Inaugural NYC Prostate Cancer Summit

Prostate cancer is estimated to claim the lives of almost 30,000 men this year. That’s 30,000 husbands, fathers, brothers and friends.

ProstateSummit

One of our best defenses against this disease is education and awareness, granting men and their families the knowledge and power to take the appropriate steps toward optimal health and longevity.

To support this goal, some of New York City’s most prestigious prostate cancer treatment centers are joining forces to host a symposium on Saturday, September 22, 2018. This inaugural NYC Prostate Cancer Summit: An Advocacy, Awareness and Educational Event to Empower Patients and Loved Ones will be led by experts from Weill Cornell Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, and Memorial Sloan Kettering Cancer Center.

Here’s a sneak peek at some of the hot topics and expert speakers slated for this premier event.

Updates in Prostate Cancer: From Screening to Diagnosis and Treatment
Screening, Active Surveillance and Prostate Cancer Biomarkers
Douglas Scherr, MD, Weill Cornell Medicine
Elias Hyams, MD, Columbia University Irving Medical Center
Mark Stein, MD, Columbia University Irving Medical Center

Imaging, Immunotherapy and Other New Targeted Therapies
Scott Tagawa, MD, MS, Weill Cornell Medicine
Joseph R. Osborne, MD, PhD, Weill Cornell Medicine
Susan Slovin, MD, PhD, Memorial Sloan Kettering
Charles Drake, MD, PhD, Columbia University Irving Medical Center

Nutrition and Diet
Rekha Kumar, MD, MS, Weill Cornell Medicine

Coping, Anxiety and Survivorship
Andy Roth, MD, Memorial Sloan Kettering

Prostate Cancer Advocacy Panel 
ZERO: The End of Prostate Cancer – Colony Brown, Vice President of Marketing & Communications
Us TOO International – Chuck Strand, Chief Executive Officer
American Cancer Society Cancer Action Network – Michael Davoli, Director, New York Metro Government Relations

In addition to having exclusive access to these discussions, patients and loved ones will also be able to connect with fellow attendees and obtain resources related to prostate cancer treatment options and quality of life.

The Summit will run from 8AM – 1PM at the New York Academy of Medicine (on 5th Avenue and 103rd Street). It is completely free and open to all those impacted by prostate cancer. Breakfast and lunch will be provided.

Seats are limited. Reserve yours today. http://bit.ly/nycprostatesummit.

Osteonecrosis of the Jaws (ONJ)

Osteonecrosis of the Jaws (ONJ) is a condition where the bone in the jaw becomes devitalized (dead) and the bone becomes exposed to the oral cavity. ONJ is a rare condition that can occur in association with a variety of conditions, including cancer and its treatments. Depending on the stage, ONJ can occur without symptoms or it can be associated with infection and pain.

Why does ONJ occur?

Doctor auscultating the neck of a patient

Within bone tissue, there are specific cells that break down and re-build the bones to release minerals into the bloodstream and maintain bone strength. Patients whose cancers have spread to the bones are often treated with antiresorptive medications that are designed to block this destruction of the bone tissue and prevent complications. In this patient population, ONJ is thought to occur due to the inhibition of the bone destruction and rebuilding process associated with certain cancer treatments. Other treatments such as radiation can also lead to necrosis.

Who is at risk of developing ONJ?

Antiresorptive medications are most often used in a general population to treat weak bones, a condition commonly referred to as osteoporosis. Antiresorptive medications are also used in the management of cancers that have spread to or involve the bone. While almost any cancer can spread to the bone on occasion, some of the most common types of cancers that spread to the bone include prostate cancer, breast cancer, lung cancer, and kidney cancer. Multiple myeloma also usually has bone involvement.

Approximately half of patients with cancer that has spread to the bone experience skeletal complications such as fractures or the need for radiation or surgery. These patients may also develop pain or elevated levels of calcium in the bloodstream. In this group of cancer patients, antiresorptive drugs are often used to prevent these types of skeletal complications, as research has shown that the use of antiresorptive drugs can decrease the risk of developing bone complications by over 50%.

While these are important medications used to manage and control cancer, patients who are taking any of these medications should be aware that they are at risk of developing ONJ.

Some specific examples of ONJ-associated medications include intravenously (IV) administered medications such as zoledronic acid (Zometa) or pamidonate (Aredia) or the injectable medication denosumab (Xgeva).

Other medications, such as “antiangiogenic” cancer drugs, can less commonly be associated with ONJ. Antiangiogenic medications aim to prevent the growth of new blood vessels within tumors. This class of drugs includes bevacizumab (Avastin) and sunitinib (Sutent), amongst many others, which are medications used to treat kidney cancers such as renal cell carcinoma and gastrointestinal cancers. Antiresorptive medications in lower doses can often be given by mouth or by injection for the treatment of weak bones (osteoporosis and osteopenia), and ONJ is much less common at these lower doses.

Because ONJ can detrimentally affect quality of life and is associated with increased risk of death, it’s important to know the signs, symptoms and risk factors. ONJ is more common in the lower jaw (mandible) than the upper jaw (maxilla). Local risk factors for ONJ include oral surgical procedures such as tooth extraction, periodontal surgery or implant placement, and the presence of dental disease. Denture use is also associated with a risk of ONJ. Systemic factors such as steroid use, diabetes and tobacco use may also increase the risk of ONJ.

How do I prevent ONJ?

Early screening and appropriate dental care is recommended for all patients who will be receiving an antiresorptive or antiangiogenic medication as part of their cancer therapy. A consultation with a dental professional who is experienced in the management of cancer patients receiving these medications is recommended prior to starting therapy. Studies have shown a decrease in the incidence of ONJ in patients who are in optimum oral health.

During cancer care, it is important to maintain optimum oral health by practicing good oral hygiene, using fluoride to prevent tooth decay and seeing your oral healthcare team for preventive care when appropriate. Any sign of infection in the jaw such as pain or swelling should be addressed immediately by alerting your oncologist and the appropriate dental professional. If possible, oral surgical procedures should be avoided unless determined to be necessary by a dental professional who is experienced in the management of ONJ.

Should I stop taking antiresorptive or antiangiogenic medications to prevent ONJ?

No. These medications should never be stopped without the knowledge of your oncologist. The benefits of taking these medications often outweigh the low risk of developing ONJ which is approximately 1-2% (1-2 people out of 100). In addition, certain therapies, such as bisphosphonate medications, can remain present in bone for many years, meaning that stopping them is unlikely to reduce the risk of ONJ.

If ONJ occurs, how is it treated?

Treatment of established ONJ aims to eliminate pain, control infection and limit progression of the necrotic bone. Depending on the clinical stage of ONJ, treatment strategies can range from management with antibiotics and pain medications to surgical removal of areas of dead bone.

At Weill Cornell Medicine and NewYork-Presbyterian, we provide supportive, specialty oral care before, during and after cancer treatment. To learn more about the services we offer, click here. To make an appointment with a dentist at our center who specializes in treating cancer patients, please call Dr. Heidi Hansen at 212-746-5115.

Special thanks to Heidi Hansen, DMD, for her contributions to this article.


For additional information about oral care during cancer therapy, visit the below links:

American Association of Oral and Maxillofacial Surgeons

National Cancer Institute

American Dental Association

 

What Women Need to Know About Sex and Cancer Treatment

Amid the onslaught of questions and worries that can be prompted by a bladder or kidney cancer diagnosis, most women are not immediately concerned with how the disease and its treatment might affect their sex life. Though sex may not be as top-of-mind as issues like survival itself or caring for a family, it is still a significant aspect of quality of life that is worth preserving and nurturing.

Maintaining a healthy sex life while dealing with cancer requires open and honest discussion both between partners as well as with a cancer care provider, but it may be difficult to know exactly what to discuss. We spoke with Dr. Tanaka Dune, a urogynecologist within the Weill Cornell Medicine and NewYork-Presbyterian Hospital (WCM/NYP) Center for Female Pelvic Health, and our Genitourinary (GU) Oncology Program’s own Dr. Ana Molina to find out how to guide the conversation.


Recognize Changes

Fighting cancer can be physically and mentally exhausting, leaving many women without much energy or desire to engage in sexual activity. Additionally, the potential aesthetic changes to the body caused by treatment, such as scarring, hair loss and weight fluctuation may hamper confidence or lead to feelings of unattractiveness. Yet, if all parties are consenting and communicative, it is safe to have sex during and after cancer treatment.

Women should be aware, however, that certain types of chemotherapy can damage the ovaries and lead to vaginal dryness, irritation and/or atrophy (thinning and shrinking of vaginal tissue due to lack of estrogen), which may cause discomfort during sex and otherwise.

Dune“You should never be aware of your vagina,” says Dr. Dune. “If you become aware, that’s when you need to start talking about it.”

Ask Questions

Healthcare providers work with the best interest of the whole person in mind, so women do not need to be afraid to ask questions or feel embarrassed about how much they do or do not know about sexuality. Clinician assistance often leads to better patient health outcomes, faster. For example, it can be difficult for women to discern between pain in the vagina and pain in the pelvic floor, the network of muscles that supports the vagina and other pelvic organs, and a doctor can ask clarifying questions to determine the appropriate next steps to treat the issue and suppress the pain.

Evaluate Options

As with most elements of cancer care, there is no one-size-fits-all approach to navigating sex during and after treatment.

To combat chemo-induced vaginal dryness, for example, lubrication options are abundant, granting patients the ability to customize based on individual needs and preferences. Certain compounds found in lubricants can trigger yeast infection, irritate the vulva and/or dry out vaginal and anal tissues, so women should avoid using petroleum-based lubricants like mineral oil or Vaseline, as well as those that contain nonoxynol-9, glycerin, glycols or parabens. Instead, they can opt for silicone- or water-based lubricants, or natural oil lubricants like vegetable, olive, peanut, avocado or coconut oil. To reduce vaginal tightness, doctors may recommend use of pelvic floor physical therapists, who teach exercises that involve contracting and relaxing vaginal and pelvic floor muscles. This type of therapy can be achieved manually and/or with the use of vaginal dilators.

For issues of insecurity and anxiety that may disturb some women’s sex lives, possible remedies include psycho-social and/or psycho-sexual support services. The WCM/NYP Genitourinary Oncology Program connects patients and spouses/partners with support groups and counseling and can even offer hair-preserving cold cap therapy or a wig prescription to combat chemotherapy-induced hair loss that may contribute to a lack of confidence.

Molina“Addressing psycho-social issues together with your partner via counseling or support groups can have a positive impact on your life and intimate relationships,” says Dr. Ana Molina.


Since most forms of cancer treatment weaken the immune system, it is especially important that women use barrier protection during oral, anal and vaginal sex to prevent exchange of bodily fluids that can lead to sexually transmitted disease.

Patients should note that while the Internet is a fantastic tool for resources and self-education – often preferred because of the ability to search for information within the comfort of one’s own home – it is best to check with a healthcare team before acting on health advice found online.