October 29, 2025 • 30 mins
Urologist Dr. Yaw Nyame joins Dr. Michael Koren to discuss bladder and prostate cancers. Dr. Nyame talks about his journey through college - including the choice between rock stardom and medical school - and how he got to the Fred Hutch Cancer Center in Seattle. Dr. Nyame explains symptoms, the history, and treatments for prostate and bladder cancer. He tells us "if you have blood in the urine, you definitely want to get to your primary care doctor." He also expands on gaps in cancer outcomes for Black men. Along the way, we weigh benefits and harms of PSA screening and talk honestly about sexual health after treatment.
Show Note: Lynch syndrome is a genetic condition also known as hereditary nonpolyposis colorectal cancer (HNPCC). It represents an increased risk of several cancers, including colorectal, endometrial, gastric, ovarian, and pancreatic cancer. It is caused by an error in the DNA mismatch repair mechanism, which normally corrects for random insertions into the DNA code.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence!, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr.
Michael Koren, the executiveeditor of MedEvidence! And I'm
really excited to introduce youto a new friend named Dr.
Yaw Nyame, who's a nationallyprominent urologist, very
passionate about research,particularly in black men, and
is going to educate us todayabout bladder cancer.
So, Yaw, thank you for joiningus here in MedEvidence!
Dr. Yaw Nyame (00:34):
Yeah, the pleasure is all mine.
Thank you for having me.
Dr. Michael Koren (00:37):
So let's just start by introducing you to the
audience.
Uh tell us a little bit how youended up where you are, which
is in Seattle right now, buttell us your whole progression.
Um we do have a lot of doctorswho listen in and they're
fascinated by how differentphysicians got to where they are
now.
So just run us by yourchildhood and in a quick version
of how you got to where you arenow.
Dr. Yaw Nyame (00:58):
Yeah.
Yeah, I was born in Athens,Georgia, when my dad was doing
his PhD in biochemistry.
Um, ironically, his researchwas all in the schistosome,
which is a parasite that infectsthe bladder and actually causes
bladder cancer.
Maybe some like heavyforeshadowing there that uh
feature in urology.
But you know, I think I my dadis a biochemist.
(01:20):
My mom was a school teacher whobecame a nurse when she when my
parents emigrated to the US,and I was kind of inundated with
academia and healthcare in myhousehold.
So-
Dr. Michael Koren (01:31):
Interesting.
Um I think they were the two ofthem were really big
inspirations for me beinginterested in the sciences.
Um, I went to college at Dukein North Carolina, that's
probably the first time that Ireally had an inkling that um
being at the forefront ofacademic medicine would be of
interest to me, just and some ofthe role models that I
(01:52):
identified along the way.
A lot of them were actuallyjust basic scientists uh at the
time because I was still fairlyundecided.
But yeah, I think the clinicalsetting and healthcare became uh
very interesting to me.
And after college, believe itor not, I was deciding between
med school and being a rockstar.
Really?
Oh, what a coincidence.
Same here.
Dr. Yaw Nyame (02:14):
Uh but it was uh after college, I moved to DC to
kind of ponder which one ofthose two pathways to try and go
down.
And um, it was in DC that Ireally became interested in
health advocacy, you know, thepatient side of things, really
meeting people at the time thatwere really championing new
concepts like what you know,cancer survivor.
You know, that was a term thatwas really being popularized and
(02:37):
resources are being allocatedto support cancer patients at
that time.
I don't think I realized howmuch each one of those little
experiences would add up to mebeing in med school and
subsequently uh in Chicago atNorthwestern thinking, okay, I
want to pursue cancer care, butthat always kind of wove in and
out of my, you know, myinterests.
(02:58):
And so um, you know, I findmyself in, I found myself in
Seattle honestly, because Ireally wanted to pursue research
that was patient-centered, um,you know, health services
research that put patients firstand had conversations with
patients.
I've had a lot of lifeexperiences that have led me to
think that that's important,including um an MBA experience
(03:18):
while I was in Chicago.
But I think the consumer, youknow, you know, the patient is
the is the most important personuh in the whole algorithm.
Dr. Michael Koren (03:29):
Absolutely.
Dr. Yaw Nyame (03:30):
And oftentimes we don't find good ways to
integrate them into the researchand our discovery and our
innovation.
So that's really becomeimportant to me uh and the work
I do.
Dr. Michael Koren (03:40):
I love that.
I love that.
So a few questions about yourbiography, fascinating
biography.
Do you have siblings and arethey involved in healthcare?
First question.
Dr. Yaw Nyame (03:49):
Yeah, I have a sister.
She's 10 years younger than me,so we have a big gap.
Uh-huh.
Uh, she is actually apharmacist at Johns Hopkins.
So, yeah, very healthcare umfamily.
Dr. Michael Koren (03:59):
Yeah, it's interesting how that that
happens.
Um, you know, families tend toproduce healthcare people.
Uh, that's one thing.
And then what instrument do youplay?
Are you a singer?
Uh tell them tell me about yourrock star career.
Dr. Yaw Nyame (04:10):
So I my pouring to music started with the
trombone.
I got obsessed with it becausemy band director uh came to our
our fifth grade class and didthis like car racing thing, you
know, with the slide on thetrombone.
And actually, I took that quitefar.
I played in the orchestras, Iplayed actually in the orchestra
in college for a year, but thenjust kind of like didn't have
(04:31):
the time.
Um, but as I transitioned fromhigh school where it was, you
know, trombone and and jazzband, um, you know, symphonium,
um, the symphony, excuse me, andthe orchestra, uh, I
transitioned away from that toguitar.
Uh, and guitar became my my newlove in college and actually
made my closest friends incollege, uh, three of whom are
(04:53):
physicians, through a sharedlove of playing guitar in the
dorm.
And uh, and we started a bandwhen I was in college that led
to a really awesome collegeexperience of playing shows
around campus.
Dr. Michael Koren (05:05):
Uh very cool.
Well, I play keyboards we'llhave to jam together at some
point.
Dr. Yaw Nyame (05:10):
We'll make that happen.
Dr. Michael Koren (05:11):
All right.
So let's transition to what youdo day to day.
Just uh tell us how you spendyour days at Fred Hutchinson uh
center in Seattle.
Dr. Yaw Nyame (05:20):
Yeah, so here at the Fred Hutchinson Cancer
Center uh in UW Medicine, Ispend half my time being a
scientist and half being aclinician.
Uh sometimes that half ofclinician feels like more than
50%.
You know, where it's uh we're avery busy program, and I see
I'm very undifferentiated.
So there are some urologiststhat specialize in cancer that
(05:42):
may see only prostate cancerpatients or only bladder cancer
patients.
I manage patients with bladder,prostate, kidney, and
testicular cancer in our in ourcancer center and um and really
enjoy that variety.
It means meeting differentpeople, uh, different age
ranges, different walks of life,because all those cancers kind
(06:04):
of have um different predispospredisposing factors and so
present at different um umstages of of life.
And and there are other riskfactors too that might increase
your risk.
So it's um uh it's reallyrewarding for me.
The other half of my time isdoing research.
I work specifically with blackmen with prostate cancer just
(06:26):
because of how much of a publichealth crisis the disparity in
prostate cancer has been amongblack people.
And as I mentioned earlier, Ithink the best way to figure out
how to solve that crisis is todirectly involve patients so
that we better understand what'shappening in their lives uh and
(06:47):
what opportunities may exist toclose that disparity gap, which
black men are twice as likelyto die from prostate cancer
compared to their peers.
And that's been true for 50plus years of collected data
through the federal government.
Dr. Michael Koren (07:01):
Wow.
Well, we'll get back to that,but I'm gonna do a little bit of
a sort of uh a segue tosomething that we've gotten
questions about.
So one of the things we like todo here at MedEvidence! is hear
what our listeners and viewerswant to learn about.
And we've had a couple ofrequests to have somebody break
down bladder cancer for us, andit sounds like that's right up
(07:23):
your alley as well.
So maybe maybe you can help usa little bit by just explaining
the incidence of bladder cancer,how it usually presents, and
and what are the treatmentoptions and what are the
research questions right now?
Dr. Yaw Nyame (07:36):
Yeah.
So bladder cancer is the tenthmost common cancer in the United
States.
There's about 85,000 new casesestimated for 2025 that will be
diagnosed.
Dr. Michael Koren (07:50):
In the US.
Dr. Yaw Nyame (07:51):
In the US, yeah.
In the United States, and about17,000 people who will
unfortunately die from frombladder cancer in the in the US.
Um, you know, it is a typicallya cancer that we diagnose from
symptom, you know.
So I manage cancers that arefound incidentally, meaning you
go in for a CAT scan and oh,there's a spot on your kidney,
(08:14):
and you come see me.
Uh, I manage screened cancerslike prostate, you get your PSA
test from your primary care andit's elevated, and you get
diagnosed.
Bladder cancer is one of thosesymptoms um related diagnoses in
that patients will present withblood in the urine.
Um, it is most diagnosed inlater decades of life, you know,
(08:36):
and uh individuals in their60s, 70s.
Um and and and so most of thetime if I'm meeting somebody
that's had that diagnosis, it'sbecause they had blood in the
urine and they got a evaluationthat's usually a CAT scan and a
cystoscopy, where we look insidethe bladder with a with a
(08:56):
skinny camera um that leads tothe to the discovery of those
tumors that then get biopsy.
Dr. Michael Koren (09:02):
A breakdown between men and women for
bladder cancer?
Dr. Yaw Nyame (09:05):
Yeah.
Men are three to four timesmore likely to be diagnosed with
bladder cancer in the UnitedStates.
And that really has to do withwhat is the primary um risk
factor for developing bladdercancer, which is tobacco use.
And as we know, um in the US,you know, through um the
(09:27):
military and other things, youknow, there's there was a heavy
smoking culture, much heavierthan than present day, and men
were more likely to smoke, andthat is is is a big part of why
we see more bladder cancer amongmen in the U.S.
Interestingly, I was just inGhana operating as part of a
mission trip with a group calledIVU Med.
(09:48):
Um, and all of our patientswere women.
And uh, one of the individualsthere was asking me what I
thought.
And I have a hypothesis, whichis in Ghana, women cook over
coal stoves that are reallysmall in their households, and
they're sitting near that andand inhaling that smoke.
And I think so, again, it justgoes to show that that burned
(10:10):
material that's inhaled has alot of carcinogens that get
filtered out in the urine thatmight drive bladder cancer um
development.
There are other risk factors,some industrial chemicals that
increase risk.
So we used to talk about uh umdyes and and aromatic amines,
you know, like taking you wayback to your your chemistry
(10:32):
days, but there are definitelysome toxins that increase uh
bladder cancer risk.
We've been doing some worklooking at arsenic here through
one of my partners here at FredHutch and water supply.
Um and then there's a stronggenetic component.
So for instance, Lynchsyndrome, which I think many of
us would think of as a coloncancer risk factor, increases
(10:55):
your risk of developing cancersof the inner lining of the
bladder called urethelialcancers, both of the kidneys and
the bladder.
And that inner lining is in incontinuity.
So you it's a very similar typeof cancer that gets developed
in both places.
Dr. Michael Koren (11:11):
Is Lynch named after a person or is that
an acronym?
Dr. Yaw Nyame (11:14):
It is named after I a person, I believe, and and
it's a uh missense mutation umthat um I I that is not like I'm
not a geneticist, so I don'twant to speak too much of it.
Dr. Michael Koren (11:28):
We'll do we'll we'll do a show note on
that to cover that.
Dr. Yaw Nyame (11:31):
But those are the that's pretty common in uh in
some colon cancer patients.
Dr. Michael Koren (11:35):
So got it.
So uh is the diagnosis ofbladder cancer death sentence,
or are there things that you cando uh kind of help us
understand what the workup lookslike for the average person
that gets diagnosed?
Dr. Yaw Nyame (11:48):
So as I mentioned, uh it's diagnosed
typically from blood in theurine.
So, you know, if I have onemessage for everyone on that's
listening, is if if that is asymptom that you develop, you
know, that especially if youhave blood in the urine without
pain, but in any context, youdefinitely want to get to your
primary care doctor and get areferral and to see a urologist.
(12:09):
You know, the majority of thecancers we diagnose are early
stage, meaning they're only onthe most inner linings of the
bladder and they have notpenetrated into deeper layers.
Um, and and and that carries avery different pathway, both in
how we uh manage those cancersand what the prognosis is
(12:29):
compared to um cancers that aremore advanced.
So the earlier it's discovered,the better.
I think I mentioned earlierthat the workup involves a CT
scan, meaning we get um, youknow, a scan of your abdomen and
pelvis, usually with contrast,so that we can kind of get a
really good understanding of theanatomy of the kidneys and
(12:51):
bladder.
Uh, and then a cystoscopy wherewe take it and a camera that's
a little about the size of asmall catheter that we pass into
the bladder to evaluate thebladder.
If we see one of these tumorsin the bladder, then we take you
for uh a surgical procedurewhere we use uh electricity to
shave a little piece of yourbladder uh and the tumor and we
(13:15):
send that to a pathologist forthe for an evaluation.
Dr. Michael Koren (13:18):
Very cool.
Um how how often can you dealwith with bladder cancers just
with local means versus majormajor surgery?
Dr. Yaw Nyame (13:27):
So I always say there are two things we want to
know when we do that bladderbiopsy when we're evaluating a
bladder cancer.
The first is how aggressive isa bladder cancer?
So we have some cancers thatare low grade, meaning overall,
when you look at thearchitecture of the cancer under
the microscope, it's not toochaotic.
(13:49):
Um, sometimes I joke, you know,if it's a brick wall, you've
got bricks that might beslightly different sizes, mortar
in between the bricks that'snot consistent, but at least it
looks like a brick wall.
Then you have high-grade tumorsthat might look like, you know,
uh, my six-year-old built thewall, made the bricks, and laid
it himself, right?
Really disorganized.
(14:09):
Um and so those two differentum settings give different
options.
And then the second one is howadvanced is a cancer, right?
Is it only in the inner liningor is it in the muscle of the
bladder?
And the muscle wall of thebladder really is that uh line
in the sand where we go fromtreatments inside the bladder
(14:29):
typically is a first line, to ifit's involving the muscle in
the bladder, typically uhchemotherapy, followed by
radical treatment, which is inthe US typically bladder
removal, although radiation canalso be considered in patients
uh who may prefer to keep theirbladder or may not be healthy
enough for bladder removal.
Dr. Michael Koren (14:50):
Got it.
Uh what's the role for infusinga chemotherapeutic agent in the
bladder versus systemictreatment?
Dr. Yaw Nyame (14:58):
So if it's um one of those uh non-muscle invasive
cancers, that's a term we use.
If it's only in the innerlining of the bladder, then we
really do have two umpredominant uh therapies that we
put inside the bladder.
The first one is actually animmunotherapy, and it's an old
(15:19):
immunotherapy.
It's BCG, which was a TBvaccine, and we administer that
inside the bladder, and that hasa pretty good success rate for
treatment, um, somewhere around70%, is what I quote, uh, over a
two to three year span.
Um and then the second therapy,which is really coming into um
(15:41):
the foreground, and we justcompleted a clinical trial um
that is gonna hopefully read outuh within a year or so, uh,
that that will hopefully show usa chemotherapy combination of
gemcitabine and docetaxel are isas just as efficient as the
BCG.
The problem with the BCG for usis drug shortages.
(16:03):
I mean, it really has mademanaging and treating this
non-invasive bladder cancer verychallenging because of just not
having the drug available.
Um, but those are have been ourtwo primary inside the bladder
treatments.
We are have had a very bigrevolution in this management of
(16:25):
non-invasive cancer, and thereare a lot of new drugs that are
coming on the market.
This is in part because I toldyou the efficacy of treatment is
around 70% at first time.
Some may say it's lower, maybecloser to 40 or 50%.
So one of the nuisance thingsabout bladder cancers is that
they want to do two things ifthey're high grade, especially.
(16:48):
If they're low grade, they aredo the nuisance thing of coming
back.
So recurrence.
And we see that with high gradetoo.
But high grade cancers not onlywant to recur or come back, but
they want to progress or moveto deeper stages of the bladder
wall or spread beyond thebladder.
And so that is really um thething that we're fighting in uh
(17:08):
when we're giving therapy istrying to um make sure that
we're keeping a close eye on thebladder for those recurrences.
And we also don't want to waittoo long or give treatments that
are not working, um, in the inthe case that a cancer may
progress, which you know, oncethe bladder cancers have spread
(17:29):
beyond the bladder, you know,they typically are incurable.
And that can affect quality oflife.
And uh um uh well, obviouslythat affects, let me start over.
Once they move beyond thebladder, they're often
incurable.
And many of the treatments thatwe have to offer can have
significant quality of lifeimpact.
So that that is the reason whywe we're looking to be more
(17:53):
aggressive, especially in thesetting where these cancers that
are still non-muscle invasivecome back.
Dr. Michael Koren (18:00):
Are there any biomarkers for bladder cancer
similar to PSA for prostate?
Dr. Yaw Nyame (18:05):
There are not, there's not a biomarker like
PSA, but there's definitely newproducts that are coming onto
the market that are looking atuh shed cancer DNA or shed
cancer cell uh cells uh in theurine.
And so there are some productsthat are starting to become
commercially available, but noneof them have moved into the
(18:27):
space of where I would say atprime time usage.
Dr. Michael Koren (18:30):
Got it.
And how about people that havea family history of bladder
cancer?
Are there circumstances wherepeople may not have any signs or
symptoms, but should still bescreened for bladder cancer
because of a high genetic riskor exposure risk?
Dr. Yaw Nyame (18:46):
We do um some screening, especially in
patients who have Lynchsyndrome.
So I brought that up earlier,uh, where we get pictures to
make sure there is no evidenceof tumors within the kidney,
especially.
Um, and we may offer somescopes, um, but there isn't
routine screening that'srecommended just simply for
(19:07):
having a strong family history.
It's mostly in those patientswho have rare genetic variants
um uh in their DNA that thatpushes us to think about uh
screening for multiple cancers,and in that case, bladder and
what we call upper tracturethelial cancer may be
included in that.
Dr. Michael Koren (19:27):
Fascinating.
Well, that was a true masterclass.
Thank you so much for educatingme and our listeners and and
viewers.
So let's transition to yourpassion, which is this
discrepancy in incidents andoutcomes in prostate cancer
compared comparing black menwith other populations.
So I'm fascinated to learnabout what you're doing, what
(19:48):
you're studying now and whatyou're trying to think through
to mitigate this discrepancy.
Dr. Yaw Nyame (19:54):
Yeah.
Uh well thank you for first ofall for giving me the
opportunity to talk aboutbladder cancer.
I know because so much of mywork is in prostate cancer, um,
that sometimes uh people are notaware of my passion for
supporting bladder cancerpatients um as well.
And um, and and certainlythere's a lot of exciting
(20:15):
research that I'm fortunate tobe able to contribute to through
my partners who have um, youknow, research programs in that
space.
You know, as I mentionedearlier, what what we have done
over the last five years is justcreate a forum for black
prostate cancer um survivors umto contribute to the advancement
(20:36):
of prostate cancer research.
And we've through done thatthrough an organization that we
call BACPAC, which stands forthe Black and African Descent
Collaborative for ProstateCancer Action.
I did not come up with thatname.
Um, but at BACPAC has been areally great group.
We started with two individualsin 2020.
You know, we have now well over40 uh people that serve in
(20:59):
advisory roles that are eithersurvivors or stakeholders, such
as researchers, that helpsupport the work we do.
Um, and we've really spent thelast five years asking the
question what research questionsare most important?
What approaches will besuccessful in ensuring that um
people from sociallymarginalized populations can
(21:20):
participate because there aresome hurdles there.
Um and uh and and whatstrategies are uh are needed um
to make sure that we answerthose important research
questions appropriately.
Um and so we've been reallylucky to have funding from the
uh multiple um sources,including National Cancer
(21:41):
Institute, Department ofDefense, PCORI, um, to help do
this work.
And right now, all of ourenergy and focus is on doing um
what would be the firstscreening trial uh in in black
uh men to understand how we canmaximize the benefit of a
PSA-based screening protocolwhile mitigating harms, right?
(22:03):
Because that is that is achallenge that we have in
prostate cancer screening, isthat although we can reduce
death from prostate cancer withPSA testing, we often do so at
the um at the cost ofintroducing harm and unnecessary
biopsies and anxiety aroundwhether one may have prostate
(22:24):
cancer for a test that um has alot of false positives.
Um and in detecting cancersthat men would would probably be
better off not having beendiagnosed with because they're
more likely to die with thattype of cancer than from that
type of cancer.
I actually believe quitestrongly that when you have a
high-risk population, you haveactually even a higher risk of
(22:49):
detecting some of these low-riskcancers uh and doing more harm.
So, yes, we need to bethoughtful in screening
high-risk populations and um sothat we can reduce the burden of
disease, but we also need to dothat in a way where we don't
also uh maximize harm.
Dr. Michael Koren (23:08):
Interesting.
Uh, are you also involved ininterventional clinical trials
in prostate cancer?
Dr. Yaw Nyame (23:14):
At this time, no.
You know, I am a umprostatectomist, so I do a lot
of prostate cancer treatment inthe localized setting.
Uh as a program, you know, Ihelp collaborate with
investigators that are thinkingabout some interventional um uh
components of the care wedeliver.
(23:34):
So, what does that look like?
Well, are there some drugs thatwe can give around the time of
prostate removal that mightreduce the chance that cancers
come back?
But you know, one of the um oneof the realities of prostate
cancer is that it's the thesimple treatments that we have
now, removal and radiation, arereally effective, even in
(23:54):
high-risk settings.
And it seems like addingadditional therapies don't
doesn't always give usadditional benefit.
Um, and so that kind of limitsthe amount of investigation we
can do.
A lot of our efforts inprostate cancer research are
focused on uh the diagnosticsand and the and um that includes
(24:16):
the screening component, but weyou know, can we find cancers,
small amounts of cancers thatmight be outside of the
prostate, you know, that mightimpact what kind of treatment
approach we we take or how wemanage cancers after treatment
if PSAs come back, you know, inthat recurrent setting.
That is very different frombladder cancer, just to
(24:37):
transition a little bit, um,where a lot of the exciting
investigation is in newtherapies that are coming on
board.
You know, two years ago, if youasked me about bladder cancer,
I would have said, well, there'sone chemo combination, um, and
it, you know, it doesn't reallyhave a strong complete response
rate, and um, but it's it's whatwe know to be most effective.
(25:00):
Now we have an antibody drugconjugate that we pair with an
immunotherapy that's reallyrevolutionized um bladder cancer
treatment, especially in theadvanced stage, that has, you
know, a uh um a notable completeresponse rate.
So um it's just uh very twodifferent cancers uh in two very
(25:22):
different um phases.
Dr. Michael Koren (25:24):
Interesting.
Uh one thing that I've readabout uh on on prostate cancer
treatment, and I'm sure it'sapplicable for bladder cancer,
is concerns about losing sexualfunction during the treatment.
Um you maybe want to comment onthat.
Dr. Yaw Nyame (25:39):
Yeah, I mean, that's a big part of what we're
learning in having conversationswith patients and community
members about what may beimpacting their decision to
screen or not screen, right?
Um and the fear and and whichare real and concerns about
impact on sexual health and andurinary health, to you know, uh,
(26:00):
I would argue just pelvichealth in general.
So, yeah, very similar risksfor erectile dysfunction with
with treatments.
But one of the things that Ialways sort of pause and and and
highlight is that erectiledysfunction is actually quite
common in men uh at the ages inwhich we are treating them for
(26:23):
prostate cancer.
So if you take a non-prostatecancer cohort and look at what
the rates of some degree oferectile dysfunction is,
starting as um young as in theages of 40 and beyond, there are
large, larger than report, youknow, I think um talked about
(26:44):
populations of men who areexperiencing some degree of ED,
uh, and that rate can be as highas 70 or 80% of patients who
are queried.
And that's not to say that theyhave no function, but they have
definitely diminished function.
And so that is one of thethings that really complicates
um erectile recovery afterlocalized treatment.
(27:07):
I quote a 50% rate of erectiledysfunction for surgery if a
nerve-sparing procedure is done.
That's similar to radiation,although the timelines are
really different.
So with surgery, obviouslyerectile dysfunction happens
right away, whereas withradiation, you have decline over
time.
So something that we counselmen on.
There are a lot of greatresources, just like there are
(27:29):
for the general population tosupport uh erectile health, if
that is a strong priority for aman, um, that that's um uh that
that we can you knowoperationalize for for patients.
And so one of the things that Ithink is really important and I
have learned is not to say,well, there's a high degree of
erectile dysfunction with thistreatment and walk away from the
(27:52):
conversation, but to reallyhighlight that erectile
dysfunction is common.
Certainly these treatments arenot going to make um have the
potential to um acceleratedecline, uh, but that there are
a lot of really effectivetherapies that exist.
And and you know, for instance,for us in our practice, I have
wonderful partners that can umthat support my my patients in
(28:16):
erectile um healthpost-treatment.
Uh, and and those types ofurologists exist across the
country and institutions um likeours and even in in community
settings.
Dr. Michael Koren (28:30):
Well, Yaw, this has been an absolutely
fascinating and educationalexperience for me and hopefully
for our viewers and listeners.
Uh any last words of wisdom orany important take-home points
you wanted to make before we uhwe sign off?
Dr. Yaw Nyame (28:46):
Yeah.
Well, I think even though a bigfocus of today was bladder
cancer, you know, I urgehealthier, younger men to at
least start engaging in theconversation of about PSA-based
screening with their primarycare doctors.
And that that's what it'ssupposed to be, right?
You have a conversation,understand what the benefits and
(29:07):
harms of a PSA test would befor you.
Uh, and and I think part ofthat conversation, understanding
what your risks may be, youknow, is it run in the family?
Do people who look like youhave higher risk of being
diagnosed or dying from prostatecancer?
Because those things are reallyimportant.
On the bladder cancer front, ifyou have blood in your urine,
that's an emergency.
Definitely seek medical um carein that setting.
(29:29):
And for those who have beendiagnosed and are trying to
understand how to work their waythrough this really challenging
diagnosis, know that there area lot of great organizations
that exist to support patients.
Uh, you know, I would be remissif I didn't shout out the
bladder cancer advocacy network,BCAN, um, that has a lot of
great resources to supportpatients and has a large patient
(29:53):
community uh where you couldfind someone who's been in your
shoes to talk to, to kind ofsee.
Guidance.
Dr. Michael Koren (30:01):
Well, Yaw, thanks for the great
information, and thank yousincerely for joining us here at
MedEvidence!
Dr. Yaw Nyame (30:08):
My pleasure.
Thank you for having me.
Announcer (30:10):
Thanks for joining the MedEvidence! Podcast.
To learn more, head over toMedEvidence.com or subscribe to
our podcast on your favoritepodcast platform.
Welcome to MedEvidence!, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr.
Michael Koren, the executiveeditor of MedEvidence! And I'm
really excited to introduce youto a new friend named Dr.
Yaw Nyame, who's a nationallyprominent urologist, very
passionate about research,particularly in black men, and
is going to educate us todayabout bladder cancer.
So, Yaw, thank you for joiningus here in MedEvidence!
Dr. Yaw Nyame (00:34):
Yeah, the pleasure is all mine.
Thank you for having me.
Dr. Michael Koren (00:37):
So let's just start by introducing you to the
audience.
Uh tell us a little bit how youended up where you are, which
is in Seattle right now, buttell us your whole progression.
Um we do have a lot of doctorswho listen in and they're
fascinated by how differentphysicians got to where they are
now.
So just run us by yourchildhood and in a quick version
of how you got to where you arenow.
Dr. Yaw Nyame (00:58):
Yeah.
Yeah, I was born in Athens,Georgia, when my dad was doing
his PhD in biochemistry.
Um, ironically, his researchwas all in the schistosome,
which is a parasite that infectsthe bladder and actually causes
bladder cancer.
Maybe some like heavyforeshadowing there that uh
feature in urology.
But you know, I think I my dadis a biochemist.
(01:20):
My mom was a school teacher whobecame a nurse when she when my
parents emigrated to the US,and I was kind of inundated with
academia and healthcare in myhousehold.
So-
Dr. Michael Koren (01:31):
Interesting.
Um I think they were the two ofthem were really big
inspirations for me beinginterested in the sciences.
Um, I went to college at Dukein North Carolina, that's
probably the first time that Ireally had an inkling that um
being at the forefront ofacademic medicine would be of
interest to me, just and some ofthe role models that I
(01:52):
identified along the way.
A lot of them were actuallyjust basic scientists uh at the
time because I was still fairlyundecided.
But yeah, I think the clinicalsetting and healthcare became uh
very interesting to me.
And after college, believe itor not, I was deciding between
med school and being a rockstar.
Really?
Oh, what a coincidence.
Same here.
Dr. Yaw Nyame (02:14):
Uh but it was uh after college, I moved to DC to
kind of ponder which one ofthose two pathways to try and go
down.
And um, it was in DC that Ireally became interested in
health advocacy, you know, thepatient side of things, really
meeting people at the time thatwere really championing new
concepts like what you know,cancer survivor.
You know, that was a term thatwas really being popularized and
(02:37):
resources are being allocatedto support cancer patients at
that time.
I don't think I realized howmuch each one of those little
experiences would add up to mebeing in med school and
subsequently uh in Chicago atNorthwestern thinking, okay, I
want to pursue cancer care, butthat always kind of wove in and
out of my, you know, myinterests.
(02:58):
And so um, you know, I findmyself in, I found myself in
Seattle honestly, because Ireally wanted to pursue research
that was patient-centered, um,you know, health services
research that put patients firstand had conversations with
patients.
I've had a lot of lifeexperiences that have led me to
think that that's important,including um an MBA experience
(03:18):
while I was in Chicago.
But I think the consumer, youknow, you know, the patient is
the is the most important personuh in the whole algorithm.
Dr. Michael Koren (03:29):
Absolutely.
Dr. Yaw Nyame (03:30):
And oftentimes we don't find good ways to
integrate them into the researchand our discovery and our
innovation.
So that's really becomeimportant to me uh and the work
I do.
Dr. Michael Koren (03:40):
I love that.
I love that.
So a few questions about yourbiography, fascinating
biography.
Do you have siblings and arethey involved in healthcare?
First question.
Dr. Yaw Nyame (03:49):
Yeah, I have a sister.
She's 10 years younger than me,so we have a big gap.
Uh-huh.
Uh, she is actually apharmacist at Johns Hopkins.
So, yeah, very healthcare umfamily.
Dr. Michael Koren (03:59):
Yeah, it's interesting how that that
happens.
Um, you know, families tend toproduce healthcare people.
Uh, that's one thing.
And then what instrument do youplay?
Are you a singer?
Uh tell them tell me about yourrock star career.
Dr. Yaw Nyame (04:10):
So I my pouring to music started with the
trombone.
I got obsessed with it becausemy band director uh came to our
our fifth grade class and didthis like car racing thing, you
know, with the slide on thetrombone.
And actually, I took that quitefar.
I played in the orchestras, Iplayed actually in the orchestra
in college for a year, but thenjust kind of like didn't have
(04:31):
the time.
Um, but as I transitioned fromhigh school where it was, you
know, trombone and and jazzband, um, you know, symphonium,
um, the symphony, excuse me, andthe orchestra, uh, I
transitioned away from that toguitar.
Uh, and guitar became my my newlove in college and actually
made my closest friends incollege, uh, three of whom are
(04:53):
physicians, through a sharedlove of playing guitar in the
dorm.
And uh, and we started a bandwhen I was in college that led
to a really awesome collegeexperience of playing shows
around campus.
Dr. Michael Koren (05:05):
Uh very cool.
Well, I play keyboards we'llhave to jam together at some
point.
Dr. Yaw Nyame (05:10):
We'll make that happen.
Dr. Michael Koren (05:11):
All right.
So let's transition to what youdo day to day.
Just uh tell us how you spendyour days at Fred Hutchinson uh
center in Seattle.
Dr. Yaw Nyame (05:20):
Yeah, so here at the Fred Hutchinson Cancer
Center uh in UW Medicine, Ispend half my time being a
scientist and half being aclinician.
Uh sometimes that half ofclinician feels like more than
50%.
You know, where it's uh we're avery busy program, and I see
I'm very undifferentiated.
So there are some urologiststhat specialize in cancer that
(05:42):
may see only prostate cancerpatients or only bladder cancer
patients.
I manage patients with bladder,prostate, kidney, and
testicular cancer in our in ourcancer center and um and really
enjoy that variety.
It means meeting differentpeople, uh, different age
ranges, different walks of life,because all those cancers kind
(06:04):
of have um different predispospredisposing factors and so
present at different um umstages of of life.
And and there are other riskfactors too that might increase
your risk.
So it's um uh it's reallyrewarding for me.
The other half of my time isdoing research.
I work specifically with blackmen with prostate cancer just
(06:26):
because of how much of a publichealth crisis the disparity in
prostate cancer has been amongblack people.
And as I mentioned earlier, Ithink the best way to figure out
how to solve that crisis is todirectly involve patients so
that we better understand what'shappening in their lives uh and
(06:47):
what opportunities may exist toclose that disparity gap, which
black men are twice as likelyto die from prostate cancer
compared to their peers.
And that's been true for 50plus years of collected data
through the federal government.
Dr. Michael Koren (07:01):
Wow.
Well, we'll get back to that,but I'm gonna do a little bit of
a sort of uh a segue tosomething that we've gotten
questions about.
So one of the things we like todo here at MedEvidence! is hear
what our listeners and viewerswant to learn about.
And we've had a couple ofrequests to have somebody break
down bladder cancer for us, andit sounds like that's right up
(07:23):
your alley as well.
So maybe maybe you can help usa little bit by just explaining
the incidence of bladder cancer,how it usually presents, and
and what are the treatmentoptions and what are the
research questions right now?
Dr. Yaw Nyame (07:36):
Yeah.
So bladder cancer is the tenthmost common cancer in the United
States.
There's about 85,000 new casesestimated for 2025 that will be
diagnosed.
Dr. Michael Koren (07:50):
In the US.
Dr. Yaw Nyame (07:51):
In the US, yeah.
In the United States, and about17,000 people who will
unfortunately die from frombladder cancer in the in the US.
Um, you know, it is a typicallya cancer that we diagnose from
symptom, you know.
So I manage cancers that arefound incidentally, meaning you
go in for a CAT scan and oh,there's a spot on your kidney,
(08:14):
and you come see me.
Uh, I manage screened cancerslike prostate, you get your PSA
test from your primary care andit's elevated, and you get
diagnosed.
Bladder cancer is one of thosesymptoms um related diagnoses in
that patients will present withblood in the urine.
Um, it is most diagnosed inlater decades of life, you know,
(08:36):
and uh individuals in their60s, 70s.
Um and and and so most of thetime if I'm meeting somebody
that's had that diagnosis, it'sbecause they had blood in the
urine and they got a evaluationthat's usually a CAT scan and a
cystoscopy, where we look insidethe bladder with a with a
(08:56):
skinny camera um that leads tothe to the discovery of those
tumors that then get biopsy.
Dr. Michael Koren (09:02):
A breakdown between men and women for
bladder cancer?
Dr. Yaw Nyame (09:05):
Yeah.
Men are three to four timesmore likely to be diagnosed with
bladder cancer in the UnitedStates.
And that really has to do withwhat is the primary um risk
factor for developing bladdercancer, which is tobacco use.
And as we know, um in the US,you know, through um the
(09:27):
military and other things, youknow, there's there was a heavy
smoking culture, much heavierthan than present day, and men
were more likely to smoke, andthat is is is a big part of why
we see more bladder cancer amongmen in the U.S.
Interestingly, I was just inGhana operating as part of a
mission trip with a group calledIVU Med.
(09:48):
Um, and all of our patientswere women.
And uh, one of the individualsthere was asking me what I
thought.
And I have a hypothesis, whichis in Ghana, women cook over
coal stoves that are reallysmall in their households, and
they're sitting near that andand inhaling that smoke.
And I think so, again, it justgoes to show that that burned
(10:10):
material that's inhaled has alot of carcinogens that get
filtered out in the urine thatmight drive bladder cancer um
development.
There are other risk factors,some industrial chemicals that
increase risk.
So we used to talk about uh umdyes and and aromatic amines,
you know, like taking you wayback to your your chemistry
(10:32):
days, but there are definitelysome toxins that increase uh
bladder cancer risk.
We've been doing some worklooking at arsenic here through
one of my partners here at FredHutch and water supply.
Um and then there's a stronggenetic component.
So for instance, Lynchsyndrome, which I think many of
us would think of as a coloncancer risk factor, increases
(10:55):
your risk of developing cancersof the inner lining of the
bladder called urethelialcancers, both of the kidneys and
the bladder.
And that inner lining is in incontinuity.
So you it's a very similar typeof cancer that gets developed
in both places.
Dr. Michael Koren (11:11):
Is Lynch named after a person or is that
an acronym?
Dr. Yaw Nyame (11:14):
It is named after I a person, I believe, and and
it's a uh missense mutation umthat um I I that is not like I'm
not a geneticist, so I don'twant to speak too much of it.
Dr. Michael Koren (11:28):
We'll do we'll we'll do a show note on
that to cover that.
Dr. Yaw Nyame (11:31):
But those are the that's pretty common in uh in
some colon cancer patients.
Dr. Michael Koren (11:35):
So got it.
So uh is the diagnosis ofbladder cancer death sentence,
or are there things that you cando uh kind of help us
understand what the workup lookslike for the average person
that gets diagnosed?
Dr. Yaw Nyame (11:48):
So as I mentioned, uh it's diagnosed
typically from blood in theurine.
So, you know, if I have onemessage for everyone on that's
listening, is if if that is asymptom that you develop, you
know, that especially if youhave blood in the urine without
pain, but in any context, youdefinitely want to get to your
primary care doctor and get areferral and to see a urologist.
(12:09):
You know, the majority of thecancers we diagnose are early
stage, meaning they're only onthe most inner linings of the
bladder and they have notpenetrated into deeper layers.
Um, and and and that carries avery different pathway, both in
how we uh manage those cancersand what the prognosis is
(12:29):
compared to um cancers that aremore advanced.
So the earlier it's discovered,the better.
I think I mentioned earlierthat the workup involves a CT
scan, meaning we get um, youknow, a scan of your abdomen and
pelvis, usually with contrast,so that we can kind of get a
really good understanding of theanatomy of the kidneys and
(12:51):
bladder.
Uh, and then a cystoscopy wherewe take it and a camera that's
a little about the size of asmall catheter that we pass into
the bladder to evaluate thebladder.
If we see one of these tumorsin the bladder, then we take you
for uh a surgical procedurewhere we use uh electricity to
shave a little piece of yourbladder uh and the tumor and we
(13:15):
send that to a pathologist forthe for an evaluation.
Dr. Michael Koren (13:18):
Very cool.
Um how how often can you dealwith with bladder cancers just
with local means versus majormajor surgery?
Dr. Yaw Nyame (13:27):
So I always say there are two things we want to
know when we do that bladderbiopsy when we're evaluating a
bladder cancer.
The first is how aggressive isa bladder cancer?
So we have some cancers thatare low grade, meaning overall,
when you look at thearchitecture of the cancer under
the microscope, it's not toochaotic.
(13:49):
Um, sometimes I joke, you know,if it's a brick wall, you've
got bricks that might beslightly different sizes, mortar
in between the bricks that'snot consistent, but at least it
looks like a brick wall.
Then you have high-grade tumorsthat might look like, you know,
uh, my six-year-old built thewall, made the bricks, and laid
it himself, right?
Really disorganized.
(14:09):
Um and so those two differentum settings give different
options.
And then the second one is howadvanced is a cancer, right?
Is it only in the inner liningor is it in the muscle of the
bladder?
And the muscle wall of thebladder really is that uh line
in the sand where we go fromtreatments inside the bladder
(14:29):
typically is a first line, to ifit's involving the muscle in
the bladder, typically uhchemotherapy, followed by
radical treatment, which is inthe US typically bladder
removal, although radiation canalso be considered in patients
uh who may prefer to keep theirbladder or may not be healthy
enough for bladder removal.
Dr. Michael Koren (14:50):
Got it.
Uh what's the role for infusinga chemotherapeutic agent in the
bladder versus systemictreatment?
Dr. Yaw Nyame (14:58):
So if it's um one of those uh non-muscle invasive
cancers, that's a term we use.
If it's only in the innerlining of the bladder, then we
really do have two umpredominant uh therapies that we
put inside the bladder.
The first one is actually animmunotherapy, and it's an old
(15:19):
immunotherapy.
It's BCG, which was a TBvaccine, and we administer that
inside the bladder, and that hasa pretty good success rate for
treatment, um, somewhere around70%, is what I quote, uh, over a
two to three year span.
Um and then the second therapy,which is really coming into um
(15:41):
the foreground, and we justcompleted a clinical trial um
that is gonna hopefully read outuh within a year or so, uh,
that that will hopefully show usa chemotherapy combination of
gemcitabine and docetaxel are isas just as efficient as the
BCG.
The problem with the BCG for usis drug shortages.
(16:03):
I mean, it really has mademanaging and treating this
non-invasive bladder cancer verychallenging because of just not
having the drug available.
Um, but those are have been ourtwo primary inside the bladder
treatments.
We are have had a very bigrevolution in this management of
(16:25):
non-invasive cancer, and thereare a lot of new drugs that are
coming on the market.
This is in part because I toldyou the efficacy of treatment is
around 70% at first time.
Some may say it's lower, maybecloser to 40 or 50%.
So one of the nuisance thingsabout bladder cancers is that
they want to do two things ifthey're high grade, especially.
(16:48):
If they're low grade, they aredo the nuisance thing of coming
back.
So recurrence.
And we see that with high gradetoo.
But high grade cancers not onlywant to recur or come back, but
they want to progress or moveto deeper stages of the bladder
wall or spread beyond thebladder.
And so that is really um thething that we're fighting in uh
(17:08):
when we're giving therapy istrying to um make sure that
we're keeping a close eye on thebladder for those recurrences.
And we also don't want to waittoo long or give treatments that
are not working, um, in the inthe case that a cancer may
progress, which you know, oncethe bladder cancers have spread
(17:29):
beyond the bladder, you know,they typically are incurable.
And that can affect quality oflife.
And uh um uh well, obviouslythat affects, let me start over.
Once they move beyond thebladder, they're often
incurable.
And many of the treatments thatwe have to offer can have
significant quality of lifeimpact.
So that that is the reason whywe we're looking to be more
(17:53):
aggressive, especially in thesetting where these cancers that
are still non-muscle invasivecome back.
Dr. Michael Koren (18:00):
Are there any biomarkers for bladder cancer
similar to PSA for prostate?
Dr. Yaw Nyame (18:05):
There are not, there's not a biomarker like
PSA, but there's definitely newproducts that are coming onto
the market that are looking atuh shed cancer DNA or shed
cancer cell uh cells uh in theurine.
And so there are some productsthat are starting to become
commercially available, but noneof them have moved into the
(18:27):
space of where I would say atprime time usage.
Dr. Michael Koren (18:30):
Got it.
And how about people that havea family history of bladder
cancer?
Are there circumstances wherepeople may not have any signs or
symptoms, but should still bescreened for bladder cancer
because of a high genetic riskor exposure risk?
Dr. Yaw Nyame (18:46):
We do um some screening, especially in
patients who have Lynchsyndrome.
So I brought that up earlier,uh, where we get pictures to
make sure there is no evidenceof tumors within the kidney,
especially.
Um, and we may offer somescopes, um, but there isn't
routine screening that'srecommended just simply for
(19:07):
having a strong family history.
It's mostly in those patientswho have rare genetic variants
um uh in their DNA that thatpushes us to think about uh
screening for multiple cancers,and in that case, bladder and
what we call upper tracturethelial cancer may be
included in that.
Dr. Michael Koren (19:27):
Fascinating.
Well, that was a true masterclass.
Thank you so much for educatingme and our listeners and and
viewers.
So let's transition to yourpassion, which is this
discrepancy in incidents andoutcomes in prostate cancer
compared comparing black menwith other populations.
So I'm fascinated to learnabout what you're doing, what
(19:48):
you're studying now and whatyou're trying to think through
to mitigate this discrepancy.
Dr. Yaw Nyame (19:54):
Yeah.
Uh well thank you for first ofall for giving me the
opportunity to talk aboutbladder cancer.
I know because so much of mywork is in prostate cancer, um,
that sometimes uh people are notaware of my passion for
supporting bladder cancerpatients um as well.
And um, and and certainlythere's a lot of exciting
(20:15):
research that I'm fortunate tobe able to contribute to through
my partners who have um, youknow, research programs in that
space.
You know, as I mentionedearlier, what what we have done
over the last five years is justcreate a forum for black
prostate cancer um survivors umto contribute to the advancement
(20:36):
of prostate cancer research.
And we've through done thatthrough an organization that we
call BACPAC, which stands forthe Black and African Descent
Collaborative for ProstateCancer Action.
I did not come up with thatname.
Um, but at BACPAC has been areally great group.
We started with two individualsin 2020.
You know, we have now well over40 uh people that serve in
(20:59):
advisory roles that are eithersurvivors or stakeholders, such
as researchers, that helpsupport the work we do.
Um, and we've really spent thelast five years asking the
question what research questionsare most important?
What approaches will besuccessful in ensuring that um
people from sociallymarginalized populations can
(21:20):
participate because there aresome hurdles there.
Um and uh and and whatstrategies are uh are needed um
to make sure that we answerthose important research
questions appropriately.
Um and so we've been reallylucky to have funding from the
uh multiple um sources,including National Cancer
(21:41):
Institute, Department ofDefense, PCORI, um, to help do
this work.
And right now, all of ourenergy and focus is on doing um
what would be the firstscreening trial uh in in black
uh men to understand how we canmaximize the benefit of a
PSA-based screening protocolwhile mitigating harms, right?
(22:03):
Because that is that is achallenge that we have in
prostate cancer screening, isthat although we can reduce
death from prostate cancer withPSA testing, we often do so at
the um at the cost ofintroducing harm and unnecessary
biopsies and anxiety aroundwhether one may have prostate
(22:24):
cancer for a test that um has alot of false positives.
Um and in detecting cancersthat men would would probably be
better off not having beendiagnosed with because they're
more likely to die with thattype of cancer than from that
type of cancer.
I actually believe quitestrongly that when you have a
high-risk population, you haveactually even a higher risk of
(22:49):
detecting some of these low-riskcancers uh and doing more harm.
So, yes, we need to bethoughtful in screening
high-risk populations and um sothat we can reduce the burden of
disease, but we also need to dothat in a way where we don't
also uh maximize harm.
Dr. Michael Koren (23:08):
Interesting.
Uh, are you also involved ininterventional clinical trials
in prostate cancer?
Dr. Yaw Nyame (23:14):
At this time, no.
You know, I am a umprostatectomist, so I do a lot
of prostate cancer treatment inthe localized setting.
Uh as a program, you know, Ihelp collaborate with
investigators that are thinkingabout some interventional um uh
components of the care wedeliver.
(23:34):
So, what does that look like?
Well, are there some drugs thatwe can give around the time of
prostate removal that mightreduce the chance that cancers
come back?
But you know, one of the um oneof the realities of prostate
cancer is that it's the thesimple treatments that we have
now, removal and radiation, arereally effective, even in
(23:54):
high-risk settings.
And it seems like addingadditional therapies don't
doesn't always give usadditional benefit.
Um, and so that kind of limitsthe amount of investigation we
can do.
A lot of our efforts inprostate cancer research are
focused on uh the diagnosticsand and the and um that includes
(24:16):
the screening component, but weyou know, can we find cancers,
small amounts of cancers thatmight be outside of the
prostate, you know, that mightimpact what kind of treatment
approach we we take or how wemanage cancers after treatment
if PSAs come back, you know, inthat recurrent setting.
That is very different frombladder cancer, just to
(24:37):
transition a little bit, um,where a lot of the exciting
investigation is in newtherapies that are coming on
board.
You know, two years ago, if youasked me about bladder cancer,
I would have said, well, there'sone chemo combination, um, and
it, you know, it doesn't reallyhave a strong complete response
rate, and um, but it's it's whatwe know to be most effective.
(25:00):
Now we have an antibody drugconjugate that we pair with an
immunotherapy that's reallyrevolutionized um bladder cancer
treatment, especially in theadvanced stage, that has, you
know, a uh um a notable completeresponse rate.
So um it's just uh very twodifferent cancers uh in two very
(25:22):
different um phases.
Dr. Michael Koren (25:24):
Interesting.
Uh one thing that I've readabout uh on on prostate cancer
treatment, and I'm sure it'sapplicable for bladder cancer,
is concerns about losing sexualfunction during the treatment.
Um you maybe want to comment onthat.
Dr. Yaw Nyame (25:39):
Yeah, I mean, that's a big part of what we're
learning in having conversationswith patients and community
members about what may beimpacting their decision to
screen or not screen, right?
Um and the fear and and whichare real and concerns about
impact on sexual health and andurinary health, to you know, uh,
(26:00):
I would argue just pelvichealth in general.
So, yeah, very similar risksfor erectile dysfunction with
with treatments.
But one of the things that Ialways sort of pause and and and
highlight is that erectiledysfunction is actually quite
common in men uh at the ages inwhich we are treating them for
(26:23):
prostate cancer.
So if you take a non-prostatecancer cohort and look at what
the rates of some degree oferectile dysfunction is,
starting as um young as in theages of 40 and beyond, there are
large, larger than report, youknow, I think um talked about
(26:44):
populations of men who areexperiencing some degree of ED,
uh, and that rate can be as highas 70 or 80% of patients who
are queried.
And that's not to say that theyhave no function, but they have
definitely diminished function.
And so that is one of thethings that really complicates
um erectile recovery afterlocalized treatment.
(27:07):
I quote a 50% rate of erectiledysfunction for surgery if a
nerve-sparing procedure is done.
That's similar to radiation,although the timelines are
really different.
So with surgery, obviouslyerectile dysfunction happens
right away, whereas withradiation, you have decline over
time.
So something that we counselmen on.
There are a lot of greatresources, just like there are
(27:29):
for the general population tosupport uh erectile health, if
that is a strong priority for aman, um, that that's um uh that
that we can you knowoperationalize for for patients.
And so one of the things that Ithink is really important and I
have learned is not to say,well, there's a high degree of
erectile dysfunction with thistreatment and walk away from the
(27:52):
conversation, but to reallyhighlight that erectile
dysfunction is common.
Certainly these treatments arenot going to make um have the
potential to um acceleratedecline, uh, but that there are
a lot of really effectivetherapies that exist.
And and you know, for instance,for us in our practice, I have
wonderful partners that can umthat support my my patients in
(28:16):
erectile um healthpost-treatment.
Uh, and and those types ofurologists exist across the
country and institutions um likeours and even in in community
settings.
Dr. Michael Koren (28:30):
Well, Yaw, this has been an absolutely
fascinating and educationalexperience for me and hopefully
for our viewers and listeners.
Uh any last words of wisdom orany important take-home points
you wanted to make before we uhwe sign off?
Dr. Yaw Nyame (28:46):
Yeah.
Well, I think even though a bigfocus of today was bladder
cancer, you know, I urgehealthier, younger men to at
least start engaging in theconversation of about PSA-based
screening with their primarycare doctors.
And that that's what it'ssupposed to be, right?
You have a conversation,understand what the benefits and
(29:07):
harms of a PSA test would befor you.
Uh, and and I think part ofthat conversation, understanding
what your risks may be, youknow, is it run in the family?
Do people who look like youhave higher risk of being
diagnosed or dying from prostatecancer?
Because those things are reallyimportant.
On the bladder cancer front, ifyou have blood in your urine,
that's an emergency.
Definitely seek medical um carein that setting.
(29:29):
And for those who have beendiagnosed and are trying to
understand how to work their waythrough this really challenging
diagnosis, know that there area lot of great organizations
that exist to support patients.
Uh, you know, I would be remissif I didn't shout out the
bladder cancer advocacy network,BCAN, um, that has a lot of
great resources to supportpatients and has a large patient
(29:53):
community uh where you couldfind someone who's been in your
shoes to talk to, to kind ofsee.
Guidance.
Dr. Michael Koren (30:01):
Well, Yaw, thanks for the great
information, and thank yousincerely for joining us here at
MedEvidence!
Dr. Yaw Nyame (30:08):
My pleasure.
Thank you for having me.
Announcer (30:10):
Thanks for joining the MedEvidence! Podcast.
To learn more, head over toMedEvidence.com or subscribe to
our podcast on your favoritepodcast platform.
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