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Sam Greenberg (Host): This is Meaningful Medicine, a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.
I'm Sam Greenberg. And with me today is Dr. Katie Moore, an oncologist with Novant Health, as we work to understand genitourinary cancers and the future of treatment. Dr. Moore, it is great to have you with me today.
Katie Moore, MD: Thank you for inviting me. It's nice to meet you.
Host: Nice to meet you as well. So, Doctor, let's start big picture. What are genitourinary cancers and which types do you commonly see? And maybe even more loaded on the question, what should people know about this specific group of cancers?
Katie Moore, MD: Sure. So, genitourinary cancers are cancers of the genitourinary tract for males and some females. Some of that is taken care of by gynecologic oncology instead. But yeah, so it is the kidneys, the bladder, the ureters, there's penile cancer, and there's a urethra even within the penis, testicular, and then prostate primarily. And genitourinary cancers are cancers that absolutely affect men, two to four times as much as they affect women. And I think that they're quite common. I just don't know that they get the same publicity and noise that some other cancers get.
Host: Yeah, people may be a little bit more afraid to talk about this sort of thing, or it may be, you know, a little bit taboo for people or embarrassing even.
Katie Moore, MD: I think that's absolutely true because people make assumptions then when they hear about a specific type of cancer. And the internet is a wonderful thing. But also, you know, can create a lot of speculation for things as well. So yeah, I think that, you know, decades ago and probably even less far back than that, you know, breast cancer was something that people weren't outrightly talking about. They weren't saying the word breast. And so, I think teaching everybody in society that, you know, these are things that affect everybody, these are parts that most everybody has and, you know, just talking about it and education is so important.
Host: Absolutely. Education is paramount in almost any sort of, you know, disease state or when you get a diagnosis. But Dr. Moore, what sort of symptoms should people pay attention to that might signal genitourinary cancer? And when is it important to see a doctor? When is that line drawn?
Katie Moore, MD: Yeah, that's a great question. I would say the number one thing is probably blood in the urine. And so, sometimes you can actually see gross blood where, you know, you see either streaks or it's bright red, but sometimes the urine can just be tinged. And there are ways with the urine samples, urinalysis that, you know, that can be tested to make sure that that is blood and that's not something else, or you're not just extremely dehydrated and need to start drinking more water.
To me, urine, having blood-tinged urine or blood in the urine is never normal. Sometimes it could be as simple as a urinary tract infection or some inflammation in the bladder, but I would still say that those aren't normal. And I think some of it, you know, depending on your age and other risk factors is important to mention as well. But monitoring your symptoms and I think just reaching out to your doctor when you notice it and letting them be the one to figure out if they want to do more testing on it.
Host: So, a cancer diagnosis can and often is very overwhelming. So, can you walk us through how you determine a treatment plan for a patient and what factors make each person's approach a little bit different?
Katie Moore, MD: Yeah. I mean, I think hearing the word cancer is probably one of the scariest things that people go through for themselves or for family members. So, I think, really having a multidisciplinary approach is the key. So, by no means am I usually just being the sole person out there kind of making a decision.
And, you know, we have tumor boards, we have multidisciplinary clinics that we share time with radiation oncology and with urology. And so, really, you know, reviewing all the details and, you know, asking the questions of your other specialists as well. So, it very much depends on the staging of the cancer and, you know, how big is it, and kind of there's a lot of different treatments.
We think about curative treatments where we are trying to give treatment either before or after surgery to try to get rid of a disease entirely, or sometimes we think of more palliative treatments where we're trying to kind of control the disease more. So, you know, depending on kind of which path we're talking about. But a lot of questions and really understanding everything is important.
Host: And talking about those different paths of treatments, how have treatments for genitourinary cancers evolved in recent years? And what role are things like immunotherapy, targeted therapies, and precision medicine playing in patient care now?
Katie Moore, MD: It is truly extraordinary how fast the field of oncology is growing. And at a lot of institutions, but including at Novant, we are really sub-specialized. And so, I feel very lucky that I am not a generalist. I don't have to do all types of cancer, so I don't have to stay up to date on all types of cancers. I have other colleagues that I can phone a friend for if I need something.
But because of the continuous research and data that's coming out, I think just, you know, trying to stay up to date in your own subspecialty is a job in and of itself. But it's honestly one of the reasons why I went into oncology because I knew we would be continuously learning. And I think you always have to be very hopeful if you're, you know, going into our field as well, because knowing that we can do better and we will do better is always something that's important to think about.
So,
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immunotherapy and targeted therapies and really precision medicine, it all kind of, you know, comes together to execute a much more personalized plan for each patient. So, with precision medicine, we have something called next-gen sequencing or NGS. We tend to shorten everything in medicine to make it a little bit simpler. We don't have to write or type as much. But with that kind of testing, we can test the patient's blood, we can test the tumor, and we can really understand the characteristics of that cancer. So, it's very different than genetic testing, but I call it kind of the genetics of the cancer to try to make it a little bit more relatable to patients.
And once we get those results, which sometimes they're helpful and sometimes they're not, we are able to kind of lay out a treatment plan. And so, immunotherapy has truly revolutionized how we treat a lot of genital urinary cancers. You know, a lot of our cancers do not respond as well to traditional type chemotherapies.
And so, we have targeted medications, something called tyrosine kinase inhibitors. But even those are oftentimes given in combination with immunotherapy and the response rates, the overall survival, you know, we're really looking at continuing to push the boundaries. And, as of right now, it is still considered standard of care to, you know, remove a bladder if somebody has bladder cancer.
Obviously, there's nuances and certain circumstances where that's different, but it's shocking to say that we are doing clinical trials that are looking at, you know, bladder sparing, and so patients are able to, you know, maintain their bladder and not have to go through a major surgery and a huge quality of life and kind of life change there.
So, yeah, kind ofnda nerd out when I think about immunotherapy because it's very exciting and it gives a lot more hope to patients.
Host: Feel free to nerd out all you want. You're the expert. And so, sticking with that excitement and those emerging therapies, clinical trials are a huge part of advancing in cancer treatment. What kinds of research and other emerging therapies are you most excited about in genitourinary oncology?
Katie Moore, MD: Yeah, I mean, I think it depends on a little bit of each cancer type. I would say for testicular, there has been decades of research done on that really led by Dr. Einhorn at Indiana University, and we have a lot of really remarkable treatments. And so, while there are always still questions being asked, I think that's probably less of a focus than when it comes to, say, renal cell or kidney cancer. You know, it is really decades of trying to find a treatment that we could give patients after they had surgery to try to prevent the cancer from coming back elsewhere in the body. Trial after trial failed, and we finally have one medication, which is immunotherapy. And, you know, I think we're just kind of continuing to try to build on that.
And then, you know, as for bladder, kind of teased that already, but the idea of are we going to be able to cure these patients without having to do, you know, major surgeries and a cystectomy, remove the bladder? And of course, that would be my urology colleagues, not myself doing that.
And then, with prostate cancer, I think, you know, there's so many different modalities of how we kind of go at prostate cancer, whether it's kind of blocking hormones or kind of traditional chemotherapy. But there are also some kind of very unique signals on prostate cancer that we're able to kind of target and give almost kind of like an IV-type radiation. And I think kind of continuing to build on that.
So, also trying to avoid—it's not that I want to take the urologists out of business. I know they have plenty to do. But, honestly, I hear this just from the urologists themselves, because they get excited about that as well, is, you know, trying to avoid prostatectomies or prostate removal if possible. And I would say in keeping with the same survival rates, patients doing just as well and potentially, you know, decreasing some of the morbidities that come along with that.
Host: There's exciting things coming down the pipeline. It seems like just about every day, every week, every month, which is really great to hear.
Katie Moore, MD: Yes. Yeah. Yeah. No, it's, you know, kind of like drinking through a fire hose at times, but it's a good place to be. I feel very lucky.
Host: We are lucky we have people like you at the helm of that fire hose, or at least maybe to drink from it.
Katie Moore, MD: Thank you.
Host: But Dr. Moore, we talked a little bit about it earlier, but with the sensitive nature of specifically genitourinary cancers, what are some common misconceptions that you wish that more people understood, particularly when it comes to symptoms, risk factors, and the treatments?
Yeah. I think, I'll kind of point out kind of risk factors first probably is that, you know, I think there are a lot of lifestyle risk factors that do increase your risk. You know, for many years, I think smoking and lung cancer was really kind of the primary correlation. But, you know, we absolutely see increased risk in many different the genitourinary cancers that we see, that we treat. Lifestyle modifications and kind of the importance of that.
And then, I think a lot of patients just assume understandably that they will have pain or they'll have symptoms or something will kind of alert them and that's not always the case. PSA, you know, prostate-specific antigen or prostate cancer screening has kind of waxed and waned in terms of recommendations. I'm biased. I've always preferred people to have prostate cancer screening as we want to catch it earlier. But, you know, making sure that you're going to the doctor every year, you know, hearing, "Well, I'm healthy, I don't really need to go to the doctor." But you're not necessarily—you know, you don't know what your PSA is unless you kind of check it.
And then, I think also just some the
hereditariness that can come with probably mostly prostate cancer. You know, we think about a lot about the BRCA gene and he breast cancer gene and, you know, the association it can have with, say, ovarian cancer as well. But prostate cancer can also certainly be affected and depending on, you know, which BRCA gene you have, if you have it, there's actually, you know, prostate screening that is enhanced and at a younger age. So, really knowing that family history and not being afraid to talk about it.
Going right along with that, for someone who has just received a diagnosis, what sort of advice would you offer for finding answers and asking questions and moving forward helping someone with their care?
Katie Moore, MD: Yeah. I mean, it's a great question. It's so tough because it's so patient-dependent, but I think letting the patient try to lead and kind of drive that ship. One of the things of the many that kind of goes along with a cancer diagnosis is just that loss of independence, that loss of power. And so, letting them kind of be the driver. And really, the decision-maker with all of that.
And, you know, I think just a lot of people rush to help and kind of be there for patients in the beginning of something. But understandably, life gets busy and, you know, we all have other things going on. But, you know, knowing that it is usually a little bit more of a marathon and not a sprint, and you don't always have to be there right, when something happens. But checking in with people, and kind of just supporting them in the way that they need to be supported.
And I think not being afraid to ask, you know, "What do you need from me?" And because, again, that answer is going to be absolutely different from everybody, and some people want to talk about it, and some people don't want to talk about it. And so, just kind of understanding how they're kind of dealing with it and just being there to lend an ear. Rides and food are always helpful. Transportation's always, you know, kind of a big one.
Host: Sometimes the little things are the things that make the biggest difference in these sort of scenarios.
Katie Moore, MD: Yeah, absolutely. I think not being afraid to talk about it, because it's the uncomfortable thing in the room, as we had kind of mentioned in the beginning, you know, of the podcast because I think we don't want to upset somebody. But just asking, you know, what do you need and letting them know that you're there to talk and be there if and when they want to.
Host: Absolutely. Sometimes that's the best we can do. That's Dr. Katie Moore, oncologist with Novant Health. Dr. Moore, thank you again so much for joining us today.
Katie Moore, MD: Yeah. Thank you so much for having me on. It's great to meet you.
Host: It was great to meet you as well. And to find a physician, you can always visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. That will do it for another episode of Meaningful Medicine, a podcast from the specialists at Novant Health.