Talking Hope: What men and their families need to know about prostate cancer

Talking Hope is brought to you by City of Hope, a National Cancer Institute-designated comprehensive cancer center offering Orange County’s most advanced cancer care. We bring together renowned cancer experts, offering grateful patients and leaders in the cancer community to share vital conversations, personal journeys, and unique insights into the disease that is diagnosed in 1 in 3 people during their lifetime and impacts us all.

In this episode, we speak with renowned surgeon Jeffrey S. Yoshida, M.D., Medical Director of Urologic Surgery at City of Hope Orange County. A pioneer in robotic surgery, Dr. Yoshida has performed more than 3,000 surgeries for prostate cancer. Dr. Yoshida joins us to dispel some common misconceptions men have about prostate cancer, raise awareness of advances in prostate cancer screening, and share how minimally invasive surgery and other advanced prostate cancer treatments and technologies are benefitting patients.

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Darrin Godin: All right, so hello and welcome to Talking Hope. My name is Darren Godin, and today our guest is Dr. Jeffrey Yoshida. Dr. Yoshida, you're the Director of Urologic Surgery at City of Hope Orange County. And I understand that you're a pioneer in robotic surgery having performed more than 3000 surgeries. Is that correct? 

Dr. Yoshida: Yeah, I stopped counting a while ago, but <laugh> <laugh>, 

Darrin Godin: I mean, that's a tremendous number for this stage in your career. That's, um, you're, you're amazing. 

Dr. Yoshida: Well, I, I owe a lot of that to, um, you know, City of Hope and getting into robotics really before robotics took off. So being part of, of City of Hope back in the early 2000s. I mean, we, we really just, I think we were one of the pioneers on the west coast for that surgery for robotic prostatectomy. So, yeah, a lot of credit goes to the institution. 

Darrin Godin: Well, we're glad to have you have you with us as part of that. So, um, before we jump into talking about your specialty and so forth, um, you know, a lot of people talk about how cool Dr. Yoshida is, and I think that's because you're an Orange County boy right now, and you're a surfer. So talk about what you like to do outside of, outside of being a doctor. 

Dr. Yoshida:  I just take advantage of living in a great area. I mean, I was just talking to another doctor before this podcast started, and he was talking about doing a staycation. He's not going to go anywhere on his time off, and it's just a great area we live and, uh, I love to surf and there's great surf here, and, uh, really lucky <laugh>. 

Darrin Godin: Yeah. Yeah. You got any favorite spots? 

Dr. Yoshida: Spend time with the family. That's, uh, time well spent. 

Darrin Godin: Yeah, absolutely. Do you have any favorite spots you'd like to surf? 

Dr. Yoshida: Pretty much anywhere in Orange County, Huntington, Newport, Dana Point, uh, San Clemente, all great spots. I mean, we're just so blessed to have, you know, warm water most of the time. Great waves. 

Darrin Godin:  Awesome. Well, that's, uh, hopefully you have a great summer out there on the water. So, the focus of our interview today and our discussion is going to be around, uh, prostate cancer. So I'm wondering what drew you to medicine and caring for patients with cancer? 

Dr. Yoshida: You know, my, my story, uh, as it relates to going into oncology, I'll have to admit I never really planned on oncology when I was in residency. I knew I needed to, to do, extra training in laparoscopic surgery, because that was kind of really the, the field that was really expanding at the time. And so I decided to, to do a fellowship at City of Hope. And, we, uh, purchased one of the very first surgical robots, da Vinci robots, uh, in the Western United about a week before my fellowship started. And, fast forward a year, we were the highest volume robotic surgery center in the country. And, and, arguably top two or three in the world. And so, you know, majority of those surgeries were, were prostate cancer patients. And so, I had just had so much experience in, in treating prostate cancer patients, it just became kind of a natural feel to, to continue on in. So I, I feel like it chose me. I didn't really choose it, and I'm feel very blessed to, be in the position I'm at. Yeah. 

Darrin Godin: Great. So let's, let's, let's dive into prostate cancer. And can you tell us, what do men really need to know about prostate cancer, first off? 

Dr. Yoshida: Well, I think, I think, you know, the, the, what I hear from men talking in the community is that prostate cancer is not a big deal. It's slow growing, you don't have to worry about it. You know, you're going to die with it, not die of it. And there's, there's, that, that's a, those are a lot of misconceptions. You know, prostate cancer is responsible for 30 to 35,000 deaths a year in this country. That's out a small number. And also with prostate cancer, it's, there's a lot of pain and suffering and, but it's a very preventable disease. And so, you know, the screening that we do saves lives, and that's really important. I think, how we screen has, has improved leaps and bounds in just the last few years. I think there's a lot of stigma behind prostate cancer screening and the, the, the biopsy process and, and the false positive, uh, issues related to the P s A test and so forth. 

Dr. Yoshida: And we've really come up with some new strategies, new biopsy strategies that are much more precise and, and patients, uh, we use an anesthetics, they don't feel it. We've also eliminated or reduced the false positive rates associated with the P s A test 'cause we have, uh, better screening tools mm-hmm. <affirmative>. So it's something that I think, you know, hopefully men can get, get past those stigmas because it's very, it's very much improved, but it could be a lifesaver. You know, prostate cancer's one of the most common cancers in men. And, uh, you know, if you get screened and, uh, if you're one of the unlucky ones that gets diagnosed with it, likely we will catch it early and we can cure you, and it can prevent all that future pain and suffering. So 

Darrin Godin: That's great. That's great news. So, I, I, I understand it's like one in seven men will be diagnosed with prostate cancer in their lifetime. So obviously, it affects a lot of us. So walk me through this. I'm a 40 something year old man. What signs and symptoms should I be looking for or, and then, you know, if I have those signs and symptoms, what is my next step? What should I do? 

Dr. Yoshida: Well, there are, there are no reliable, there are no reliable signs and symptoms of prostate cancer. If a man has symptoms related to prostate cancer, likely it's superior of advanced form. Hmm. Um, so the, the majority of patients, um, that, that are diagnosed with prostate cancer, they don't have symptoms. Now, there's, you know, enlarged prostate symptoms, um, also start affecting men in their fifties and sixties, and that's in seventies, and that's when prostate cancer is diagnosed. So I think there's, there's some confusion about enlarged prostate symptoms and those related to prostate cancer, but, but truthfully, there's really not a lot of symptoms to rely on. So for a 47 year old, it, you know, we would, we would, make recommendations on screening based on your risk profile. Right? So at-risk, patients should probably get, should start their screening at an earlier age. 

Dr. Yoshida: So an at-risk individual would be someone who has a family history, your brother, your father. So if, if, if your brother or father have prostate cancer, your risk of developing cancer is higher than one outta seven. Hmm. If you're African-American, you're already at risk. Your risk is higher than one outta seven. In fact, if you're an African-American plus a family member, boy, your, your, your risk is really high. So, so focusing on at-risk patients, you know, probably around 45 or 50 for patients who don't have that family history or are not of that at risk ethnicity, you know, having the discussion with your physician about the pros and cons and, and maybe starting that around age 55, there aren't, there aren't, you know, universally accepted guidelines, but I think, I think that's kind of the most common recommendation. 

Darrin Godin: Okay. Yeah. 

Dr. Yoshida: And then, so 

Darrin Godin:  Yeah, go. So, so you, you mentioned, screening then, if there's no reliable signs and symptoms and screening's going to be important, so the age at which you start that screening might be important depending on your risk profile. You mentioned a P S A earlier, can you tell us what that P S A is? What is P SS A and what is a P S A test? 

Dr. Yoshida: Sure. So, so P s A is kind of the main screening tool we use in this country and actually around the world as well. And it stands for prostate-specific antigen. That's medical terminology for a protein that we can measure in the bloodstream. And the majority of that P S A or that protein comes from the prostate. So we, we can measure that in, in the bloodstream. And if, if a level comes back at a, um, at a, at a higher level, that then that would trigger maybe some additional testing. Um, we also recommend the, the prostate examination, uh, which is also called the digital rectal exam. That examines the pros of the prostate with the finger. So that's that, plus the P SS A is, is what we use to initially screen a male. 

Darrin Godin: Okay. And you also mentioned maybe some other tools that are available now with screening. 

Dr. Yoshida: Yeah, so, so the, the problem with the P S A test, and, and this is well known, is it's a non-specific test, but we're using it for a specific purpose. So we're using it really only to screen for prostate cancer. But there's many other factors in addition to prostate cancer that can drive that level up. So when a man's P s A is higher, um, that's, you know, which one of the, the factors on the list, is it cancer, is it not? So we have newer tests that help look into that further. So historically, men have had biopsies, or it was recommended, men have biopsies. When A P S A hits a certain level, that number has changed over the years. It, it's been around four, but that number has gone down to three in some instances. But the problem is if you just use the P SS A and you biopsy man, just from that level, there's a high likelihood that you could do an unnecessary biopsy. 

Dr. Yoshida: And that's what men are afraid of. That's one of the stigmas I mentioned earlier. So we have other additional tests that are non-invasive. We have, um, urine based tests, other blood tests. We have imaging like an M R I, and we would do that first and, and do a, a real complete, much more accurate non-invasive risk assessment. And if a lot of these tests look okay, it's likely that you don't have cancer. And then a biopsy's not necessary, but you, that's, so the P ss a I look at that as kind of an entry level screening tool that gets patients to us. Um, and then we, then we go from there. But, but gone are the days when we're saying, oh, your PSSA is at this level. You need a biopsy. We always try to do this additional testing. 

Darrin Godin: Gotcha. Thank you for that. Um, how is robotic surgery changing prostate cancer treatment? 

Dr. Yoshida: Well, you know, robotic surgery's been around a while. Um, so really the big, the big, um, change between the, the traditional surgery and the robotic approach is that just men recover, um, much more quickly. And so, you know, with the traditional surgery, men were in the hospital for a few days. They were, you know, not returning to normal activities or work for several weeks, sometimes even not even returning to sports or working out for a couple months. Now with robotics, we're sending patients on the same day of surgery. Um, men are back to work in a week and a half, two weeks back to exercising and, and most, most activities within two to three weeks. So it's really just you're back on your feet, you're back to normal life. And then the side effects to treatment, um, improved quite a bit with the robotic technology. The, the main two side effects of, of the prostate cancer surgery, radical prostatectomy is leakage of urine and, and sexual dysfunction. And with the, all the advantages of the robotic approach, we've really, um, improved those side effects. So, so, um, we can preserve, um, men's ability to control their urine, their preserve, their sexual function much more often than with the older approach. 

Darrin Godin: Great. And what other options are there to men besides surgery? Uh, how does medical oncology and radiation oncology play into this? 

Dr. Yoshida: Yeah, so that, that's for, for a man diagnosed with prostate cancer, the, the, um, for most difficult decision that I've seen in, in patients is making the decision of should they do surgery, should they do some of these other things that you mentioned, radiation therapy, uh, there's even some patients where we don't need to treat depending on the cancer. It's, it's a, it's a observation protocol called active surveillance. And there's even, um, neuro treatments called focal therapies. And, and, and really basically it's, it's, I think for a patient having, you know, kind of a team approach with experts that, that, that, that know those different entities, those different types of treatments, and then having a patient, um, you know, have a detailed discussion with all these, these different experts, um, and, and, and, and having that team help a patient make that decision. It's a, it's a, there's a lot of information that goes into that decision. 

Dr. Yoshida: Um, and I think meeting with, um, like we do here at City of Hope, when a, when a patient is diagnosed with prostate cancer, they'll meet with myself, I'll discuss surgery, that's my thing. I'm a surgical oncologist. And then immediately following that, they'll meet with the radiation oncologist to get information on that. And then sometimes we'll even pull in a medical oncologist where if, if the cancer might be more advanced or much more aggressive, we, we might even, um, um, adopt some, some, uh, some therapies, uh, that the medical oncologist would be involved with. But it's really this team approach and, and, and it's really being able to get patient the information, the information they need to make that difficult decision. Um, so, so that's, it's a tricky one, but, but that's, um, that's what we do here at City of Hope, is that team approach. 

Darrin Godin: Uh, I, I love that. And obviously as a man, I, I'm glad there are options, and I'm glad that we have options for our patients here at City of Hope that there is a team approach and you do have options to choose from. Um, let me ask you another question about, um, maintaining prostate health and preventing prostate cancer in the first place. So what can men do right now that helps improve their prostate health, maintain their prostate health? What can we be doing to, um, to do that? 

Dr. Yoshida: Well, I, I don't know about maintaining prostate health necessarily. Um, but I think, I think there are some lifestyle changes that a man can adopt that might reduce their risk of developing prostate cancer. I mean, um, there's been multiple lifestyle studies looking at, you know, many, many different factors. You know, being a non-smoker is really important. Um, exercising regularly, and we're talking, you know, three hours per week that has been shown, um, being of a normal weight, normal body build. In other words, not being overweight. We use something called the body mass index, and we have certain parameters, but, but not being overweight or obese is really key. And then there's dietary things, you know, um, more of a Mediterranean or vegetarian kind of diet where you're, you're not consuming red meats, high fats, um, green leafy vegetables called cruciferous vegetables, that spinach, kale, broccoli, having daily servings in your diet. Um, those are all things that a man can do that, that, that could reduce the risk a little bit. Unfortunately, um, you know, if somebody's got a, a genetic predisposition, doing all that might not make any difference at all. Mm-hmm. But, but I think if you, if you're trying to control what you can control, those are things that are important. 

Darrin Godin: Great. Thanks for, thanks for sharing those. So what is your, um, rooftop message, if you will, the shout it from a rooftop message that you would say to men listening to this podcast today about, uh, prostate cancer? 

Dr. Yoshida: Yeah, I, I just think that, that the stigma around prostate cancer screening and also treatment, um, we've, we've changed technology has significantly changed and eliminate some of those, those negative, you know, um, um, ideas that, that, you know, some of those negative factors that men, men think about mm-hmm. <affirmative>, we've, we've eliminated that. So I think screening is, is really important. It could save your life, it could prevent a lot of pain and suffering later on in life. And, you know, the way we do, um, the screening here at City of Hope, um, we, we really aim to, you know, minimize, uh, invasive testing. We use the latest technology and it's a team approach. So, um, that was a long-winded answer, <laugh> of rooftop message, but, um, but do the screening and, and we do it differently and, and, um, and, um, I, I think we've eliminated a lot of the negative, uh, negativity surrounding that. So 

Darrin Godin: Thank you. Um, Dr. Yida, you've given a lot of men hope, and not just men, but their families and their wives and their partners and so forth. So, um, let me ask you this question before we come to a close. What does hope mean to you? What does the concept of hope mean to you? 

Dr. Yoshida:  What is the concept of hope? I mean, it's, it's, um, well, look, I'm, I'm looking at it when I, when I hear the word hope or the, the term I'm thinking about City of Hope, uh, that's what comes to mind. And, and you know, when we, and, and, and the reason I'm here is, is the culture that this institution has and, and, and what we give to patients when we first meet them, and as we take them through the whole treatment process or diagnostic process or whatever. And so it's, um, it's a very caring, um, individualized and, and, and, um, you know, really high-end team approach. So it's, that's what I think about when I think of hope. Unfortunately, I'm, I'm the city of hope, you know, doctor, and, and when I hear them that, that word, that's what I think of. So, 
Darrin Godin:    No, that's, that's, that's awesome. We, we appreciate that. Well, thank you so much for being with us today, Dr. Yto. We know you're very busy and we appreciate your time to talk with our patients and those listeners. Um, and thanks for talking hope with us today. So for the rest of you, we hope you'll join us on our next episode of Talking Hope. Until next time, I'm Darren Godden. Thanks for joining us. 
Speaker 2:    Thank you all for listening to Talking Hope. We're breakthrough conversations about preventing treating and curing cancer have been brought to you by City of Hope, an N C I Designated Comprehensive Cancer Center. This is the hope you've been waiting for. For more information, visit city of or make an appointment at any of City of Hope's five Orange County locations, including City of Hope, orange County, Lennar Foundation Cancer Center, the most advanced cancer treatment center in Orange County. Call 8 8 8 3 3 3 4 6 7 3. That's 8 8 8 3 3 3 H O P E.