Travel author Rick Steves takes us along on his prostate cancer 'journey'

Dr. Felix Feng dies: co-founder of Artera, developer of AI apps for prostate cancer, including Active Surveillance.

(Note: I reported in the last issue that readers of this newsletter have come from 49 states and 62 countries. I asked readers to guess: Which state has never had a subscribers= to this newsletter? I got a variety of guesses. Mostly Mississippi. But a couple guessed Alabama and Wyoming.

(But two of you on a first try correctly guessed the MIA state. The answer is North Dakota. Jeff Olson, an American, and Phil Segal, a Canadian, got it right and won valuable prizes.

(I asked Jeff how he got it right. “…mostly dumb luck. :) My reasoning, such as it is, first chose South Dakota - but since you obviously have at least one subscriber there, that left North Dakota! Why the Dakotas? Because people here tend to be ‘hard’: they fix things themselves, aren't into self-diagnosis, and don't believe in complaining or alternative medicine. They're kind of prairie stoics, I guess. Sadly, I'm a Californian, so I'm a sissy. :)” Jeff is a native of Minnesota.

(When I asked Phil, how he did it. He said, “I just picked what I thought was a small state out of the picture.” C’mon, Phil. I love North Dakota, especially the Badlands.)

(Badlands by Howard Wolinsky. Where are your AS patients?)

By Howard Wolinsky

Travel author Rick Steves tells the New York Times about his latest journey--prostate cancer. He’s a great tour guide.

He feels that he lucked out even though he recently underwent a prostatectomy.

“A month ago I said goodbye to my prostate, and I see it as a journey. I don’t speak the language. I don’t know exactly where it’s going. I’m not in control of the itinerary. I want to tackle it with what I consider a traveler’s mind-set. But it’s scary at the same time,” he told Lulu Garcia-Navarro, Opinion Audio podcast host for The New York Times.

I think Steves has captured what probably most of feel as prostate canncr patients--from low risk across the spectrum to high risk. We are moving through an unknown territory, terra incognita. We are strangers in a strange land.

We’d all rather be somewhere else. But as Steves points out if you’re going to get cancer, prostate cancer is a good one.

It grows. Some of us can avoid aggressive treatments. Others are “cured.” And prostate cancer, though it is the most common cancer in men and is the second most common cause of cancer deaths in men, is unlikely to kill us.

Steves said: “My prognosis is very good. If you’re going to get cancer, prostate is a good kind of cancer to get. And it’s interesting to me, it hasn’t gotten me down. I mean, it has me nervous and a little bit worried about what could happen. I’m kind of having not fun, but I’m having a journey. I’m having a learning experience.”

Good ‘tude.

What’s he learning about?

“I didn’t really want to be an expert on incontinence, but I’m going to get through it,” he said.

Steves found the strength of the “reluctant brotherhood” when he went public. Not enough celebs tell their PCa story, especially those on Active SUrveillance, who can easly keep their cancers secret.

“And people are coming out of the woodwork telling me about their experience. One of the most, one of the most commented on and shared posts I’ve ever had on Facebook was when I shared my experience there. And, it was a very, very positive thing. I’ve always thought it’s important not to keep these things secret, to be embarrassed about anything.

“... I’ve had a lot of prayers and a lot of thoughts, thoughts and prayers and warm feelings and all that. And it almost has a tangible value. It fills the sails that motor me through this journey, and I’m really thankful for it.”

The interviewer asked if the disgnosi shas given more more of an urgency to do things he hasn’t done before? “No, but it gives me an awareness of what you might regret when you’re wrapping up your life. You think about that, and it does make me consider and reconsider, you know, my priorities and be more mindful, be more mindful, yeah.”

Dr. Felix Feng dies; his research using AI and genomics changed PCa care, including active surveillance

By Howard Wolinsky

Prostate cancer researcher Felix Feng, MD, died in his sleep Dec. 10 from cancer of the small bowel at age 49.

His obituary notes: “It is only too ironic that Felix ultimately succumbed to cancer himself.”

Dr. Feng made contributions that have changed prostate cancer care including AI to help patients decide whether to go on Active Surveillance and informing men with intermediate-risk prostate cancer whether they are good candidates for Androgen Deprivation Therapy (ADT). These new tests were developed at Artera AI, which Feng co-founded.

Peter Carroll, MD, MPH, of University of California, San Francisco, one of the developers of AS, recruited Dr. Feng to UCSF.

Carroll said: Felix’s untimely death is a tragedy and a very personal loss, we were very, very close.Felix Feng burned brightly. He lit up every space he entered – home, laboratory, clinic, lecture halls around the world and our hearts. I noted this when I first met Felix on a visit to the University of Michigan.

“I felt he was perfect for UCSF. I count his recruitment to UCSF as one of the luckiest events in my life. He brought a great program in the research and clinical care of prostate cancer to higher levels! We were very close and talked often. Felix was a brilliant and charismatic father, colleague, scientist and notably the most effective mentor I have ever known. He started and sustained the careers of innumerable people around the world. Despite an age difference of 25 years and 2 days (we have birthdays 2 days apart) he was a mentor (and trusted colleague) to me.”

(Sample ArteraAI test results.)

In August 2023, Dr. Feng, a radiation oncologist, told The Active Surveillor: about the first iteration of the AI prostate test “This test does not currently address Active Surveillance – but stay tuned. ArteraAI is currently working with collaborators to develop an AI test designed specifically for patients who may be considering active surveillance.”

(Dr. Felix Feng)

One year later, Artera announced that the Artera Prostate AI Test was available as a guide to help patients with low-risk to favorable intermediate risk prostate cancer decide about going onto Active Surveillance.

Earlier this year, Artera’s prostate test was made available to help patients with intermediate-risk PCa decide whether to go on ADT .

Feng told The Active Surveillor in 2023: “The ArteraAI Prostate Test is the first test that can both predict therapy benefit, particularly in the context of who should receive hormone therapy, and prognosticate long-term outcomes in localized prostate cancer. The long-term goal is to enable personalized care for patients.”

The researcher founded the Feng Lab the University of California, San Francisco, which is credited with producing the first clinical-grade biomarker panels that predict prostate cancer response to radiation or hormone therapy after surgery, as well as a plasma-based cell-free DNA biomarker that predicts resistance to PARP1 inhibitors.

Additionally, his laboratory helped identify the mechanisms by which genes, such as PARP1, DNAPK, SChLAP1, and PCAT1, contribute to prostate cancer progression and performed key preclinical therapeutic studies that have contributed to the initiation of clinical trials investigating PARP1 inhibitors, DNAPK inhibitors, and bromodomain inhibitors in patients with metastatic prostate cancer.

In an interview with the ASCO Post, Feng said his decision to go into medicine “was shaped by a lot of personal family events. Unfortunately, cancer is prevalent in my family. In fact, all four of my grandparents died of cancer, which certainly motivated me to think about medicine with an emphasis on oncology.”

His sister died from metastatic cancer.

Carroll said, “Felix had a clear plan for a better future for those with cancer. I never doubted that he wouldn’t get the world there. Lastly, Felix was the most resilient person I have ever met. Despite huge health obstacles, one after another, he never lost his passion for his family, friends, patients, colleagues, and science. In summary, he simply made all of us and the world much, much bett

Paul Nguyen, MD, MBA, vice-Chair for Clinical Research and Director, Genitourinary Radiation Oncology at Brigham and Women's Hospital, Department of Radiation Oncology, said, “Felix was an extraordinary leader, mentor, scientist, doctor, entrepreneur, family man, and friend. He was a visionary who saw in the NRG GU [research consortium] group the potential to have a trial in every disease state and to integrate biomarkers to personalize systemic therapy and he successfully built a large portfolio that did both of those things.”

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What are you waiting for” Time to register for the ‘Active Surveillance 2025’ webinar is running out

By Howard Wolinsky

The Active Surveillor’s first webinar, “Active Surveillance 2025,” is less than a month away.

Some super-stars in the AS world will be speaking at noon-1:30 p.m. Eastern on Saturday, Jan. 4, 2025.

If you are a paid subscriber, sign up for your free pass. (Check your email.)

If you are an unpaid subscriber, please sign up for a paid subscription:

Click here:

If you can’t afford a subscription ($80/year or $9/month), contact me at howard.wolinsky@gmail.com and we’ll work something out.

Meanwhile, an anonymous donor has created a fund for Active Surveillor who can’t afford a subscription. He’s paying it forward after having undergone a second opinion that changed his prognosis.

If you are on, or, are considering surveillance, you don’t want to miss this program.

Speakers for “Active Surveillance 2025” include super stars in the field:

--Jonathan Epstein, MD, former chief pathologist at Johns Hopkins University School of Medicine, one of the world's leading pathologists. Epstein, now based in New York, will be making his first appearance before a patient audience in almost two years,

—Brian Helfand, MD, PhD, chief of urology at NorthShore University HealthSystem outside Chicago, an expert not only in prostate cancer but also in molecular biology.

—Christian Pavlovich, MD, who runs the Active Surveillance program at Johns Hopkins and recently co-authored a major study on diet.

—Timothy Showalter, MD, MPH, medical director of Artera AI, which has made news with its prostate test to help patients decide whether to go on AS.

Hope to see you there.

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Unsolicited testimonial

“Howard. I don't fit your active surveiller profile, but I still like reading your thoughts. I really enjoy your meditations on PC. I applaud you for your service to humanity. :) I'm serious about that, by the way.”—Jeff Olson

Well, Jeff. I’m not sure how to respond. But flattery will get you everywhere. Howard

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