Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: April 11, 2020
Dr. Oliver Sartor, one of the leading researchers in advanced prostate cancer today, talks about what is happening in New Orleans this week, increased COVID-19 testing, and the beginning of antibody testing over the next few weeks.
He is the Laborde Professor of Cancer Research in the Medicine and Urology Departments of the Tulane School of Medicine, the editor-in-chief of Clinical Genitourinary Cancer and the author of more than 400 scientific papers
Dr. Oliver Sartor: I think we're turning the corner a little bit. Italy is finally doing better, Spain's finally doing better, and we're finally doing better. Some of the dreadful scenarios that were predicted by a variety of experts in the New York area have not come to pass. It's dreadful, but the deaths are not going to be in the millions. With the projections I'm seeing now, deaths may come in under 100,000.
Dr. Oliver Sartor: We're doing better. I track three hospitals that are within our system. The faculty go to three different hospitals, and we have unequivocal downturn in the number of COVID-19 admissions. We have unequivocal uptick in the amount of testing that is available and the rapidity of the testing. There's a new Abbott test that looks good. We also have a polymerase chain reaction (PCR)-based test and a Roche analyzer base test. We have terrific capacity and are sending our test kits out to other hospitals that don't have the same capacity.
We're now working with first responders. We're expanding our testing within the next day or two into the cancer centers. We will have all patients on chemotherapy get tested whether they are symptomatic or asymptomatic. We're broadening the amount of testing availability and creating new algorithms over who should and should not be tested.
Dr. Oliver Sartor: We're doing fantastic on ventilators. We have an excess of ventilators, and we are sending them to other hospitals. We are not in the same situation as New York. I've heard that one of our hospitals has the best extubation rate of any hospital. They get patients off the ventilator, which is tremendously important for ventilator capacity because it's not just how many patients you put on, it's how many patients you should take off and how long they're on the ventilator.
At least two of our hospitals are exceptional in terms of getting patients either off the ventilator or keeping the duration shorter than what might otherwise be expected. I don't know what their secret sauce is. They've got some algorithms. I will say that our ICU leadership is strong. We're doing better than expected on the ventilator front, and we're doing better than expected on the testing front.
Louisiana is a relatively small state, about 4.5 million people. We have tested 81,000 individuals, which is good. We're shifting the testing to include a broader range of either barely symptomatic patients or asymptomatic patients, and we're turning the test results around more rapidly. We have a 15-minute testing machine.
Dr. Oliver Sartor: The plan is to broaden out the antibody starting next week. That will give us a better idea about the patients who may have had it and never knew they had it. It'll also help out with immunity. What we believe is that people who had the virus and recovered are likely immune from further infection, assuming that there are not additional major mutations.
One hope is for herd immunity. Once you get a significant number of people infected, it is harder for the virus to spread. Infectivity begins to diminish.
We can prevent the spread in two ways. The first is by isolating, which we're doing right now. My patients are so good at it that sometimes I have to talk people through getting out of the house and getting some testing done. The prostate cancer patients have been fabulous about isolating. What happens after you stop isolation? This herd immunity could occur with the younger population, which has fair amount of exposure. In South Korea, which has had the most widespread testing results, 29-year-olds were the most likely to be infected.
Dr. Oliver Sartor: They were spreading it, they were bringing it home to their mothers or grandmothers, their aunties. They'll probably be the first ones out on the street partying too. The bottom line is that a lot of people could be infected and have very mild symptoms, particularly if you're young. Our cancer patients, and our older cancer patients, they're a completely different category. If you're an older cancer patient, particularly on suppressive therapy like chemotherapy, that's where there's real danger.
Dr. Oliver Sartor: The two big issues this week are the availability of testing, which is dramatically different than it was two weeks ago, and the coming antibody testing, which will determine if you've had a past infection. That could be available in the next week or two, both as a research tool and as a tool for epidemiologists to learn who might be immune or not.
There are a large number of protocols being worked on. We're going to have clinical trial results as soon as the end of the month.
Dr. Oliver Sartor: Yes. One trial from the University of Minnesota involves healthcare personnel who are in exposure to COVID-19 who are going to be put on a drug, randomized, and then self-report the results after four weeks. Health care providers are reliable, and the trial has online consent and allows for easy online reporting. This type of clinical trial is going to turn around rapidly.