Listen in: Lanse Scriven and Dr. Kosj Yamoah

Parmvir: September is designated as National Prostate Cancer Awareness Month in the U.S. It is the most commonly diagnosed cancer in men along with skin cancer, and the chances of receiving a diagnosis increase with age. Since this is a podcast about Black health equity, you will no doubt already have an inkling about the subject of today’s episode.

While the conversation focuses on those currently recognized as being at greatest risk, namely Black men, we’d also like to acknowledge that people with prostates may include trans women, nonbinary and intersex folks and they too could be at risk of prostate cancer. Moffitt Cancer Center is proud to be considered a Leader in LGBTQ+ healthcare, and to be there to address your concerns.

This could be a whole episode in itself, but now, it’s time for our conversation about prostate cancer and the patient experience, so join us to get “A PSA about your PSA”.

Dr. Blue: Hello, hello, hello everyone and welcome back to Cancer in Our Community, where we are having conversations about Black health equity. As always, I am Dr. Brandon Blue, an oncologist in the malignant hematology program at Moffitt Cancer Center and your podcast host. As some of you may know, September is Prostate Cancer Awareness Month.

This is of particular importance to the Black and African American community because prostate cancer is one of the cancers that unfortunately disproportionately affects African American men, not only as far as how many African American men get it, but the age at which they get it, and how they do once they get the diagnosis.

So for today's conversation, we'll have Mr. Lansing Scriven. I'll refer to him as Lanse and my colleague here at Moffitt Cancer Center, Dr. Kosj Yamoah. How are both you guys doing today?

Lanse: Doing wonderful.

Dr. Yamoah: Very well. Thank you.

Dr. Blue: Wonderful. Wonderful. Now, before we get started, I have to tell the folks who are the people sitting across from us today.

So I want to tell you a little bit about our guests.

Lanse graduated from Duke University in 1984 and earned his law degree with honors from Florida State University, College of Law in 1987. He's the principal of Lanse Griffin Law. He has a distinguished record of service in his local bar community, as well as devoting substantial time to several community and civic organizations.

Now, Dr. Kosj Yamoah received his medical degree from the Icahn School of Medicine at Mount Sinai in New York and his PhD in Oncologic Science from Mount Sinai Graduate School of Biological Sciences of Memorial Sloan Kettering Cancer Center also in New York, New York.

Dr. Yamoah completed his radiation oncology residency at Thomas Jefferson University in Philadelphia, Pennsylvania, where he served as the chief resident. He also completed a research fellowship in prostate cancer disparities and epidemiology at the University of Pennsylvania. And now, he has done great things right here at Moffitt Cancer Center.

So, Kosj, I'm going to start with you. When people Google you and they look at you on Google and Moffitt's website, they see that you are the quote-unquote Chair of the Department of Radiation Oncology at Moffitt Cancer Center.

Seems like a strange title. So can you explain to the people listening what exactly is that title and how does that relate to the work that you do?

Dr. Yamoah: Well, Thank you very much, Dr. Blue, Brandon, for this warm introduction. The question, that I'll ask to describe what a chair is what do you do with a chair?

We all sit on chairs, right? So my role is to be a servant leader, right? That, I can support people. That's exactly what that role is. So yes, it has fancy names associated with that, and you lead a department, but really I am everyone's cheerleader.

Dr. Blue: Good. And so, can you explain a little bit about radiation oncology and exactly what that does to help cancer care?

Dr. Yamoah: Thank you for that question. So, radiation oncology is a very fascinating medical discipline. And in some ways, poorly understood by even members of our own specialty. It's simply using radiotherapy as a drug to treat cancer. And, because it contains the word radiation, it can give a scary connotation, but really not.

So, the intricacies of radiotherapy is because we're able to harness photon energy and proton energy, and these elemental particles and subatomic particles to direct at cancer. And the real mechanism is that we're able to disrupt that radiation, nucleus or that DNA that programs the way cancers operate so that they are not able to operate anymore.

And that's how we're able to effectively destroy cancer cells with radiotherapy.

Dr. Blue: Now when people hear this, the first thing that comes to my mind is a microwave. That's the radiation that I know.

Dr. Yamoah: That's true [laughing].

Dr. Blue: Now, I would imagine some of the things that you guys are doing a little bit different than that, but, but maybe not. I don't know. Is that any different or are we talking about you using the microwave on cancer and now the cancer...

Dr. Yamoah: Right. Yeah. So there is microwave technology to treat cancer, but that's not radiotherapy, right? So the way to think about it is the way I like to describe it to a lot of my patients is that it's not a laser that burns through you and tries to burn cancer.

But simplistically, it's really focusing light energies through a lens to basically focus it on a specific area and the way I can describe it is in our high school experiments where you have a lens and you can focus the sun rays on a piece of paper and you have the incident area right in that spot and you can actually burn it, right?

But anywhere in between the spot and the lens is not hot at all, right? So if you think about that simplistic concept and you expand it into all the technology that we have, we can harness these photons and protons and electrons, whatever you want to use into these intricate areas and really shape that beam around exactly where the tumor's outline is and effectively, destroy these cancer cells.

Dr. Blue: So I'm going to tell you something. Most people may not know this about me. When I was a child, I must've been a budding radiation oncologist because I would take a magnifying glass and a leaf and I'm going to tell you, if you take the sun and hold it at the right angle, that same kind of light can get focused through that magnifying glass and burn a hole in that leaf.

[All laughing] So that was many years ago. So, Lanse, you know, the audience heard me refer to you, as someone who's graduated from law school. And, we have a lot of medical professionals that come on this podcast and explain how their medical professions interact with cancer care. But a lot of people might be asking: why is there a lawyer on the podcast today? So can you explain to the people who are listening, why exactly you're here and kind of your connection to Moffitt?

Lanse: Yes, so it's actually, I would say, at least twofold. So my first connection to Moffitt came around 2012 when I joined the Foundation Board here at Moffitt.

And the Foundation Board is the arm of the hospital that raises funds to support all the research and other initiatives here at Moffitt. And I served on that board for about five or six years. And then I moved over to the hospital board, for Moffitt Cancer Center and I've also had some, I guess I call it involuntary service here as a patient and that was in 2017.

And before I go any further, I do want to just comment on Dr. Yamoah and how I met him. That's kind of important to my story. I met Kosj, maybe around 2015 or 2016. We were at a restaurant, with a few other physicians. And the one thing I recall about him was just his enthusiasm for what he did.

And I asked him, what do you do? And he said, you know, what do you do? So I said what I did. And we all kind of described our professions, and I recall just his enthusiasm about his work. And, you know, he told me he was a radiation oncologist, it meant nothing to me at all. And, you know, once he got started, I mean, he just, I mean, really, I was a little envious. And I say that in all sincerity, because there are very few people you meet when you ask them what they do and their level of enthusiasm, and just his interest in what he did and, you know, wanted to explain it. He explained it, and again, I had no idea because, you know, he, I think he was so enthused about what he did, as most physicians do, you know, he talks in the medical vernacular, which is over my head. But, I thought to myself that evening, you know, this is a guy who loves his work. Truly loves his work.

Dr. Yamoah: Thank you. That means a lot to me.

Lanse: I mean that sincerely.

Dr. Yamoah: I'll try to maintain that enthusiasm several, several decades to come.

Dr. Blue: That's what I'm saying, man. You gotta make sure that it's contagious, you know, your enthusiasm spreads through it. And I think that's something that we've really been able to highlight here on the podcast. We've had a lot of people who really have very unique disciplines in healthcare, but they really just kind of all affect change very differently, but also very passionately.

And I think it's the passion is the thing that shines through and something that we really want to highlight so that the people who are listening to this know not only are we the medical team that's taking care of you, but we're the people who actually care about you. And so that's one of the things that we want to do is always affect change.

And so, you know, as I mentioned before, you know, we really want to shine the light this month on prostate cancer. And so, with Lanse telling us that you were a patient, and actually had a diagnosis of prostate cancer. You know, I think one of the things that's always important when we talk about really any cancer is what they call about early detection.

Meaning that like, we know a lot of times if you can find the cancer before it has spread, before it really starts to affect what we call the quality of your life, then a lot of times you have better outcomes. And so because we want to shed light, and this is talking specifically about, you know, Black health equity, you know, I was hoping Dr. Yamoah, can you spread light to the people listening about exactly how this cancer is affecting our community and how should all the Black males and even the Black females listening, because they have brothers, they have husbands, you know, what is it that we need to tell them about this cancer as it relates to our community?

Dr. Yamoah: This is a very important topic and being able to shed light on it in this month, in September is going to be critical because we cannot highlight this enough. This is actually a global problem. It's a global pandemic that plagues men of African origin across the globe. That, with prostate cancer, the incidence among Black men is a lot higher than non-Black men.

Not only is the incidence 1. 8 fold higher than their non-Black counterparts, but it's also, mortality is also higher. In fact, it's 2.2, 2.4-fold. That means that at each stage of prostate cancer, there is an opportunity to level the playing field. Whether it's going to be how Black men are getting the disease in themselves, why are more people getting that? That's an incidence question. And how can we make sure we are paying attention to that, right, in terms of the early detection you had mentioned, right?

But even when they get it, how are we coordinating care to make sure that the treatments are equitable and people are getting the care they need and all this? That's also a whole different discipline.

And then the treatments that are being delivered, is that quality enough? Is that meeting the needs? Is there any way we can personalize it more, right? And obviously the outcomes of mortality. So in its face of the disease continuum, there are experts in the field and at Moffitt in other areas that are looking to solve this problem for equity, not only for Black men in the United States, but actually across the globe.

And that's why this is such an important topic to talk about and to highlight for our community to be involved in and become advocates.

Dr. Blue: Yeah. And so, you know, I just want everyone listening to understand, you know, that, that really this is something that we need to, what do you call: sound the alarm on. Because again, when he used that word mortality, that basically just means we're dying from this at a much higher rate than other folks and other groups. Okay. And so because of that, we need to make sure that everything that you learn today does not stay with you. There's that you share the word and you spread the word to make sure that, what Dr. Yamoah mentioned level that playing field.

So Lanse, because you have personal experience with this, and a lot of people who may be listening may have heard the word prostate cancer, but really not really sure how people get diagnosed or really walk through the process. So I was hoping that you can maybe share if you're comfortable, cause we'd like to kind of keep things open and honest here about your experience with how you got diagnosed and how someone told you that now you have cancer.

Lanse: Sure. So, my road to my diagnosis was fairly nondescript and routine. I was applying for an insurance policy. And it's pretty customary that when you apply for an insurance policy, you have to give some blood and urine samples. And, I gave my samples, you know, they were tested and my PSA level came back high.

I didn't know if it was, you know, high enough to be of concern, but I knew that it was higher than it had been previously, from my annual physicals. And I also had a family history of prostate cancer. So prostate cancer took my grandfather. My father was also diagnosed about 2010 or so. So I knew I had a family history.

My mother and sister were also breast cancer survivors. So, I at least had enough awareness to, you know, realize I need to have this further investigated. So, I kind of reflected back, Oh, I'll call Kosj. So, I called Dr. Yamoah and explained my family history and the fact that my PSA level was higher than it had been previously. And he arranged for me to be seen here at Moffitt by a different physician. And, that physician had me undergo what's known as a biopsy, where there is actually tissue taken from the prostate.

The only thing I would say about the biopsy is, you know, if you ever have a prostate biopsy, ask a lot of questions. Because it can, I think, be a very unpleasant experience if you don't know what you're about to get into. But yeah, ask a lot of questions.

So I had the biopsy and that came back, you know, showing signs that I did have prostate cancer. And so from there, you know, it's just a matter of treatment options.

You know, I'll say the one thing that I recall the day I got my diagnosis, you know, the doctor came in and I think, you know, pretty matter of factly, told me that the biopsy showed I had, carcinoma. Well, first of all, what is carcinoma? I didn't know that term. I know what it is now. It's just another term for a cancer. And we discussed some options briefly.

And as I was walking out of the room, a young lady approached me and asked me about being involved in a clinical study. Alright, so thanks to my wife, you know, kind of stepped in and said, not the best time right now. I mean, we just, just got some news we weren't expecting.

I understand now the importance of clinical studies, but that was not the right time for me. And so that's how I found out. Like I said, I could not say I was completely shocked, just given my family history. But the one thing I would tell, you know, listeners is that certain kinds of cancer can be very, I would say asymptomatic.

And so it's very important to have annual physicals at least for prostate cancer and Dr. Yamoah can speak to the age, but at a certain age, you should you know, have a PSA test on a periodic basis so you have a baseline what your PSA is because in my case I felt fine and had I not applied to that insurance policy, my cancer would have gone undetected, at least for some time probably.

Dr. Blue: Now one of the things that we have talked about in previous episodes would be things like breast cancer and people are like, oh, the breast, that makes sense. We also previously talked to experts in lung cancer. People know the lungs and that makes sense. Now, I would imagine there's some of the listeners probably never heard of a prostate and really not sure exactly what we're talking about when we're talking about where it is that people get this cancer so Dr. Yamoah, what the heck is a prostate not only what is it but maybe, when should people get checked? How do they get checked? And then how do they know if something's wrong?

Dr. Yamoah: So, the prostate gland is like any other gland. We have the thyroid. We have different glands in the body. It has a PSA that is a: prostate specific antigen, that's the name for it, that goes into the bloodstream. So anytime the gland gets an infection, anytime the gland is big enough, you can produce more of that. It's almost like a blood test that tells you the function of the gland. That's what PSA really is.

Now this gland is found just between the rectum, which is just before the stool comes out and the bladder where your urine collects, it's really right in there.

And so that area is where the gland sits. And so that's why in order to evaluate it in the, past, more often you had to do a rectal examination, which is where you have to go through the rectum and actually find if the gland has a problem with it, that's the way to do it. Like in breast cancer, do a breast exam in other ways. You do a neck exam to find a gland. That's how you access that gland.

And so, the PSA is not a blood test that allows you to know how the gland is functioning, right? And so, when we say somebody has cancer, oftentimes the gland, the cells in that gland will produce a whole lot more than normal. There's a normal variation in the PSA levels, and there's a normal range, and that range is age-specific.

As you grow older, sometimes the level gets a little bit higher, and as your prostate gland gets bigger, the level also increases. So there's an age-specific cut point that is still not an exact science, but some range that we work with. And so when we say, check your PSA and things like that, we know that for Black men, not only are they getting the cancer earlier on, which requires that you check that PSA early, we often recommend that for a Black man at least at age 40, know your first baseline and then you can go from there.

If it's lower, on the lower end of that range, you probably have time to really decrease the cadence of how much you check it. But if it's on a higher end of that range, you might want to actually talk to your doctor and check in more frequently.

So there's this advice I want to give Black men, that because we get it almost a whole decade younger. So the median age for prostate cancer is 68. For Black men it's around 62, 63. So if you think about it, that's, So a 60-year-old person might be in the median range for prostate cancer for a Black person and 68, 70 is for the white men.

So clearly if you're screening at 50, for the general population, that's too late. So there is already a movement to try to fix that number, but we need a lot of data and a lot of people to get involved. So that's one piece of it. I'm very glad that Lanse brought up that point that you should check it.

If you don't have prostate cancer or you have a brother or you are someone else on the call that have a sibling somewhere in that range, ask them, do you know your PSA? Especially if they're past 40, right? Because that's a number you should know. And that's really where, where the conversations are in terms of early diagnosis and what PSA is and what this gland is.

Dr. Blue: All right. All right. So, yeah. So I just want the listeners to understand that really when we talk about this Dr. Yamoah has mentioned, this is something that unfortunately disproportionately affects Black and African American males. But as he mentioned before, this is something that is a global problem and not something that we're just seeing here in the United States. So I do appreciate that.

Now, you know, that we have at least an understanding of what it is we're talking about here. We know about the prostate. We know some of the blood tests that could be checked. But what we don't really understand is how is it treated? Like, can you help us to figure out if someone does get that call? And unfortunately, sitting across from a doctor and they do tell them and say: Hey, you now have prostate cancer.

Can you explain to the listeners, what are some things that that person could look for, because as Lanse mentioned, options are very important, but what could be some of those options?

Dr. Yamoah: And before I say that, I have to say that I'm very honored to actually have Lanse here. He's a prostate cancer survivor for a number of years, and he will tell us about that.

He went through the process of options and figuring out what options are. And, you know, I want to say congratulations on this incredibly difficult journey that you've come on the other side and for being an advocate for a lot of people to really learn from and save lives. So thank you very much for your story. We'll hear more about it in a second.

But this really sets us up for options because I would say that this is where things can go wrong. Remember I said that there are different areas of care, right? There is the early detection, find it early and you know, we can treat. But once you're diagnosed, what do you do, right?

And, and I think that that's where I would encourage any person or anyone on a call is that know your options. Know your options. There's a lot of health inequity. That is in our society and it comes from a lot of decades of different disparities and this becomes an important component. When we talk about early detection and getting to know those things, a lot of times you cannot do anything about it, right? Because, you know, sometimes we still don't know the cause of prostate cancer, but we know that there are certain things that could influence prostate cancer, to our care, right? So those things are, in some ways, a bit out of your control. But once you have it, certain things you can do for yourself, and this is where advocacy and getting involved in your own health becomes critical.

You know, speak to experts and get all options available. Why do I say this? Because the couple of things that goes into treatment recommendations is your risk grouping. First of all, prostate cancer is almost like two disease states. Are you localized or are you metastatic? Metastatic simply means, has it gone outside the prostate into other parts of the body?

The options are very different. But today we're going to focus on localized. When we think it's just in the prostate and maybe in the regional areas, what do you do? And I'm here to tell you that there's no right or wrong answer. It's really what is tailored for you as an individual. Because the best treatment for some patients might be actually to, what we call, to undergo active surveillance.

Which is not do surgery or do not do radiation just continue to monitor your PSA and continue to do maybe an MRI. We simply say it's a different picture of the prostate to make sure that everything is where it's supposed to be or not. Or have a biopsy frequently, maybe once every other two years, or something like that, or every year, depending on your doctor's recommendations.

And that's sometimes the best recommendation for your health. And that's actually very good, right? Versus take it out, which if you took it out when you didn't have to, that's not a good recommendation either. Or undergo radiotherapy, or a combination of that with what we call hormonal therapy. And I want to say that last one a little bit, that when we say hormonal therapy, it means that the fuel for prostate cancer is also our testosterone levels. So the higher the testosterone, it's like, it doesn't cause prostate cancer, just fuels it. So if you have the fire, the gasoline is like testosterone. Without the fire, gasoline doesn't create fire. But when you have fire and throw gasoline on it, you get it worse. So that's where testosterone is. And so sometimes, you need to drop the testosterone levels in order to suppress the cancer and put out the fire. And in some instances, that's part of the treatment.

But you have to go and speak to experts to get those options.

Dr. Blue: Well, no, I appreciate that because, you know, we hear about all these things, surgery and radiation, you know, and it's nice to know that we have options and that somebody saying, well, this is the only thing that we have available. So, you know, Lanse, I hope if you have some time with the listeners today that you can really kind of shed some light on your experience, you know, so as you mentioned before, someone sat across from you and told you something that, you know, kind of ran in your family, and then, you know, how you kind of chose which option was best for you and how you was your experience with, that treatment for your prostate cancer?

Lanse: Well, the one thing I would say in terms of options is it is extremely important to find physicians you trust. I mean, I can't overemphasize how important that is because treatment of cancer is so complicated and there's a lot of information that, you know, we as patients can consume. And that's not always a good idea.

By that, here's what I mean. The night I was diagnosed, my best friend came to my house. We were sitting around, my kitchen table eating Chick-fil-A, all on our phones. You know, Googling, you know, radiation therapy and, you know, all the different treatment options for prostate cancer.

Now, I had no business doing that but, you know, this was, you know, probably six hours after I had been given this news. And there's so much information whether it be from, Cleveland Clinic or Mayo, Moffitt, MD Anderson, these are all cancer centers.

And it's overwhelming. And so where I essentially came down was, I don't have the training. to make this decision myself, but what I can control is I can get good counsel. And fortunately, my experience at Moffitt, one of the things you can do, as Dr. Yamoah mentioned, is you can have surgery to remove the prostate. You can also have what's known as radiation therapy. And so at the count of considering all the options and all of the ramifications, because all of these treatment options have a consequence. I'm fairly young, I think, to be diagnosed with cancer and there are repercussions, some that affect your sexual function, depending on which option you go with, and so I had to weigh that. Sit down and talk to my wife, and really kind of study this, but, you know, I was very fortunate that the physicians here were very patient, because I had a lot of questions.

I mean, I went in and I had three different, I would call them information sessions. One with a surgeon, and then two with physicians in the radiation department. And, they were all very patient, answered all my questions.

And, I ended up choosing something called brachytherapy, which Dr. Yamoah can elaborate on, but my understanding is it's a surgical procedure where a very high dose of radiation is injected into the prostate and then it's taken out the same day. And in addition to that, I did five weeks of what's called external beam radiation therapy.

And even though it sounds very, you know, complex I mean it's actually not bad at all. And I do have one funny story about that. So, you know, one of the things that is important, having any kind of radiation, is that the radiation beam is targeted the right place. And one of the things that's important in radiation of the prostate is you want to try to avoid the bladder and other organs in that area.

And so, you are told to drink a lot of water. So your bladder can be easily seen by the radiation technologists. And so, of course, I fill up on water, and I go into the radiation room, and I'm in the waiting room, and they're not calling me, and, you know, I don't want to urinate because then I got to start over, so then you start to kind of, you know, close your legs [Kosj laughs].

It's like, when are they going to call me back? And so you know, I get back there, and I can't make it. And so [Lanse laughs], I ended up saying, you know what, I have to use the bathroom. So I went to the bathroom, urinated, drank some more water, sat around for a while, and I didn't appreciate the full bladder doesn't mean: about to explode [everyone laughs]. It just means that have enough water. So, for me, it's different for everybody, for me, it was about three quarters of a 16 ounce bottle of water. And I think that first day I probably drank about two pints of water [Kosj laughs]. And, because I didn't know. And I wanted to be sure that they could see everything. So I was taking no chances. So, you know, that was my first day.

But then after my first day I went in, I was fully dressed. And then you kind of learn that you're going to disrobe as soon as you get there. So you just kind of learn how to wear very loose fitting clothes, and it actually takes more time to get there and on the table itself, probably five to seven minutes. And after I completed the radiation therapy, about maybe six to eight weeks later, I had an appointment with Dr. Kosj Yamoah and he gave me the wonderful news that in February 2018 that the therapy had been effective, there was no sign of cancer.

Dr. Blue: Wow. Wow. And Dr. Yamoah, you have to tell us, like, what was that experience like telling someone that they go from having cancer to now being cancer free?

Dr. Yamoah: It's one of the best news you could ever, you know, give to you know, anybody, right? Because that's what we are here for, right? We want to end cancer as we know it and part of the enthusiasm that we all share in this line of work is that we can do that.

And I have to say that at Moffitt and other Cancer Centers, at Moffitt we have physicians that are dedicated to that mission and we have, you know, medical oncologists, we have surgical oncologists and radiation oncologists all bringing these tools and these years of expertise and research to the table to be able to give that news to every patient that walks in the door.

And we want to make sure that that's available for everyone listening that you can also get there. Now, I have to say that not all cancers share the same fate. You remember I mentioned about prostate cancer having localized and metastatic, right? With the metastatic phase, not everyone gets to get that news, right?

And so for all of us on the call listening, this is what we are pushing so much for that, early detection and knowing where things are at. Because the good news is that there are effective treatments that can actually get everybody the same report and no evidence of cancer, but it has to be caught at the right time in the right phase and also be treated by a great team that know what they're doing.

So I'm very, very encouraged to hear that, you know we were able to successfully do that for Lanse and up to today, you know, we're still having the no evidence of disease report and we are very, very grateful. And celebrate that every moment.

Dr. Blue: You know, I think that's fantastic.

And so, you know, I really want to ask you both because, you know, these are questions that people have is that, but what does life seem like now, like what is life like for you now? You know Dr. Yamoah used the words that you are a prostate cancer survivor. So what we call this period of time after this treatment, they call that survivorship, So, as you mentioned before, each treatment that you were being offered had a different consequence, right. And, different potential problems that could happen down the road. And so I think the listeners want to know, now that you had such good news so many years ago: what is life like now after these treatments have finished?

Lanse: So I would say overall wonderful, but i'm just going to be very transparent in answering your question and so one of the effects that men can experience after prostate cancer treatment is loss of erection. And I've had friends that have experienced that.

I did not experience that fortunately. But I did experience loss of ejaculation. And if you have not experienced that, you know, it sounds very substantial, like a high price to pay. And I cannot explain the physiology behind how the body functions. But in terms of sexual satisfaction I don't ejaculate.

But that's the only physical difference. But the sensation that a man feels, that I feel when you reach sexual climax, it's all the same. And as that was being explained to me it didn't make any sense. And, you know, physiologically, I said, wait a minute, my best friend, wait a minute, you're telling me, you know, you don't ejaculate, but it feels the same.

I said, yes. That's absolute truth. Now, I don't know that everyone's gonna have the same experience. And that's why it is so important to ask the questions that you're a little maybe shy about asking or embarrassed to ask. It shouldn't be an embarrassment, but the worst time to ask the questions is after the fact, because then you can't make an informed decision. But to me, you know, knowing that loss of ejaculation, may be a consequence of having radiation therapy was a risk I was willing to take versus the risk associated with removal of the prostate.

And, again, you're talking your overall health. And, I think for men, it's very important to include your partner in these decisions because, you know, it affects them. And I can say that the effect on your partner is something my wife struggled with. And I would say, you know, more in a way that I really didn't fully appreciate, but just kind of give you one example.

We were flying to Portland for a short vacation in the fall of 2017. This was after I had an ultrasound to determine whether my cancer was localized or had traveled outside the prostate and I was on the plane about to take off and I saw a 745 number on my phone. And one thing you learn when you have prostate cancer, you ever see 745, 813 745, you take those calls.

So, I took the call, it's actually a voicemail message. And it was the hospital informing me that there had been no metastasis of the cancer. Everything was localized. And so the plan we had laid out, we're going to go forward with. And that was great news.

So my wife was across the aisle from me on the plane. And I handed her the phone. And, you know, she listened to the message, and she just broke down. And I really hadn't thought that this affected her that way. But you know, she was so concerned and had so much anxiety about what this could mean. And, she was just, on that flight, just tears just pouring down and that's when I really realized that in addition to the patient, there's a whole, another level to this of how it affects the patient's family. But getting back to the original question, I think the first year I had quarterly appointments with Dr. Yamoah, and then it goes to bi-annual, so twice a year, and, you know, assuming everything is proceeding as it should, then once a year.

So I'm now on annual checkups, and my time now is really just, not even about cancer. I come in, you know, I have a blood test. If everything, you know, looks well, we end up just talking about life. So it's a great non eventful visit.

Dr. Blue: Good, good. And Dr. Yamoah, you know, I know that that's not everybody's experience as Lanse said, but can you explain as well for some people listening, some other things that maybe this after treatment, issues that could happen for folks?

Dr. Yamoah: So the way I like to frame it is, in the visits, we often tell you everything that could happen in the book, right? Because you need to know, our patients need to know that, and a lot of times that's scary and that's information overload. And what I would often do is I'll narrow it down to the more common things, and then, and also give a little bit of a detail into why those are more common.

And a few, you know, maybe a half hour ago I spoke about where the prostate sits and the organs around it. And so if you think about side effects, that's exactly those organs that are usually affected, the bladder, the erectile wall and the nerves that actually come by that prostate too, for erections, those are usually what it does.

And so when you outline those symptoms, when you remove the prostate, it comes with some issues that are related to that, right? Which may be sometimes incontinence in some instances, also could be the nerve, if the disease is on the edges, sometimes the nerve has to be removed and hence you can have erectile dysfunction.

Does everyone who has surgery experience that? No. There's a lot of recovery that occurs, sometimes they have nerve sparing surgeries and things like that. So, again, you hear everything, right? For radiotherapy, it's another example of that, right? Ultimately, the gland gets affected, whether you do surgery, where you remove it, or do radiotherapy where it doesn't function to its full potential.

And because this gland is the biggest source of seminal fluid production, everyone experiences this sort of low ejaculate that occurs for surgeries immediately, for radiation it's over time, right? So that's one thing. And then you can have add ons, right? Where you can have actually erectile dysfunction for some others, more so than others.

And urinary issues. Some people do not maintain the entire capacity of their bladder. So if you used to drive to Miami and stop once, now you're stopping twice, right? If you have to wake up once at night, you're waking up twice. So there are these nuances to the bladder function as well. And then obviously sometimes you get also the anterior rectal wall, your changes in bowel habits because there's some reactions that take place.

But ultimately, these are the areas that are of most concern. And there is a spectrum from 0 to 10. Some 0, nothing at all, to 10, the worst of the lot. And so this is where, you know, everyone's story gets a little different and everyone's sensitivity to treatment can be a little bit different. And also based on the severity of the cancer and how aggressive you have to be to treat can also buy you more of those side effects.

And so I would say that having the informed decision that Lanse spoke about, that speaking with someone you trust, getting all the things that can go wrong and knowing the ones that are more frequent or less frequent. Can allow you to really pick an option that says in five years in ten years if I'm still here, what side effects am I okay with? And that can guide you your treatment choice.

One of the biggest problems with prostate cancer treatments when it's localized again when it's localized, because we can actually effectively treat it, treatment regrets can be in the top of the list if you do not understand fully what you're walking into. Even though you've gotten the best outcome or an outcome, the price you're paying for it brings you into a state of intense regret because you didn't understand those options.

And so hearing those options and making sure that whatever side effects that could occur, you could come to peace and to terms with that, that yes, the benefit outweighs that risk and navigating through that process is critical in the shared decision making process.

Dr. Blue: Well, listen gentlemen, I just know that you guys have given us mountains of information and it's a lot for folks to digest.

But really, I hope people listen to this episode not only once but twice and actually sit down with the whole family because this is all vital information. But because sometimes as people in general, we all just need to keep things simple. And so with that, sometimes we just need a simple thing to remember. Meaning that if they fast forward and could only listen to 30 seconds or a minute of this episode, what do you want people to remember or to understand?

Lanse, I'll start with you. If there's one thing that as a patient that you could tell people about this prostate cancer and either the diagnosis or the treatment or whatever you think is important that you want them to really leave here with this message, what would you tell the people?

Lanse: I would probably say, take ownership of your body. And by that I mean, if you don't know what your PSA level is and you're not having annual physicals, you need to correct that. Because a lot of things we discussed today they're dependent on just you being aware of your body, and its own unique characteristics.

And the other piece is about information. There are so many sources out there, but I would think I mean, I would say that the most important thing is just take ownership of your body and get that annual physical, get that blood work done, so that, you know, if you're in this unfortunate position, you are in the best position to make informed decisions.

Dr. Blue: Yeah. And Dr. Yamoah, what would you say? I mean, what would you want folks to leave here as a take home message from this?

Dr. Yamoah: Ditto to everything that Lanse said [they all laugh]. And I'll just add that from a medical perspective that I would say that first of all, do men of African origin or Black men need to get PSA screening?

The answer is unequivocally yes. Now when should you know your baseline PSA, your first PSA? I would say by age 40 at least you should know that number. Subsequently, you can talk to your doctor about what to do about that next, because that's where things get very complicated. And always remember that when this is caught early, it's very, very treatable and that there are options available.

And then the third point is to make sure that you are constantly speaking with doctors that are in centers that are multidisciplinary, which means that multiple specialists coming together to help take care of you because multidisciplinary care is important, very, very important in prostate cancer care, and going to a reputable place.

And with this information and taking ownership, as Lanse said, in your health and being involved in that process and spreading the word and making sure that everyone that you know that is in the same plight understands these key points, you'll be helping us change the world because it's really something that we can do together.

Thank you.

Dr. Blue: Well, I really appreciate that. You know, before we finish this interview, we always try to remind the listeners that, we're not just doctors or lawyers in this particular case, that we're just people who have a tendency to want to help. And outside of that we're not robots, okay?

Which means that we do something outside of either practice law or you know, see patients with cancer. So can you tell the people maybe something that you do outside of kind of your day in nine to five that kind of brings you a little joy? What do you do for fun these days, Lanse? Like what are you looking forward to that has nothing related to do with prostate cancer?

Lanse: [Laughs] Well, you know, I would tell you that I actually enjoy staying fit. That's you know, very important to me, and I just had this conversation with my son a few nights ago. I believe that our bodies are vessels that God gives us to take care of. And so I think part of good stewardship is not just our financial resources, but, you know, our time, but it's also our bodies.

And so that's part of who I am. And so whether it be, you know, walking, running, hiking, swimming but I enjoy it, trying to take care of this vessel.

Dr. Blue: So we'll see. You. 5:00 a.m. in the gym, is that what you're saying?

Lanse: 6:00 a.m.

Dr. Blue: Six. Alright. There you go.

Lanse: I was there this morning.

Dr. Blue: Alright, what about you, Dr. Yamoah? Is there anything that you do outside or do you just live here at Moffitt? Gimme something else that you do.

[Laughs]

Dr. Yamoah: I think I do way too many things outside. Right. Well, so I love to sing. I mean, you know, I've been singing in church for a long time. My dad is a reverend minister, so I do a lot of singing.

My siblings, we each have a band and I still keep singing. I play the guitar. I compose music myself. And so, and then other things I do is also giving back to the community. We have a non profit organization that, you know, takes care of kids with medical and special needs. And so we have and my wife helps us run that and we do a lot of things in the Tampa Bay area and have volunteers all across the area helping out. So that's really something that I enjoy doing on my off hours.

And then one last thing is I'm a soccer fan, so I play real football, so I do watch some, some sports as well in soccer.

Dr. Blue: All right. Well, because this is a podcast and the people will be listening, I'm sure that we probably want to listen to a little bit of a little tune from Dr. Yamoah [everyone laughs].

Dr. Yamoah: Oh my goodness.

Dr. Blue: One, two, three.

Dr. Yamoah: Maybe, maybe next time, how about that? Let's bring a little bit of, you know, and make, make a jam session. I love it. Well, if you want some, some original music, you could, you could check me out on Spotify. Just type Kosj Yamoah on Spotify, you get a "Journey to Zion" album release. So enjoy it [more laughter].

Dr. Blue: Good. All right. Well, listen, give me front-row seats to the next concert.

Dr. Yamoah: All right.

Dr. Blue: Well, listen, gentlemen, I just want to really thank you for spending some time today, just to really educate the community, talk about not only men's health, but Black men's health.

And this is something, again, that people should not keep to themselves. So if you're listening, make sure you share it with your whole family because this is something that unfortunately is affecting our community more than others.

So thank you for your time, gentlemen.

Dr. Yamoah: Thank you.

Lanse: Thank you, Brandon.

Dr. Yamoah: Thanks for having us.