Dr. Charles Ryan

¡Gracias por ver el video! Patients need help understanding how these innovations affect them and how they can participate meaningfully in decisions about their care. Joining us today to help us get answers to these concerns is Dr. Charles Ryan, a genitourinary medical oncologist who specializes in treating advanced stage prostate cancer from Memorial Sloan Kettering Cancer Center in New York City. Welcome to the show, Dr. Ryan. Bueno, gracias por haberme, Virgil. Bienvenido a estar aquí. Bueno, vamos a empezar con la situación que muchos pacientes y familias se encuentran en y son un poco más fricidados. Un hombre tiene una enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad Sure, so there's two things, two broad things happening in the cancer at this point for the patient. One is, as you pointed out, the hormone therapy has stopped working, and we'll talk about what that means. And the second is that the cancer is experiencing a spread or it's growing in new parts of the body that it maybe wasn't before, and that's called metastasis. So it's a reasonable moment for a patient to have a heightened concern about their care and about what treatments they're going to be receiving because When we think about prostate cancer, it's an incredibly diverse disease ranging from maybe 20% of patients who are diagnosed with it who don't need any treatment ever in their life to a proportion of patients who may experience a life-threatening form of the disease. And in fact, it is those patients who have hormone resistance. y metastasis que face a life-threatening form of the disease. Now, that does not mean that when it reaches this point, it is a terminal illness, but what it means is that this is a point where new therapies are needed, and often the intensity of the treatments may, in fact, need to go up. What's happening in the cancer is a really complicated question because hormone therapy, which serves as the foundation of systemic treatment or medical treatment for prostate cancer, interestingly, it doesn't kill all of the cancer. If it did, we wouldn't need to have this conversation. But what it does is it sort of puts a lot of the cancer on notice. It stresses the cancer. It puts it into a remission. But then the cancer can experience adaptations that can lead to this form of disease we call hormone-resistant disease. It's been historically called castration-resistant disease. And more recently, we've started calling it androgen pathway modulation-resistant disease. And that's because it speaks to the point that we are modulating this androgen pathway or the hormone pathway, and it's become resistant to that. Ahora, ¿es resistencia simplemente un tema de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad de la enfermedad? It's a great question, and I think both happen. But really, when you think about this, and more and more we think about cancer as an adaptive genetic phenomenon, and I'm not talking about the family genes, I'm talking about the genes in the cancer. And what can happen is the cancer can undergo other mutations. It can undergo what's called selection, which means if you have several different populations of cancer cells, you may... Kill some with hormone therapy alone and some of the more hardy.