lot of different liver diseases that lead to cirrhosis -- but that damage and scarring and repair leads to an inflammation that we think leads to liver cancer. And the hepatitis C virus, the infection in and of itself, causes changes that lead to liver cancer.

Host Amber Smith: Does liver cancer show up in a medical image or a blood test? How do you detect it?

Thomas VanderMeer, MD: It does show up on a number of different imaging studies. When people have hepatitis B or hepatitis C infections, they are screened for the development of liver cancer, and that screening is done usually with ultrasound. And so ultrasound is simple and a pretty reliable way of detecting liver cancers, but it's also seen on CT scans, and MRI is particularly sensitive for picking up liver cancers. There are blood tests that we use if somebody has an established diagnosis of liver cancer, to follow the response of the tumor to the treatment.

Host Amber Smith: Well, once liver cancer is diagnosed, is surgery usually the first treatment?

Thomas VanderMeer, MD: Surgery is the best treatment for liver cancer. Now, there are two types of liver cancers that are the most common. One is generally related to viral hepatitis and cirrhosis. And then there's another type that's derived from the bile ducts within the liver. So they have slightly different treatment options and different things that we can do.

But by and large, yes, we try to do surgery whenever it's possible. There are limitations on when we can do surgery to remove the tumor. For example, some people have cirrhosis that is so severe that we can't remove part of the liver safely. Removing part of the liver in some cirrhotics, especially with advanced cirrhosis, will lead to liver failure. And so we have to be very careful about looking at the liver function, how much viable liver needs to be removed to remove that tumor. That's for resection (surgical removal).

Liver transplantation is also an option. It's been well shown that for patients with up to three relatively small liver tumors, the liver transplantation can be very effective. And that's especially attractive in people with advanced cirrhosis who wouldn't be able to tolerate a liver resection.

For the other type of liver cancer that arises in the bile ducts, there are centers that are investigating the utility of liver transplantation for those tumors as well.

Host Amber Smith: Are there other therapies that are used in coordination with surgery?

Thomas VanderMeer, MD: There are alternatives to surgery for people that they can't have surgery for whatever reason. By and large, surgery -- resection of the tumor -- is the best treatment. And additional treatments beyond that have not been shown to be effective. So when we're talking about all the other different things that can be done, there are alternatives. And which alternative we use depends on how localized the tumor is.

So, if a tumor is localized and small, but the condition of the liver, the location of it, makes it not amenable to removal, there are devices we have where we can use microwaves to destroy the tumor. Increasingly, we're looking at high-dose radiation to the tumor, and that can be very effective as well.

We can also access the arteries that take blood to the tumor and inject things like radioactive microspheres that implant in the tumor and give a local dose of radiation internally to the tumor. We can also target the blood supply to it. We can clot that off and so kill the tumor in that way.

And then for more widespread liver tumors, then we're looking more at the tumors that are spread widely through the liver and potentially through the body. So, in those cases, we're talking about what we call systemic drugs that get through the body, so, immunotherapy, medications and other things that are given intravenously.

Host Amber Smith: What do you see on the horizon for liver cancer?

Thomas VanderMeer, MD: So, like with most cancers, there's really exciting work being done around the harnessing the body's own immune system to attack the tumor and kill it. And so there's a lot of different ways to do that. We're also understanding the different genetic profiles of these tumors so that we can have much more targeted therapies just like with a lot of other tumors.

Liver cancers have been kind of lagging behind the advances made in some other tumors like lung cancer, where there's lots and lots of different immunotherapy options. What we've recently found is that drugs that prevent the tumor from creating blood vessels to supply itself with nutrients, we can interrupt that process with some medications. That's been shown to be effective.

And other things like viral therapy are being investigated actively, as are more direct radiation techniques. And then just from a population health standpoint, getting more people screened who are at risk for developing liver cancer, that I can make a huge difference in terms of early detection.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with Dr. Thomas VanderMeer. He's a surgeon and the interim director of the Upstate Cancer Center.

Pancreatic cancer is 3% of all cancers, but 7% of cancer deaths. Is the relative death rate high because it's particularly hard to detect this cancer early?

Thomas VanderMeer, MD: Yeah, that's part of it. But also it's a difficult cancer to treat. So it will present often late in its course, because there aren't symptoms early on in a lot of cases. And so the tumor is often metastasized, or disseminated through the body without anybody really having any symptoms to notice it.

And then we have relatively limited treatment options for it, although there are some emerging technologies and techniques and medications that are looking very promising.

Host Amber Smith: What causes pancreatic cancer?

Thomas VanderMeer, MD: Like most cancers, the cause is related to mutations in the genes. And what I mean by that is that our bodies are made up of cells. And the cells will normally divide, to refresh our body and keep it functional. And then the original cell will die off.

But mutations can cause dysregulation of the growth of cells. And so in pancreatic cancer, there's four specific genes that trigger these changes in growth of the cells. But the other thing that these cancer cells do is that they put the brakes on our own immune system so that they can escape the normal process that our bodies use to rid itself of things that are not good for us, like viruses and abnormal cells. So once a cancer gets started, it does things to our immune system that kind of put the brakes on it.

Host Amber Smith: But, like you said, we might not have symptoms of this or know that this is happening. How does pancreatic cancer usually get discovered, then?

Thomas VanderMeer, MD: Depending on what part of the pancreas the tumor is located in, the tumor may block the bile duct. And that's a fortunate thing because people then get jaundiced. And so those tumors tend to get detected pretty early.

If it's in another part of the pancreas, then it can grow to be pretty big before it infiltrates nerves and causes pain or causes pancreatitis. Or sometimes it's already advanced so far that people are already starting to lose weight, and so they just go to the doctor because they're not feeling well. And usually it's a CAT scan that is the first test to detect this.

Host Amber Smith: Is surgery part of the treatment for pancreatic cancer?

Thomas VanderMeer, MD: Surgery is the most effective treatment that we currently have for pancreatic cancer. There's generally just two operations that are done, depending on the location of the tumor. And increasingly we're using minimally invasive surgical techniques so that we can avoid a big incision and really improve the recovery.

It is very important to get chemotherapy around the time of surgery, either before and after, or after. So it's important that the recovery from the surgery be relatively straightforward and quick and uncomplicated so that patients can get on to their next phase of treatment, which is chemotherapy.

Host Amber Smith: Have immunotherapies been helpful?

Thomas VanderMeer, MD: Not significantly. There are a small percentage of pancreatic cancers that are amenable to immunotherapy and responsive to immunotherapy that we currently have. But there's been some novel techniques that have been tried that have shown some very early promise.

Host Amber Smith: What can you tell us about an experimental mRNA vaccine that's being tested against pancreatic cancer?

Thomas VanderMeer, MD: So that was one of the new techniques that I was kind of referring to. There was a pretty exciting study -- it was only about 20 patients, I think -- but what those investigators did was they actually partnered with the same vaccine company that created one of the COVID vaccines, to use mRNA technology to train the cells, so the immune cells would be able to attack that particular cancer. So what they did was they removed the tumor. Then they processed the tumor, and they found out what the proteins were on the surface of that particular cancer. And they're different depending on the person. And then they generated a vaccine against those exact proteins that were on the surface of that cancer. And then they injected the mRNA vaccine, and about half the people had a really good response.

And in terms of response, what they looked at was whether or not the immune cells in that patient were able to specifically attack those proteins that they intended to have them attack. And only about half of them were successful in generating those T cells. But of those people, at, I think, one-year follow-up or so, very few of those patients had any recurrence; where the patients who didn't have such a good response, most of them had their cancer recur within a year. So not only did they show that they could engineer these immune cells to attack that particular cancer, but they also were starting to show that there was a difference in survival and prolonging tumor recurrence. So, a pretty exciting study.

I think the next thing for them to work on is to see how they can get more of the patient's immune cells to adopt these receptors.

Host Amber Smith: So it sounds like this new approach holds some promise.

Thomas VanderMeer, MD: Very much so. Yeah. And there's been other investigators that -- I think it was pretty big in the news a few months ago -- it was only one patient, but the patient had pretty widespread metastatic pancreas cancer, and, again, they programmed her immune cells to attack that particular cancer. And I think it was like a 72% response, but the response generated over a long period of time, and they showed that these immune cells had been replicating in the patient's body. And so we are still waiting to hear, but the hope was that once those cells were there, they'll continue to fight the cancer over a long period of time.

Host Amber Smith: Well, Dr. VanderMeer, thank you so much for making time for this interview.

Thomas VanderMeer, MD: Well, thank you for having me, Amber.

Host Amber Smith: My guest has been Dr. Thomas VanderMeer. He specializes in hepatobiliary and pancreatic surgery, and he serves as the interim director of the Upstate Cancer Center. I'm Amber Smith for Upstate's "HealthLink on Air."

Is increased screening helping to reduce lung cancer deaths? -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Lung cancer remains the leading cause of cancer death in the United States, even though the death rate decreased from 2015 to 2019. For help understanding what's happening with lung cancer, I'm talking with Dr. Stephen Graziano. He's professor of medicine and chief of hematology and oncology at the Upstate Cancer Center, and many of his patients have lung cancer.

Welcome back to "HealthLink on Air," Dr. Graziano.

Stephen Graziano, MD: Thank you, Amber.

Host Amber Smith: What can you tell us about the latest statistics for lung cancer in terms of survival?

Stephen Graziano, MD: Well, it's a long trajectory of statistics for lung cancer. When I started as a fellow (specialty training) back in 1982, the long-term survival for lung cancer, and by that we mean five-year survival, was probably in the 8% to 10% range. With 40 years of research and improvements in treatments, we're probably up to 25% to 30% five-year survival for lung cancer.

Host Amber Smith: So,it's improving?

Stephen Graziano, MD: It is improving. And, not captured in those statistics are the average patient is living longer. But reflected in the five-year survival, we're still in that range of 25% to 30%.

Host Amber Smith: Are there differences between women and men?

Stephen Graziano, MD: So, the difference between women and men mostly has to do with the incidence of smoking. You know, men probably had double the rates of smoking going back to the '60s, when the surgeon general's first report came out. I would estimate that probably about 40%, 45% of men smoked and maybe about half the rate for women. So those rates have come down markedly, and I think that's probably driving most of the decrease in mortality for lung cancer.

I checked this in anticipation of your question. Currently about 13% of men smoke. And about 10% of women smoke. So that's just a huge epidemiologic (statistical) difference in what we're seeing. And that, of course, is reflected in the mortality from lung cancer.

The mortality for men probably peaked around 1990 and has been coming down several percent per year since 1990, 2% to 4% per year, which is a huge difference. For women, they started smoking a little later than men, and they probably peaked out around 2000, and then their rates are coming down as well. But I think what's different now is we're also seeing some of the newer therapies also making an impact. So the reduction in mortality is not just decrease in incidence, but I believe treatments are also influencing the reduction of mortality as well. That's a first.

Host Amber Smith: The American Cancer Society says 10% to 15% of lung cancers are small cell lung cancer, and the rest, 80% to 85%, are non-small cell lung cancer. Which is the one that's more common in smokers?

Stephen Graziano, MD: So, all are increased in smokers, compared to nonsmokers. Small cell is most strongly associated with heavy smoking. Next would be squamous cell cancer, and then next would be adenocarcinoma. So adenocarcinoma is the subtype which makes up, now, about 60% of newly diagnosed cases, but that is the one associated with nonsmoking most commonly and, also, with a lot of the cancer mutations that you see in the news where there are targetable mutations and agents that will attack those targets.

Host Amber Smith: Well, let me ask you this: Is vaping as dangerous as cigarette smoking in terms of the lung cancer risk?

Stephen Graziano, MD: I think it's too early. I think there's a growing concern about vaping as exposing the lungs to carcinogens, but I think it just hasn't been around long enough to see increases in lung cancer in that group.

Host Amber Smith: Regarding lung cancer screening that's been available in recent years, have enough people done this so that it's helping to reduce mortality?

Stephen Graziano, MD: I am glad you raised that point. I think this is an area where we're falling short. The U.S. did a large study looking at screening CT scans. And then the Europeans did a trial called the NELSON trial that was reported about four years ago. And both showed marked reductions in mortality with the uptake of screening CT scans.

So probably only about 20% of people are getting low-dose screening CT scans, that are eligible. So I think we need to do a lot better in this area. We do Pap smears for cervical cancer, PSAs for prostate cancer, colonoscopy for colon cancer, which have all made impacts in those diseases. I think we have a great opportunity to decrease mortality further by doing low-dose screening CT scans.

Now, the criteria for this is, if you've smoked one pack a day for 20 years, that's called 20 pack-years, and you're between the ages of 50 and 80, and you quit smoking less than 15 years ago. That's the criteria now for someone to be eligible for a low-dose screening CT scan. And the nice thing about the low-dose screening CT scan is, it exposes patients to minimal radiation, but it's quite accurate. We have algorithms for what do you do if there's a nodule that's picked up on that CT scan. So, we're pretty sophisticated in terms of how to manage the small pulmonary nodules that might be picked up on a CT scan.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Stephen Graziano. He's a medical oncologist at the Upstate Cancer Center, and we're talking about lung cancer.

You mentioned that some of the improvement in survival has to do with treatment, so I wanted to ask you about some of the treatment advances that have helped with that. What does treatment usually consist of these days for early-stage cancers?

Stephen Graziano, MD: So, we can divide lung cancer into basically one-third, one-third, one-third.

So, one-third present with early-stage disease where surgery is the main treatment for those patients. One-third present with disease that has spread to the lymph nodes in the middle of the chest. That's stage 3 disease, and that's approached in a different manner. And then stage 4 is when it has spread to distant sites. So about one-third of patients present in that way.

So, for the first group, the early-stage patients, they generally undergo surgery, and if they have certain characteristics, they would be eligible for what we call adjuvant chemotherapy. So if they have lymph nodes involved and their risk is over 50% of for recurrence, we generally will treat them with about three months of chemotherapy. And then immunotherapy has just come online the last two years, which was also making a big impact in preventing recurrences. So, for early stage disease, it's surgery. And then for certain patients at higher risk, they'll get chemotherapy and immunotherapy.

For the middle group, for the stage 3 patients with lymph nodes involved, generally we will treat with a combination of radiation and chemotherapy, followed by one year of immunotherapy. This was also a huge step forward for patients. Cure rates went from 20% up to nearly 50% with that approach. So research is building on that, adding to that backbone of treatment.

And then for advanced stage disease, the biggest difference is we are identifying patients that have genetic mutations where we might have oral agents that will treat these targets. Probably around 40% of advanced lung cancer now will have a target of some sort where we have not just chemotherapy and an immunotherapy, but we also have oral agents that can be effective. So that adds to our armamentarium of chemotherapy and immunotherapy for patients with advanced disease.

Host Amber Smith: So it sounds like a lot more options.

What are the survival rates for each of these thirds? The early, the middle and the later stage?

Stephen Graziano, MD: So, for early stage patients, we're probably looking at, oh, 70% to 80% long-term survival. For the middle group, we're probably looking at three- to four-year average survival, but cure rates in the 50% range. And for advanced-stage disease, this is actually where the biggest changes have been seen. We used to not see much, a high percentage of, long-term survival, so maybe five-year survival in the single digits, you know, 3%, 4%.

Now, remarkably with the advent of immune therapy, we're seeing close to 20% five-year survival for patients with stage 4 disease. That is truly a remarkable achievement and obviously a long way to go. But, there are patients that have been treated with chemotherapy and immunotherapy, and the current standard of practice is to treat patients for two years. If they're in remission after two years, you discontinue therapy and put them on surveillance. And patients remain in remission for months and years off therapy.

My earliest patient where I discontinued therapy was February of 2018, and she had stage 4 disease. She remains in remission. And I just see her periodically in clinic (for follow-up checks). It's quite remarkable.

Host Amber Smith: That is encouraging. Do you anticipate that lung cancer survival rates are going to continue to improve?

Stephen Graziano, MD: I do. There are some roadblocks. For patients who become resistant to immune therapy, we're looking at ways to reestablish sensitivity to immune therapy. So there's a lot of strategies that are being looked at in research and clinical trials to try to reestablish sensitivity to immune therapy.

Host Amber Smith: Well, Dr. Graziano, thank you so much for taking your time for this interview.

Stephen Graziano, MD: Thank you for asking.

Host Amber Smith: My guest has been Dr. Stephen Graziano. He's professor of medicine and chief of hematology and oncology at the Upstate Cancer Center. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," why is the incidence of prostate cancer climbing?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Routine screening helps detect prostate cancers, but there's been a troubling uptick in advanced-stage diagnoses. At the same time, more kidney cancers are being found incidentally and treated successfully.

Here to talk about each of these cancers is Dr. Gennady Bratslavsky. He's professor and chair of the department of urology at Upstate, and he and his colleagues care for patients with both of these types of cancer.

Welcome back to "HealthLink on Air," Dr. Bratslavsky.

Gennady Bratslavsky, MD: Thank you, Amber. Great to be here.

Host Amber Smith: How is kidney cancer typically discovered? Are there symptoms?

Gennady Bratslavsky, MD: Unfortunately, kidney cancer is something that is often not discovered until very late. If there are symptoms, by the time people have symptoms, the disease is usually quite advanced or at least has a stage when it had either grown in size to be felt, cause local symptoms or cause blood in the urine. And all these are usual signs of something a bit more advanced than a small renal mass.

The vast majority of kidney cancers nowadays are still diagnosed with an incidental screening done for other causes. Somebody may have an abdominal pain, a back pain. They are seen in the emergency room. And because kidneys are in the area of the body that is often being scanned, the small renal tumors are usually found.

The only time when we continually screen for kidney cancer are in patients that have hereditary disorders, which means that these people are at risk to develop kidney cancers because of a family history of kidney cancer, or a known problem with the gene code that is known to predispose to later, or at some point in life, develop kidney cancer.

So, in summary, you have three groups. You have patients that are diagnosed with kind of a more advanced kidney cancer, usually when they have symptoms from the tumor itself, whether it's, again, blood in the urine, pain in the abdomen, swelling of the legs, loss of weight. Most of the cancers in the second category are diagnosed incidentally, from scans done somewhere else. And the third, much smaller, group of patients are diagnosed because of a very meticulous screening in a very specific proportion of patients at risk for developing kidney cancer when we know who these people are.

Host Amber Smith: If you suspect that someone might have kidney cancer, how do you go about diagnosing that?

Gennady Bratslavsky, MD: Certainly we do a specific scan that is either a CAT (computerized tomography) scan or an MRI (magnetic resonance imaging) that just gives you a very simple answer: Is the tumor of the kidney present or not? And, is this tumor likely to be cancerous or not? Never can we guarantee that something is a cancer, because even among some large renal tumors, a small percentage of tumors may turn out to be non-malignant, also known as non-cancerous or benign.

But the most common type today is diagnosed via a classic scan known as CAT scan or MRI. Sometimes ultrasound can be used, but usually the definition or the information about anatomic and some specific things that we see when evaluating kidney tumors are better seen with, again, CAT scan or MRI.

Do we have additional scans that help us further with trying to predict or guess what kind of kidney cancer or kidney tumor this is? Yes. But that is a much more specific type of both scans as well as research that is ongoing that, very soon -- it's already FDA approved; it's not yet in the mainstream -- but we have now some PET scans coming for our use where we will be able to not only say, "Yep, the tumor is there," but we will be able to say with high certainty what kind of tumor is this, not only that it's malignant. But even among malignant tumors, there are different types of tumors, so we will be able to even pinpoint what type of histology or what kind of cells these tumors consist of. But that's a bit down the line, probably a year, and then we will have many more breakthroughs coming our way.

Host Amber Smith: Is surgery usually the treatment for kidney cancer?

Gennady Bratslavsky, MD: Just like with any disease, the earlier stages are often treated with surgery. Later stages are treated with medications, whether it is immunotherapy or targeted therapy. In kidney cancer, we use surgery typically for certainly stage 1 and 2. We often use it for stage 3, which is a bit more advanced cancer, and we occasionally use it -- or I should say often enough, but not all the time -- use it for stage 4, which is a metastatic kidney cancer.

There are many things that go into decision making: how far the kidney cancer has spread, has it spread? Is the tumor only located in the kidney, or somewhere else? What is the burden or amount of disease outside of the kidney, for stage 4? And that is what is the performance status of the patient? So there are many predictors that we put in together to calculate certain scores, to put patients into certain risk categories that later allow us to decide whether or not the surgery is the right next step.

But for the earlier-stage disease, when the tumors are small, surgery is usually the most viable type of treatment. Although, small renal tumors, even when they are cancers, can be safely observed and can be followed. And we utilize something known as active surveillance for small renal masses. It has been not only accepted, but it is in guidelines for treatment of patients with kidney tumors. And, of course, there is something known as ablation, which is either freezing or frying the tumor. And those are also some of the therapeutic, or treatment, options for patients that are made together with the patient and the family.

Host Amber Smith: Well, before I talk to you about prostate cancer, let's talk about survival rates for kidney cancer. Why have they improved in recent years?

Gennady Bratslavsky, MD: It's a great question. We, of course, are trying to, I want to say not only attribute this improved survival to new treatments, but indeed we are finding more and more renal tumors. So more and more tumors now are diagnosed at an earlier stage.

With the earlier stage in diagnosis, you have a denominator for the number of total renal tumors growing pretty high or pretty large. And while the denominator is growing and the rate of kidney cancer death is still close to 15,000 a year, the ratio of the patients dying from the disease -- so the number of patients diagnosed with the disease -- is smaller. And we certainly have much improved therapies today. There was an era of targeted therapy that has now been mostly surpassed by an era of something known as immunotherapy, where the medications administered to patients allow the immune cells to get activated. Or, to be more specific, they allow immune cells to not be inactivated by cancer cells. A lot of immunotherapy are now focused on allowing these cancer cells to stay active and to prevent tumor cells to turn those immune cells off.

So overall, we still have close to 80,000 new diagnoses expected this year, and there will probably be close to 200,000 people living with kidney cancer in the United States alone, with about 15,000 of patients with kidney cancer dying from the disease.

So it still is a major health care problem. It still is one of the top 10 cancers in humans. And, understanding of everything from diagnosis to time to intervene, to when to intervene, to to intervene or not to intervene, and the treatment options, this is a long continuum of many issues that we're facing today.

And, I'm happy to say that at Upstate we do all the modern imaging. We're doing all the modern trials and therapeutics, and we also have a very strong basic science lab that is funded by the government and donors to find new potential cures for the kidney cancer.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Gennady Bratslavsky. He's professor and chair of urology at Upstate, and we've talked about kidney cancer. Now we're going to turn to prostate cancer.

The American Cancer Society says the incidence of prostate cancer increased by 3% from 2014 to 2019. Dr. Bratslavsky, is this a statistical blip or is it a concerning trend?

Gennady Bratslavsky, MD: Well, one of the reasons for relatively small increase that is unlikely to be just a statistical blip is because these were the years of controversial recommendations by United States Preventative Task Force, when prostate cancer screening was discouraged. And this was using the PSA (prostate specific antigen test), which is a blood test drawn in the doctor's office. So there were a few years when the blood test known as PSA was not recommended to be done. So these are the interesting years of 2014 to 2019. Unfortunately, as a field, we're dealing with these recommendations because we're noticing a run of higher-risk disease patients with more advanced prostate cancers that are now coming to us because of a lack of screening.

And of course, let us not forget implications of COVID that followed these recommendations by United States Preventative Task Force.

So I would say that perhaps the epidemiology and numbers have been influenced by both recommendations of preventative task force and by relative lack of access of care to many of the offices during a year and a half or two with COVID, when many patients were not looking or able to see their primary care doctors or urologists. So I think we're going to see effects of these two things in the next few years.

Host Amber Smith: I want to ask you about how prostate cancer is typically diagnosed and what the common treatments are like. Is it usually found after a PSA screening?

Gennady Bratslavsky, MD: Correct. So PSA, while controversial, if used appropriately, is one of the most commonly used markers to screen for prostate cancer. There is no question that it has numerous drawbacks from identifying men with just large prostates or inflammation of prostates. Nevertheless, several studies have shown that baseline PSA levels are very good, especially at the younger age, that potentially predict a possibility of men dying from prostate cancer at a later age.

Well, I know that treatment depends on the man's condition and what else is going on. It's very individualized. But in general, what are the more popular methods of treatment these days?

Just like we discussed with kidney cancer, not all prostate cancers are created equally. In more advanced cases, again, the treatment will be very different from treatment for a more localized disease. And, treatment for localized disease is very different based on the aggressiveness of the cells that we see under the microscope. It's different based on the starting PSA level because just because we may not be able to see anything outside of the prostate, I mean in most modern imaging, we always have to keep a good degree of suspicion that some cells may have escaped and are just not picked up by our modern imaging.

For localized disease that urologists typically see and diagnose, the three most common types of treatment include active surveillance for patients that have a very low risk disease that is highly unlikely to progress and highly unlikely to hurt patient. And it is important that urologists are not only comfortable offering it, but know who to offer and are able to follow these patients appropriately.

Of course, surgery, removal of the prostate, which now in well over 90%, 95% of the places in the United States and in the world, no, perhaps in United States and Westernized world, is done using a robot. And it doesn't matter whether you make one tiny hole or you make four or five tiny holes. Patients now, after their surgeries go home the same day essentially. Sometimes stay overnight.

And of course, radiation is another very important option for patients that has been proven to be as effective as surgery for many of the patients. And again, the field of prostate cancer is so wide and broad that to just say, "Yep, you can either do surgery, radiation or active surveillance," that would be a very incomplete answer.

There are some men that may have one little area of cancer they wish to not risk with any of the side effects associated with the surgery, or radiation or even anxiety associated with active surveillance. So focal therapy sometimes is an option as well, where patients are given an option of treating just one small area within the prostate using newer technologies.

And of course, in more advanced cases, at least in cases when we suspect that the disease may be advanced, not only we here at Upstate offer traditional therapies, we also offer patients to have an opportunity to participate in clinical trials, which are very important, based on uh, either genetic makeup of the tumor, genetic makeup of the patient based on some of the knowledge of the literature. We have been extremely active in clinical trials, just moving the needle forward in terms of options that we can offer for patients.

Host Amber Smith: Well, Dr. Bratslavsky, thank you so much for making time for this interview.

Gennady Bratslavsky, MD: You're welcome, and thank you for having me.

Host Amber Smith: My guest has been Dr. Gennady Bratslavsky. He's professor and chair of urology at Upstate University Hospital. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Ioana Medrea from Upstate Medical University. Is aspirin a good headache remedy?

Ioana Medrea, MD: Aspirin is a great medication for small aches, generally, and for headache as well. My only concern would be is how often is someone using aspirin? If you're using it infrequently, I think it's great. I have nothing against it. If you're using it every day, it becomes a problem. There is a risk of bleeding from the gut with aspirin, and that can be dangerous. But in addition to that, there's problems with kidneys that are possible, problems with blood pressure. So I would not want you to use it unnecessarily. Of course we use an aspirin every day for prevention of stroke or heart attack, but that is in someone who already has those risk factors, and the risk/balance trade- off is warranted. But in someone who has no medical conditions, I wouldn't say that that would be my go-to every day. If you find yourself using aspirin very frequently, perhaps you might need preventive treatments for your pain and headache, which is a medication you get every day to decrease the frequency of your headaches, and that would be an indication that you need to see either your primary care (provider) to start that or a neurologist or headache specialist.

Host Amber Smith: You've been listening to neurologist Ioana Medrea from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Lisa Wiley teaches English at SUNY Erie Community College in Buffalo, New York. She sent us a short but joyful portrait of a good doctor. Here is "Dr. Moon Is My Mother's Oncologist":

Wonder if I'll see all his phases?

Luminous, his round, smiling face

pushes the celery-colored curtain aside,

pulling all anxious tides toward him.

My mother questions her arm hooked up

to "the juice," my father calls it.

You need this, Dr. Moon says,

or else, my whole life is wrong.

These shimmering rays of certainty,

no sliver of tiny crescents,

waning or waxing.

You've got this, asserts

quick-to-laugh Luna.

A brilliant harvest moon.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink On Air," can medications for attention-deficit/hyperactivity disorder help people who don't have ADHD?

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink On Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.