Prostate/Colorectal Cancer

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Prostate cancer is the most common cancer among men, while colorectal cancer is the second leading cancer killer in the country. Dr. Roscoe Nelson of the Arizona Center for Urology will discuss prostate cancer and free screenings his office will be providing and Dr. Neeraj Singh of Valley Surgical Clinics will give us details about colorectal cancer.

Video: "Arizona Horizon" is made possible by contributions from the Friends of Arizona PBS, members of your PBS station. Thank you.

Ted Simons: Good evening and welcome to "Arizona Horizon," I'm Ted Simons. Governor Doug Ducey today vetoed a pair of bills that threatened to weaken existing water supply regulations on developers. One of the bills allowed municipalities in Yuma and Cochise counties to opt out of a 100-year water requirement for planned developments. The other bill allowed the two counties to periodically renew the 100-year requirement. The governor called the measures, quote "bad bills" and added that he was concerned that the measures would quote "encourage a patchwork of water ordinances throughout our cities and leave our water supply securities in peril. Ensuring the certainty and sustainability of Arizona water is a top priority. I will not sign legislation that threatens Arizona's water future."

Ted Simons: And Sky Harbor set a new monthly record with nearly 4.3 million passengers traveling through the airport in March. Phoenix officials cite warm spring temperatures, little in the way of rain and spring training baseball as the main reasons for the record monthly total.

Ted Simons: Our continuing coverage of proposition 123 continues tonight with a proponent of the measure who specifically wants to counter state treasurer Jeff DeWit's claims that alternatives to prop 123, settling an education lawsuit, exist and should be considered. Joining us now is Chris Thomas, the general counsel for the Arizona school boards association, which favors the measure. Good to see you again, thanks for joining us.

Chris Thomas: Thank you.

Ted Simons: Treasurer DeWit says there are alternatives out there. Does he have a point?

Chris Thomas: Well, not really because we work with the legislature on this to get as much as we could for schools. We knew what was possible, we knew where we started and ended up and so to see there's enough money that's already in the actual general fund to settle this lawsuit, that's actually not true. I mean, you have to have a couple of things. One you have to have sustainability and the other thing is you have to have the political will to do that and I don't think we have either one of those.

Ted Simons: He said that 123 assumes that Arizona is broke when Arizona really is flush with cash. Again, does he have a point?

Chris Thomas: Well, he has a point only in the sense of the short-term. He doesn't have a point in the long term. The problem -- it's not a problem, it's something that we definitely are in favor is that inflation builds each year so the next year you have to build on that number. And if you look at the revenue projections, after a couple of years, we no longer have that general fund to absorb all of those funding requirements.

Ted Simons: He says -- again, the reason for the lawsuit is no money due to the recession but he says the cash, April alone, more money handled by his office in any month in Arizona history, he's never seen anything like it, managing $14 billion in their account, the money he says is there.

Chris Thomas: Right. Well, let's keep in mind, you know, who Jeff DeWit is. Jeff DeWit is the treasurer. He's the banker of the state. And he doesn't have a policy making role. He doesn't have a role that he can appropriate money. He can't pass the bill. He can't veto the bill. He's the defendant in name only in the lawsuit so he doesn't have a lot of power. It's one thing to say if you have skin in the game and you have a stake and you have a vote to say here's what we ought to do but he doesn't. And he's just the banker and I'm not -- when I go to the bank, my banker doesn't tell me whether I can have my money and how to spend it.

Ted Simons: He can certainly advise you.

Chris Thomas: He can give information certainly but he's not having to balance all the other priorities of the state.

Ted Simons: What are some of the other priorities? Because again, we've done so much on prop 123, we're going to have the league of women voters tomorrow night to ensure all sides are heard but this settles a lawsuit that critics say shorted education. The legislature was supposed to spend this money, they didn't. The state Supreme Court says you must, they didn't. Now, granted it is on appeal and that appeal could stretch out a while but at base here you're asking voters to approve something that will fix something that voters already approved, but the legislature said we don't feel like it.

Chris Thomas: I don't disagree with those critics. If I got to write proposition 123 the way I wanted it, it wouldn't look the way it does. Having said that, it's a fair compromise. When you look at the obligations that the legislature had, when you look at how long it was going to take for us to resolve judicial finality, it was a really long time and our schools are starving right now. We have teachers that have not received raises in four or five years and teachers are leaving the profession in droves. So we needed to do something now if we could.

Ted Simons: And as far as the extra money, the rainy day funds, all these sorts of things that treasurer DeWit and others say could be used to settle this lawsuit once and for all, you say...

Chris Thomas: I say that it's not sustainable. It will get us there for a year or two but pretty quickly it won't. And when you look at the segment and the mediation and the discussion that we had, essentially you had one side saying tax increases were not on the table. So then you start looking at what possibilities there are, and that's why the trust land emerged, the trust land funds emerged because it's the one source that's out there and this would be doing what it's supposed to do. It's going to education.

Ted Simons: The treasurer also brought up a couple of other things on the program when he was here. He said the promise of more money for teachers is simply not true. There's nothing in here that requires a single dollar to teachers.

Chris Thomas: I definitely take issue with that. Teacher salaries are the greatest need. And yes, it's going to be determined at the local level but those teacher salaries are going to be different in every location. Maybe you have a problem attracting new teachers so you want to raise your starting salary. Maybe you have a problem with teachers that have been around for five or six years and want to receive that raise. We want to allow our local elected officials a chance to have that flexibility, to work with their staff.

Ted Simons: But is there accountability? Because again, he says that no accountability was negotiated into the deal.

Chris Thomas: I totally disagree with that. The accountability rests with the local school board and to us, the local school board is the most accountable body there is because they're the government that's closest to the people.

Ted Simons: Okay. But again, nothing is required in the deal? The hope is that they will be accountable.

Chris Thomas: Well, let's step back. Why is it not required? It's not required because this is funding that was supposed to come to general operations funding. It didn't have strings attached. If it were appropriated at the time. But it wasn't. And now, we're coming back and redoing that so to put strings on it now after it never would have had strings was something that was a deal breaker for us.

Ted Simons: When he was here he also mentioned that the campaign for 123 says it's not going to raise taxes. He says that is simply not true.

Chris Thomas: Right. And that's -- and I think that's telling a half-truth because the way our funding system works if you have enough property wealth in your school district and they raise the amount of money you can spend per student well you're not going to get funding from the state. The funding is going to come directly out of local property taxpayers. And so that's just the way it would work and it would work without prop 123. If you raise the amount of money going in it's going to be a tax increase for some people that are in that category.

Ted Simons: So no state tax increases but the possibility for some, a property tax increase.

Chris Thomas: What would be the alternative? To leave those districts behind and I don't think anybody wants that.

Ted Simons: He says 45 districts around the state won't see a single dollar out of this settlement. True?

Chris Thomas: No, he's using the funding system to make that argument and we don't think that's a fair argument at all. Again, one of the things that Arizona can be proud about in its education funding system is the equity that there is. We're all low but at the same time, we're all the same. And that equalization formula which has been in place since the early '80s has served that purpose.

Ted Simons: There's concern out there from the treasurer but others probably even more so regarding these poison pills as they're described for the future of education, these triggers are written into the deal in a certain way, that in the future, if the economy goes one way or the other, all of this money, all of this wonderful glad tidings goes away. Are you concerned about that?

Chris Thomas: Not at all. We've added that, we've had independent economists look at that. The recession trigger that we like to talk about, the great thing about that one is that even if the legislature does not need to fund us in a given year because there is a recession, the base still gets adjusted which means that in the next year and the recession trigger is not in play, the actual amount they would have to come up with a double amount so we don't lose ground for the effects of inflation.

Ted Simons: So in 2019 all of a sudden lots of tax cuts and lots of revenue, not coming in like it used to and education hits that 49, 50% threshold, which triggers the trigger as it were, you're saying no big deal?

Chris Thomas: No. That one is not a big deal because basically our peak was 43% and that was when we were paying for all-day K. We're nowhere near that 49% figure and when you look at the obligations that the state has we're not going to be anywhere near that.

Ted Simons: But it's possible to get there.

In Chris Thomas: the long term it could be possible and if that's a problem, the voters of this state could repeal that.

Ted Simons: Are you concerned over legal action regarding the enabling act or any other aspect of this provided 123 passes?

Chris Thomas: I'm not and here's why because I don't think that Jeff DeWit has standing. He's but one of a member of a board, the board would have to approve that lawsuit. So this idea that we're trading one lawsuit for another not true. We have one lawsuit that would take three to five years to resolve, another lawsuit that would be handled in a matter of weeks or months.

Ted Simons: If a lawsuit were filed by someone other than Jeff DeWit, someone who would be considered having standing, are you concerned about that?

Chris Thomas: Well, that would be a concern but I also think that we have the facts on our side. In fact, just like the senator -- our senator did get advice that basically the enabling act does not need to be amended.

Ted Simons: So you're saying that the 49% threshold likely won't happen, even if it does, it won't be that big of a deal and you're not expecting any lawsuit for the enabling act?

Chris Thomas: If there is a lawsuit, it will be dealt with in a perfunctory way.

Ted Simons: As an education person are you comfortable with this?

Chris Thomas: Again, it's a compromise. It's not what I would want but it's our best chance to move education funding forward and get do all those other issues that we have to deal with, reversing the cuts of the Great Recession, bringing back all-day kindergarten, dealing with our school facilities issues, and renewal of prop 301 which has four years left.

Ted Simons: It's good to have you here, thanks for joining us.

Chris Thomas: You bet.

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Ted Simons: Prostate cancer is the second most common cancer for men and colorectal cancer is the second leading cancer killer in the country. Here now to talk about advancements in treatment and prevention of prostate cancer is Dr. Roscoe Nelson of the Arizona Center For Urology, and to speak about colorectal cancer is Dr. Neeraj Singh of Valley Surgical Clinics. Good to have you both here. Thanks for joining us.

Roscoe Nelson: Thank you.

Ted Simons: So second most common, behind skin cancer, this is it, huh?

Roscoe Nelson: This is it. It's the number two cancer killer of men in America. That's a number that people don't realize because it's such a common cancer and most people hear if you live long enough you're going to get prostate cancer. It's a lethal cancer, it's the number two cancer killer of men in America.

Ted Simons: Is it a more lethal cancer the younger you are?

Roscoe Nelson: The surprising statistic, people think of people that are very old that are dying of prostate cancer. Average age of dying of prostate cancer, 64. Much younger than what most people think.

Ted Simons: How long on average would that particular patient have had prostate cancer?

Roscoe Nelson: Really depends on how aggressive that cancer is. Prostate cancer is a mix of some very slow-growing cancers but then there's a handful that are very aggressive, very fast growing so these ones that kill people tend to be around for maybe less than five years by the time they get out, go to the bone, go to the lymph nodes where we can't cure them.

Ted Simons: Colorectal cancer. What is colorectal cancer?

Neeraj Singh: It's a cancer which arises from the cells within the rectal lining, we call it the lower intestinal tract. We have a small intestine and large intestine.

Ted Simons: Are there symptoms of colorectal cancer?

Neeraj Singh: Mostly the patients come with bleeding, obstruction if it's very advanced. Sometimes, people present with anemia. Those are the common symptoms that we look for. Abdominal pain is an advanced symptom when people obstruction and they come with the complete blockage.

Ted Simons: Risk factors? What do we know about colorectal cancer?

Neeraj Singh: People say it's genetics but most of the common causes is sporadic cancers. Diet, environment, your lifestyle, a mostly sedentary lifestyle, smoking, diet mostly red meat is the most common cause that's been categorized as the risk factor.

Ted Simons: As far as symptoms and treatment for prostate cancer? I mean, are there symptoms of prostate cancer?

Roscoe Nelson: Once it's spread there are symptoms. You can have blood in the urine, pain in the bones. In the '90s, that's how people presented, they came in with bone pain. Now with psas, we're able to catch it early but there aren't a lot of symptoms of early prostate cancer that hasn't spread yet.

Ted Simons: You brought up psas. What is a PSA test and why is this particular test controversial?

Roscoe Nelson: Well, PSA is very controversial. It's just an enzyme. Every man with a prostate has a PSA level in their blood, and it's normal. It helps -- it's an enzyme that gets a woman pregnant but PSA we start testing for it in the late '80s, early '90s, and what happened is we pulled out a lot of people that already were metastatic that lant been treated yet they weren't seeing an improvement in the death rate of prostate cancer. So they started to question are we doing the right thing? And if you look at the long-term data, the Swedish data, the European data, we are actually seeing a big success with that. If you look at any short-term study you're not seeing that success. So we just have to be better with it and the controversy is we need to also be more selective in those who we treat with prostate cancer.

Ted Simons: Who would be someone who would not necessarily need a PSA test.

Roscoe Nelson: If your life expectancy is less than 10 years, probably you don't need to check for your PSA and that's the number one, the older you get, the less likely you're going to die of an aggressive disease. If somebody comes in and I always laugh, a poor old guy comes in in a wheelchair and oxygen and they have a PSA, I do everything I can to say it's okay, as long as it's reasonable.

Ted Simons: It could be around longer than they are, in other words.

Roscoe Nelson: Most of the time, it is.

Ted Simons: As far as colorectal cancer, third most common cancer, second leading cancer killer, that second leading. What makes colorectal cancer so deadly?

Neeraj Singh: You know, I'll say it's the diagnosis, you know. Most like in America we are pretty advanced as far as screening is concerned. I'll say that the colonoscopy has been the best in the history of mankind, the best screening test to detect. But if you see all over the world, people don't have any screening protocols. Other things, which is in America we are seeing more and more, the younger age. Medicare approves the screening starting from the age of 50 but in the literature, the last 15, 20 years, most of the patients they are even 40 and 50, they have been getting the majority of the cancers and I see it all the time. Because the screening has prevented, you know -- we detect the cancers early, the polyps, if the polyps form the cancer.

Ted Simons: When you find polyps, what happens? What's next after finding a polyp?

Neeraj Singh: Next step is they can be removed endoscopically. You stop the progress of the disease and based on the number of the polyps, the size of the polyps, the need for the follow-up colonoscopies. But in the younger age like 40 to 50, because there's no screening yet, and we are seeing because of the environment and the diet factors, we are seeing more and more younger people with the cancer.

Ted Simons: And as far as these precancerous polyps, do you know immediately it's precancerous? Does it have to be treated?

Roscoe Nelson: There's a lot of features. Most people who do colonoscopies routinely, we know what kind of polyps the majority of the times but some are flat, some are raised, but absolute answer is the pathology and they tell us if it's cancerous, precancerous.

Ted Simons: Are there risk factors for prostate cancer?

Roscoe Nelson: It's very similar to what he was talking about with colorectal cancers. A lot of it is family history but diet, our American diet is not good for us. The processed foods, these types of things, the high-fat diet, it's worse with obesity. There's some other groups, the African-American men much higher risk of getting prostate cancer and a more aggressive form of it.

Ted Simons: Is that genetic based?

Roscoe Nelson: We don't fully understand it but that needs to be taken into consideration as we screen these men and do it at a little earlier age and get baselines and follow them along to make sure we can pick it up early.

Ted Simons: And you mentioned bone cancer. Is that where most commonly a prostate cancer, if it were to metastasize, is that where it goes?

Roscoe Nelson: The bones and lymph nodes yes.

Ted Simons: And so once you find it there, different ballgame correct?

Roscoe Nelson: Different ballgame, different treatment, you have to become systemic treatment, you have to take the whole body into consideration, treat everything.

Ted Simons: Talk about those treatments. What are available out there?

Roscoe Nelson: So for years, in fact Nobel Prize winning research on testosterone and the relationship with prostate cancer is to remove the testosterone and that's the first method and we do it with shots now, first method of treating metastatic prostate cancer. There's research recently that combining it with chemotherapy improves the longevity. When I came out even in the '80s and early '90s, when people were diagnosed, it was in their bones and they failed hormones, the life expectancy was less than a year. Today, it's much longer than that. In the last three years we've had four new medications, two of them oral, that will improve not only the hormonal treatment but the chemotherapy.

Ted Simons: As far as the PSA test is concerned, let's say it's high-ish okay. And let's say there are other indications, other testing says something's going on here. You find out there is cancer there. Can someone beat prostate cancer completely?

Roscoe Nelson: Vast majority of men are cured of prostate cancer. The question is there are a lot of men who don't need to treat it. If I was 75 and I had a very small volume of a low grade cancer, that's a guy that a watchful waiting protocol will be the way to go. Do a biopsy six months later. Follow that person. Only 10% of those people progress to a more aggressive form and you can still catch it early.

Ted Simons: But again, if you are younger, the odds are a more aggressive form of treatment is needed?

Roscoe Nelson: We still cure the vast majority of that group.

Ted Simons: Treatment for colorectal cancer. What's out there? How effective is it?

Neeraj Singh: I'll say it's a very effective treatment. Currently, overall, it's about 61% survival, five-year survival date from the date of the colorectal cancer. Stage three, treatment for the colon and the rectal cancer differs. The rectal cancers, we use radiation as a modality. And in colon cancer obviously we never use radiation. It's a little bit different.

Ted Simons: Have those treatments evolved? Are things different now than they were five, 10, 20 years ago?

Neeraj Singh: Absolutely. There's a lot of new studies going on but the quality of the surgery improvement, you know, we're using more and more advanced robotic techniques. So patients are recovering fast, they go home fast, you know, essentially we are shortening the time in the hospital so that's one of the major disadvantages.

Ted Simons: We mentioned that third most common cancer, second leading cancer killer, colorectal cancer, and the idea that it's something that can be -- if not cured, certainly found early, treated better, why don't more men get screened?

Neeraj Singh: Well, there's a lot of factors. It depends, patients are just scared of colonoscopies and many patients, I still see patients in my office we're worried about procreation. I think that's a major dilemma in the patients. Many people don't want to go through that discomfort or the bowel prep, patients don't want to go through that but I think it's a very simple test in the common world and everybody in America does it.

Ted Simons: The concerns regarding preparations. Success rate on that, improving over the years? Do we see that as much as we used to? Did we see it all that much in the past?

Neeraj Singh: It's very, very rare and it depends upon the volume and we see it very rarely those kind of complications.

Ted Simons: As far as prostate cancer is concerned, are there new treatment techniques, new diagnostic techniques?

Roscoe Nelson: We're better at surgery, radiation, chemo, immunotherapy but patient selection, I think that's where the big change is coming. We're seeing you take two people with the same cancer, the way we used to grade it and now we're able to get into the DNA and look at it and stratify those into guys who are high risk of progressing and people who are low risk and maybe we're going to be less aggressive with this one and more aggressive with this one, go early on after that cancer, be more aggressive with that.

Ted Simons: How do you know what's more aggressive? Are the PSA numbers a certain range? How does that work?

Roscoe Nelson: You can have a guy come in with a PSA of 8 and a Glisan 7 and their genetics can be totally different. There are certain genes that control whether the cancer wants to spread, whether the cancer wants to grow fast and we can look at those and help determine, help that patient make a decision on what to do with their cancer. I think the key you asked him about screening, men are a little bit scared of the whole rectal exam and it's not just the PSA, 15% of prostate cancers are found with nodules, normal PSAs and sometimes, those are the more aggressive cancers.

Ted Simons: Wow. Real quickly, are you optimistic now on treatment for colorectal cancer?

Roscoe Nelson: Absolutely. We detect them, 100% curable.

Ted Simons: Very good. It's good to have you here. Thank you so much for joining us. Good information.

Ted Simons: Tuesday on "Arizona Horizon," hear from an opponent of proposition 123, the school funding ballot measure.

Ted Simons: And we'll look at a new study to be released tomorrow on marijuana use and driving. That's at 5:30 and 10:00 on the next "Arizona Horizon." That is it for now, I'm Ted Simons, thank you so much for joining us. You have a great evening.

Video: "Arizona Horizon" is made possible by contributions from the Friends of Arizona PBS, members of your PBS station. Thank you.

Dr. Roscoe Nelson: Arizona Center for Urology,Dr. Neeraj Singh: Valley Surgical Clinics

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