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Zach Klaassen: Hi, I'm Dr. Zach Klaassen. I'm a urologic oncologist at the Georgia Cancer Center in Augusta, Georgia. We are live in Chicago at ASCO 2023, and I'm delighted to be joined by Dr. Alicia Morgans, who is the medical director of survivorship at Dana-Farber. Thanks for joining us today, Dr. Morgans. 

Alicia Morgans: Thank you so much for having me.

Zach Klaassen: So you have a new edition coming out, looking at survivorship in European Urology Focus. So just tell us about what we can look forward to in that, in that edition.

Alicia Morgans: Well, of course, and thank you again for talking with me about this. So just to sort of back up a little bit, I, want to ensure that everyone understands about the importance of survivorship, which is, of course, important across cancers, but this edition is going to focus on prostate cancer survivors. And this is a really heterogeneous group of individuals, and it includes people who have a diagnosis that actually may be a low grade cancer that they continue to follow on active surveillance, but may have over time anxiety or concerns or even, you know, discomfort related to repeat biopsy. But very different set of things that they think about than those patients who may have localized prostate cancer, undergo radiation or surgery maybe with or without hormonal treatment, and have the complications that they have from those therapies. And, you know, prostate cancer survivors also include those patients who are diagnosed with incurable prostate cancer. Whether it's locally advanced or metastatic. And those patients are often living not only with the potential complications of the cancer itself, but often have more symptoms, at least in early stages from the treatments themselves. So all of these patients are kind of wrapped into what makes a prostate cancer survivor. And in this addition, we hope to address things that might be meaningful to these different populations.

Zach Klaassen: So you, you mentioned a lot of good points. So from local disease all the way to advanced and just like probably in your clinic and mine, the second you're diagnosed, you're in the survivorship program, right? Absolutely. So does this issue reflect all of these sorts of stages of prostate cancer and those survivorship plans?

Alicia Morgans: It really does. And it tries to kind of dig into things, whether it's lifestyle, nutrition, exercise, those kinds of things, or consideration of bone health maybe in an advanced population. So really, again, spanning the spectrum,

Zach Klaassen: And I think it's important because we, when we're sitting there in the clinic and you know, you're going through patients and it's busy. It may just be a PSA check, but it's important to have these patients, you know, ask those couple of questions, how's your sleep? How's your mental health? And sometimes it's just as simple as a screening questionnaire when they come in the clinic. Sometimes it's just visible cues. Maybe just take our listeners through some of those things that you do in your clinic from a survivorship sort of just awareness standpoint.

Alicia Morgans: Great. I'm happy to do that. So a lot of the patients in my clinic either are on androgen deprivation therapy or have been on androgen deprivation therapy. So when we have them come in, especially if they're still on treatment, we are, we're certainly talking about their PSA, but we're also relatively reasonably often thinking about, are you taking your calcium and your vitamin D, if you're on ADT, do we need to get a DEXA scan, whether it's baseline or a follow-up scan to calculate a FRAX to understand if you may have a higher risk of fracture and may need some prophylactic bone, health agent to be added onto your regimen. We're also thinking and talking about cardiovascular health. Yes. We, I always look at blood pressure. I don't routinely check cholesterol or hemoglobin A1C, because I have had some issues. It's interesting, with billing for some of my patients getting bills because I'm seeing them for prostate cancer. So why would I check some of

Zach Klaassen: These things? A1C is coming up on their, on their insurance. Yes.

Alicia Morgans: It's the A1C. So it's interesting. I'm always reminding them though, and reaching out to their primary care. Can you please make sure that you're checking the hemoglobin A1C and, and the lipid panel. So these are things that we routinely talk about and we, we do it on a regular basis to make sure that patients are thinking about it, and really following up. Yeah. But whether they're on ADT or not, we're talking about things like sleep. We're talking about things like hot flashes again for those patients, on or recently off ADT and certainly always thinking about and commenting on sexual health. Yes. I think that, you know, sometimes patients don't expect that because especially our older patients may think, well, first of all, she's a woman, she's not gonna ask me about this. Or maybe no one assumes that would think that I still have

Zach Klaassen: I'm from medical oncologist too. Right.

Alicia Morgans: Yeah, exactly. Or that, that, you know, why would this person ask? Right. But I think they're grateful when we bring it up. Yes. Sort of break that barrier and say, this is an important part of your life too. And you can see my colleague in urology who can talk to you not only about pills. But about injections or about, you know, pumps or even prosthesis that may be helpful.

Zach Klaassen: Sure. No, that's great. I think, you know, we obviously are advocates of prostate cancer or survivorship in those plans, and we speak a lot of the same language, but give our listeners some of the multidisciplinary aspects. So we have a psycho oncologist at our cancer center. We use a lot, whether it be for testis cancer for the young men that are going through that, but often, you know, bladder and prostate cancer. So tell us about some of the multidisciplinary efforts that go into having a good prostate cancer survivorship program.

Alicia Morgans: Sure. You know, one of the things that's most important, as you mentioned, is mental health. Yeah. And these kinds of challenges can be, they can affect prostate cancer survivors or any of our cancer survivors early on when they're going through treatment and then certainly in the long term. Yeah. And one of the challenges that I face, and I'm sure many institutions face, is that we don't have enough mental health support, for our cancer survivors. We really are focusing most of our, of our resources on those people who are actively in treatment simply because there are so many prostate cancer survivors.

Zach Klaassen: The denominator's huge.

Alicia Morgans: The denominator is huge. And so it's challenging. What we are trying to do is always talk about and ask about these challenges. And we do have social workers and support groups that we plug people in with. That's, as we get further on the survivorship journey though, I try to get people connected with support groups. You know, zeroprostatecancer.org is a really important, organization that has some support groups. They, they've partnered with us too, a group that used to be, you know, a few years ago. And there are groups all around the country that people can engage with, even virtual groups that they can, that they can engage with. But that's, I think mental health is actually one of the biggest challenges. In our care.

Zach Klaassen: Totally agree, and I think too, you know, I'm fortunate, I have a partner that does sexual medicine and incontinence, Dr. Sherita King. And so some, for some of the urology folks out there listening that are prostate cancer specialists or urologic oncologists use your partners too. I mean, they, they have specific training for a lot of the survivorship stuff that we're seeing in the clinic. You're seeing in the clinic, you know, reach out to your colleagues that have that specialization as well. I think that's important too.

Alicia Morgans: That's so important. I mean, the docs that are doing the prostatectomy are not the doctors, that are doing the sexual health, the penile prosthesis or, even the medical management of erectile dysfunction and libido dysfunction. So we have a special group of urologists and we have a behavioral therapist who is also helpful, in those areas. And you mentioned other multidisciplinary care. So, I'm, often reaching out to physical therapists to try to get our patients some physical function improvement. We do have access to a dietician who can help with nutrition. And, I think it's also important to engage our nurses who can sometimes work on polypharmacy and, and some of the other aspects that can be really challenging for patients. Absolutely.

Zach Klaassen: So just to wrap up, give us, if you want to give some shout-outs to the names of the authors that are gonna be in this issue. Anybody you want to highlight in terms of, some of the folks that are gonna be contributing to this issue?

Alicia Morgans: Well, in, truth, there are so many authors that I would feel pretty guilty calling out somebody out, anyone. But I, do want to say that I'm, so grateful that we have radiation oncologists. Exercise scientists multi, we have medical oncologists, obviously urologists, we have people internationally writing for this edition. And I'm just really grateful that everyone got their stuff in on time.

Zach Klaassen: It's always a challenge.

Alicia Morgans: It was really helpful. And, and I of course was the late one with my editorial, but it's hopefully a really useful addition.

Zach Klaassen: Well, I think too, when you have it all in one spot, it's really nice to sit down and be able to go through all these, all these articles. So we look forward to reading that and look forward to European Urology Focus coming out soon. Thanks so much for joining us today, Dr. Morgans.

Alicia Morgans: Thank you so much, Dr. Klaassen.