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interviewer: For patients that were just diagnosed with multiple myeloma or have had a recurrence of the cancer, receiving the treatment that's appropriate for your situation requires an expert.

Dr. Aman Godara from Huntsman Cancer Institute is that expert. He's an expert at diagnosing and treating multiple myeloma, and we're going to get to some of those treatments and some information about clinical trials. But first, Dr. Godara, some context, what is multiple myeloma?

Dr. Godara: So multiple myeloma is a type of blood cancer, which occurs from the proliferation of plasma cells that are present in the bone marrow.

So patients who have multiple myeloma can have several complications as a result of this cancer. These complications usually involve weakening of the bones that can lead to fractures. These complications can cause low blood counts, high calcium levels, and sometimes can also affect the kidneys of patients who have multiple myeloma.

interviewer: And how does a person kind of come to realize that they have it? Are there some symptoms or signs that they notice?

Dr. Godara: Patients who are newly diagnosed with multiple myeloma, the way this disease comes to light is that these patients can have fractures very easily. So we see patients who have had a fracture recently and have a lesion that was weakening the bone there, a tumor that was weakening the bone there, that resulted in that fracture.

A lot of times, patients have low blood counts and when the testing is done to identify what the cause for the low blood counts is, that can also reveal a presence of multiple myeloma. This type of cancer produces a protein that we call the monoclonal protein that can be detectable in the blood or urine of the patients who have multiple myeloma.

And sometimes patients would also have kidney failure, and that's another population of patients when patients have kidney failure that we don't have a good explanation for. Those patients are also looked out for this disease to make sure that they don't have multiple myeloma.

interviewer: So a person would go to their primary care physician or perhaps an urgent care or emergency room because they fractured a bone. What are some of those other types of symptoms that have taken them to that first step?

Dr. Godara: So, a lot of times, patients have gone to an emergency department or to an urgent care center because they just had a fracture. And whenever patients have a fracture, they will have some imaging done of their bones, whether that is an X-ray, whether that's a CAT scan, and those things can also identify the tumors, the kind of weakening that this kind of cancer can do to the bones.

A lot of times patients end up into the hospital because they have very low blood counts, and that's also a sign and symptom of this disease.

interviewer: And how does physically having a low blood count manifest itself?

Dr. Godara: So patients who have low blood counts usually feel that they are getting tired easily with any work that they would normally do in their day-to-day life. Patients who have low blood counts could also have multiple infections one after another, and these infections usually are infections such as pneumonia. Patients who have low blood counts can also have increased bruising over their body. And these are all reasons that would lead to a diagnosis of multiple myeloma in a patient.

interviewer: And as far as the diagnosis goes, if somebody is experiencing these symptoms, they go to their primary care physician or the emergency room in the case of fractures. Is it pretty easy at that point to tell that that's what's causing these types of things when those typical tests are run?

Dr. Godara: Sometimes the answer could be a little bit complex. If somebody has a fracture and you see a tumor in their bone, the first thing that somebody should think about is that is this multiple myeloma?

But when patients have low blood counts or when patients have kidney failure, when they have come to see a doctor or they have come to an emergency department, then the answer is not really very straightforward. In that scenario, we have to look at different possibilities, different diagnoses, and ultimately confirm whether a patient has or does not have multiple myeloma.

interviewer: Tell me about the treatments for multiple myeloma. What are we talking about there?

Dr. Godara: Patients who have multiple myeloma and are just newly diagnosed with it, the way we treat these patients is a combination of three or four medicines together. And we have come a long way in the past 20 years in this regard. Twenty years ago, when patients would be diagnosed with this disease, they would receive chemotherapy as their initial treatment. But now, the treatment has become a lot more focused on the disease and the problem that causes this disease.

So the three or four drug combinations that we usually treat our patients with are medication combinations that work particularly well against this type of cancer. They have side-effects that are predictable and manageable in the hands of the clinician who is treating these patients.

interviewer: And from what I understand, multiple myeloma is not something that's ever cured. So, after a first round of treatments, they might be cancer-free for a while, but eventually, is there going to be a relapse?

Dr. Godara: Once patients are diagnosed with multiple myeloma, they will initially receive a treatment that consists of three or four drugs combined together. And the initial attempt is to control the myeloma and put it into a remission. Once that happens, we have to decide upon the next steps for the patient.

And the next steps depend on how aggressive the myeloma was at that time of diagnosis, whether there were any high-risk features associated with the myeloma, and these are genetic changes usually that accompany the diagnosis of multiple myeloma.

So, based on that decision-making at that point of time, sometimes we choose and recommend our patients to undergo a technique called stem cell transplantation with high-dose chemotherapy, where patients receive a high dose of chemotherapy that otherwise would be toxic to their bone marrow, but in this technique, patients' stem cells are collected before they receive this chemotherapy so that we can overcome the side effect of that chemotherapy on the bone marrow.

And this is a treatment that has been well-established for patients with multiple myeloma for the last 30 years, and we still continue to use it, especially in patients who have any aggressive features associated with their myeloma or have high-risk myeloma when they presented at the time of their diagnosis.

So once patients have received their initial treatment and have received either a stem cell transplant or not, they would still continue some form of maintenance treatment, at least until a few years into their diagnosis. This is to confirm that the myeloma remains in remission and does not come back early.

interviewer: And generally, how long is it before the first remission might come back then?

Dr. Godara: So this will depend a lot on what the initial treatment for the patient was, and it will also depend on the risk-staging of multiple myeloma when it was diagnosed.

On an average, when we talk about a standard patient with multiple myeloma, the time that this disease could take to come back would be somewhere around four to six years after the treatment has been initially started. But patients who have some aggressive features associated with this type of cancer, their myeloma can come back within the first two or three years of their diagnosis.

interviewer: And for that patient that then has had their first or their second remission, what are the treatment protocols at that point? Do you change up the treatment or is it pretty much the same thing just again?

Dr. Godara: So patients who are experiencing their first or second relapse, we make a determination of what their initial treatments were and how long ago were those treatments done.

If there has been a long gap between the time that the patients received those last treatments, we can certainly use those treatment options again in the same combination as they were used initially.

But if a patient experiences a relapse while they are on one of those treatments, then in that case we usually tend to make some switches to their treatment combination and start off with a new regimen for those patients who have relapsed.

interviewer: And there's been a lot of development in those treatments over the past few years. Can you tell me a little bit about that?

Dr. Godara: There has been a lot of development in the field of multiple myeloma. And when we talk about that, we are not just talking about new treatments but more innovative ways of combining these treatments together that have become available in the past few years.

So when a patient is newly diagnosed, as I mentioned earlier, patients could receive a combination of three drugs or four drugs together. So there's been a lot of focus on whether one strategy is superior to another.

And there are certain populations of patients where one strategy has been proven to be superior than the others. So patients who are not very fit when they are diagnosed with this cancer, or are above the age of 70 or 75 years, those patients are not eligible to receive a stem cell transplant usually.

And in that scenario, we have information to the effect that if we use four treatments together, they serve to be better than three treatments together, not just in terms of the duration of response that these patients get out of that particular treatment, but also it can impact survival when we use four treatments together. Patients can have a longer survival compared to when they receive three drugs together.

So that's been one area, one aspect of this disease where there is currently a lot of focus identifying what works better and what combination works better than another.

When patients have relapsed, what makes a difference there is what type of relapse we are talking about. Patients who have had their first or second relapse, we have several different options that we can easily choose from to treat those patients and put the myeloma back into remission.

But one other aspect of this disease is that the way all this progress is happening is through the clinical trials.

There are clinical trials that are focusing on patients who are just diagnosed with multiple myeloma.

There are clinical trials that are focusing on patients who are experiencing their first or second relapse, from the time that they have been diagnosed.

And then we also have a lot of clinical trials focusing on patients who have received multiple different lines of therapy before and are running out of options when they suffer from a future relapse.

So some of the clinical trials that are ongoing right now are not just looking at some innovative treatment combination, but these treatments are innovative by themselves.

So there has been a lot of focus on immunotherapies in treating multiple myeloma. So one of the antibody treatments that we use in these combinations to treat multiple myeloma became available around seven years ago and has been a game-changer for the patients.

And these treatments are particularly focused on targeting the plasma cells that are causing this multiple myeloma, and at the same time, they don't have the toxicities or side-effects that we usually associate with cancer treatment.

Now, in just the last couple of years, we have had also some other immunotherapy treatments where we are harnessing the power of your own immune system to target multiple myeloma. Those treatments have shown us that they have efficacy and they work for patients who have had multiple different lines of therapy. Their toxicities are very unique and very different, but at the same time they are predictable toxicities that we have measures and steps we can take to mitigate that toxicity that comes along with these treatments.

interviewer: So if I'm understanding correctly, somebody who has had multiple myeloma a few years back and then it has come back will have a whole different selection of treatment options possible to them that might have fewer side-effects, might be more effective in treating the disease. Is that accurate?

Dr. Godara: So that's accurate to some extent, because as we start focusing more and more on the disease, and more and more on treatments that are not having any off-target effects, as a result, there is more efficacy and less toxicity.

So one of the questions that we are commonly asked when a patient has experienced a relapse is that when we do start a new treatment, what will be the duration of the treatment? And in this regard, there has been a lot of focus to developing treatments that are just a one-time treatment and do not require any continuous administration.

One of the newer treatments for patients with multiple myeloma is Car T-cell therapy where patients' own immune cells are engineered to fight this cancer. And this treatment is given as a single-dose treatment and has a toxicity that is predictable. It requires administration of this treatment in the hospital, but once the patients are out by a few days or a few weeks from this treatment, we don't anticipate any further toxicity related to this treatment.

Then there are also some similar treatments that are, again, harnessing your immune system to fight the cancer, which require a weekly or every other week administration that requires patients to come in every week or every other week to get these treatments.

But again, these are treatments that usually have toxicities that are more pronounced at the beginning when patients start these treatments, rather than toxicities that continue as long as those patients continue on those treatments.

interviewer: Multiple myeloma is a complicated disease that takes a lot of medical expertise from different specialties to manage. Tell me how, at Huntsman Cancer Institute, you're able to provide that to the patients.

Dr. Godara: So patients who have multiple myeloma usually require a multitude of services. Patients are sometimes sent to see an orthopedic surgeon because they have suffered a fracture. Patients are sometimes sent to a radiation doctor because they have a bone tumor that requires a radiation treatment. And sometimes the effect of this cancer on your wellbeing is so immense that patients have to participate in some wellness programs to get back to where they were before this diagnosis occurred. We provide a multitude of these services under the same roof at Huntsman Cancer institute.

At the same time, all the innovation that's occurring in the field of multiple myeloma, an opportunity to participate in that is through clinical trials. We provide clinical trial options for patients who are not just newly diagnosed with this cancer, but also patients who have had their first, second, or multiple relapses in the past. We give them an opportunity to participate in clinical trials for some of these innovative cancer treatments right at their doorstep.

interviewer: What is the value of somebody getting a second opinion that has had a multiple myeloma diagnosis or has relapsed?

Dr. Godara: So patients who have multiple myeloma, I strongly recommend them to see a specialist for their disease so that not only we can discuss what's the right combination of treatments to start off for their disease, but also patients who have had relapsed myeloma, the opportunity for them is to participate in clinical trials and bring some of these innovative treatments out to the front long before they are available as an option for treatment for these patients.

The ultimate goal here is that we want our patients to live longer, we want to minimize their toxicity, and at the same time maintain a quality of life that patients can enjoy their lives with.

My patients tell me that they've had an ovarian cyst. "What kind?" I ask. "I don't remember," is the common answer. Well, that's not a helpful answer.

Ovarian cyst comes in two flavors, functional cysts and nonfunctional cysts. Functional cysts are usually the good kind. They arise from the function of the ovary. A woman who ovulates makes a cyst about one inch in diameter every month. And there are a lot of smaller cysts every month that go along for the ride. These functional cysts come in two types. Follicular cysts that have the eggs and corpus luteum cysts that the follicular cyst turns into after ovulation.

Now the Follicular cyst is filled with clear fluid, doesn't have much of a blood supply, and occasionally can get pretty big, as big as four inches. Getting that big isn't common, but it happens. And unless there's a lot of pain with this big cyst, the important thing is to leave it alone. These cysts go away after a few weeks. How do you know if you have one? Well, every woman with functional cysts has these, and they usually don't know about them unless they're getting an ultrasound for some reason.

We watch these cysts grow with great interest and hope in infertility therapy and in vitro fertilization. Sometimes a woman can learn she has one because it becomes bigger and causes pain. Follicular cysts can look a certain way on ultrasound, clear fluid, with a very thin cyst wall. So we know for pretty sure that these are good cysts, and we try to wait and let them go away.

After ovulation, the follicular cyst becomes a corpus luteum cyst. This is a progesterone factory whose job it is to make the hormones to prepare the uterus for pregnancy. If no pregnancy occurs with the ovulation, then these cysts go away in about two weeks. These cysts are very active making hormones, and they have a rich blood supply. If they get bumped, and you can figure out ways that they could get bumped, they can bleed and grow rapidly with blood and can hurt.

Women who have a corpus luteum cyst that bleeds a lot can come to the doctor or the emergency room and an ultrasound can usually make the diagnosis because they look like a cyst with new blood in it. We try not to operate and let the cyst go away on its own, which may take a month or so. Sometimes there's so much bleeding into the abdomen that it requires surgery, but we try not to operate and leave scars on the ovary if possible. So when a woman can tell me that she had a functional cyst or a corpus luteum cyst that required surgery or a follow-up, I know I don't have to worry because these are the good cysts.

Now, the bad cysts. There are nonfunctional cysts or neoplastic new tissue cysts new tissue cysts. Any of the tissues in the ovary can grow to make a cyst and some of these cysts can get big, really, really, really big. The biggest neoplastic cyst in recorded history was 328 pounds. That is really big. These cysts come in different types, depending on the kind of cells that made these cysts. Serous cysts, mucinous cysts, dermoid cysts, I could go on.

We usually operate to remove these cysts when they get bigger than two inches because they can grow and it's much easier to remove a cyst when it's two inches than when it's 20 inches or bigger, bigger, bigger. We cannot tell exactly what kind of cyst it is some of the time just by looking at an ultrasound, but we do know what it is when the pathologist looks at it. Some cysts are made out of egg tissue make hair and teeth and other kinds of tissues, and they look a certain way on ultrasound. But usually, we give them to the pathologist and let them figure it out. Why should you know what kind of cyst you had removed? Because some cysts tend to predict that you'll get another one.

Now, for the ugly. Some nonfunctional cysts are ovarian cancer. This is another reason that we remove nonfunctional cysts when they grow and look different on ultrasound than functional cysts. Ovarian cancer is not terribly common. About 10 per 100,000 women per year or a little more than 1% risk in a woman's lifetime.

Ovarian cancer has no symptoms when it's very small so it can be hard to catch early. When a cancerous ovarian cyst gets bigger, it can cause pain, and pressure and a feeling of abdominal fullness because we cannot always tell which cysts or cancerous on ultrasound. Although cancer cysts do tend to look quite different from functional cysts, we tend to want to remove cysts when they grow, and especially if we find them in women who are post-menopausal and shouldn't be making cysts.

So if you've had surgery or medical care for an ovarian cyst, you should keep a record of what kind of cyst it was. Get a copy of the report from your doctor and keep it in your medical records. Ovarian cysts come in different types, and we have different concerns, and different follow-up, for women with some cysts. In fact, any woman who has had surgery on her reproductive organs should have a copy of her operative report and pathology in her permanent medical records.

Maybe someday, we'll have a universal electronic medical record and all of it will be there for your doctor to help you. But until then, keep your own copies on file and thanks for joining us on The Scope.

updated: July 9, 2020
originally published: August 11, 2016

Kim: Prostate cancer is the second leading cause of cancer death in men, but how do you know if you are one of those men with a high risk of developing the disease? That story is up next on The Scope.

Announcer: With the latest news and research from Huntsman Cancer Institute this is the Cancer Care Update.

Kim: A new study finds that when it comes to prostate cancer, your family matters. You could be at higher risk not only if your father had it, but even if a relative you have never even met had it. Lisa Cannon-Albright at the Huntsman Cancer Institute is the senior author on the study published in The Journal Prostate.

Lisa: My goal was to try to use available information to estimate a particular man's risk of prostate cancer, and the data that I wanted to use was his own family history.

Kim: Instead of asking thousands of men their family history, Cannon-Albright and colleagues used a resource called The Utah Population Database. It contains a computerized genealogy linked to medical information for over 7.3 million Utahans including those that have cancer. She says what they found was that having a first degree relative such as a father, brother or son, doubles your risk for getting prostate cancer. But surprisingly risk also increases by having a second or third degree relative such as an uncle, grandfather, cousin, or even great-grandfather with the disease.

Lisa: Most people would agree that if you have a first degree relative affected with prostate cancer that your risk must be higher than it is for other men in the population. But we found that second degree relatives and even third degree relatives, if you have them in your family history constellation you are also at increased risk.

Woman: So even just one?

Lisa: Yes, even just one.

Kim: Cannon-Albright says Doctors should not only pay attention to the men on your father's side of the family, but also on your mother's.

Lisa: The relative risk was exactly the same whether the family history was on your mother's side or your father's side.

Kim: Knowing your family history and whether this increases your risk for prostate cancer will help your doctor develop a health monitoring plan specific for you. For Cancer Care Update, I'm Kim Schuske with Huntsman Cancer Institute.

Announcer: For more resources from the cancer care and research experts, Huntsman Cancer Institute, go to HuntsmanCancer.org. The Cancer Care Update is a co-production with TheScopeRadio.com University of Utah Health Sciences Radio.

Interviewer: You've been diagnosed with prostate cancer. What next? We'll talk about that on The Scope.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: For men that have been diagnosed with prostate cancer, figuring out the right treatment option can be really overwhelming. Dr. Jonathan Tward specializes in prostate cancer at Huntsman Cancer Institute. Dr. Tward, what treatment option would you recommend for a man just diagnosed with prostate cancer?

Dr. Tward: It's really an equally important question in a cancer that often won't take someone's life, Should they be treated? Because the treatments themselves can just as easily impact someone's sexual health, urologic bother, or bowel bother. One of the problems with prostate cancer, which is sort of unique to prostate cancer and different from other cancers, is that unlike other cancers where there's a very defined treatment paradigm, this particular cancer has many treatment options, and it is overwhelming to a lot of men who are faced with a new diagnosis of a relatively early stage cancer. Should they choose a surgery? Should they choose one form of radiation therapy or another radiation therapy? It's a big struggle for a patient who is contemplating their mortality to also have to go through the various treatment options and side effects because, honestly, when you start parsing treatment options for prostate cancer, there are essentially 20 different little ways of skinning that cat. It can paralyze people with this anxiety over 'Am I choosing the right thing? Am I not choosing the right thing?' So one of the things that I advocate for to a patient who is diagnosed is if they have an early stage prostate cancer, which is 80 to 85 percent of new diagnoses, they should speak to a urologist because the urologist will specialize in the surgical management of that disease. However, they should also speak to a radiation oncologist who specializes in the curative treatment of that disease with radiation therapy because they have non-surgical treatment options that are just as curative as the surgical option. But you're starting to choose on subtleties of different side effects.
When you're talking about sexual function, especially, this can become very important. There are certain ways of doing the surgery that will guarantee that you have erectile dysfunction whereas there are other ways of doing the surgery that will improve the probability that you don't. Or you might decide that radiation therapy in the form of external beam treatment or seed implants may have a favorable sexual function preservation rate relative to surgery, maybe, at the expense of an increased risk of a bowel bother. So men struggling with these treatment decisions are trying to balance risks of side effects to their urinary functions, risks of side effects to their bowel, and risks of side effects to their sexual function. And that's what is very challenging in terms of making treatment decisions.

Interviewer: And it doesn't sound like there's any easy way to really pick one. It sounds like you just kind of got to go through the options and then decide what's important to you.

Dr. Tward: Right. There is no way, and the reason that I advocated speaking both to your urologist and radiation oncologist is that a urologist, and rightfully so, should be biased towards 'You should get surgery' and may kind of communicate that perspective to the patient whereas a radiation oncologist may be biased that you should get radiation. But ultimately, you want the patient to hear the experts in those fields kind of discussing the details with therapy. If they're fortunate and maybe have friends who have gone through the different kinds of treatments, they can ask one friend who's had one form of treatment and another friend who's had another if they have that luxury. Or they can join a men's group where they can easily talk to men who have had different perspective. They can even include their primary care doctor in that decision making to help them kind of go through this decision and make an informed decision.

Interviewer: So there are men's groups that actually help support this sort of thing?

Dr. Tward: There are men's groups. The men's groups are not as active as, let's say, breast cancer groups.

Interviewer: Sure.

Dr. Tward: Women are very motivated to have survivorship groups and support groups, and men historically have been a little less motivated, but they do exist.

Interviewer: And you think they're a good resource?

Dr. Tward: I think they're an excellent resource, especially because it's one thing to hear a doctor tell you what you think and what you might feel, but it's another thing to hear it from someone who's gone through it. As much as I think I know about prostate cancer and what it feels like to get radiation therapy or what it feels like to get surgery, it's never been done to me. So I think there's extreme value in talking to people who have endured our therapies and the possible side effects.

Interviewer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Interviewer: If you're a man and you live long enough, prostate cancer is going to likely be part of your life. It can be really confusing. When do you get screened? What does a positive screening mean? What should you do then? We're going to talk about these things and more coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Prostate cancer is one of the most common men's cancers, and although it likely won't kill you if you're diagnosed it can have very negative impacts on your quality of life. That's why you should get screened. Learn about the facts now with Dr. Jonathan Tward from Huntsman Cancer Institute. He's a prostate cancer expert. Let's start out with how effective is prostate cancer screening?

Dr. Jonathan Tward: We think that we are usually picking up the diagnosis 10 to 15 years in advance of when someone might feel a problem.

Interviewer: Oh, really? So, it's a cancer that's easily detectable?

Dr. Jonathan Tward: Easily detectable, although even that is controversial. We do have a screening test that helps guide us on whether or not we should do additional testing like a biopsy to prove it, but we are in fact able very early on to detect prostate cancer.

Interviewer: Is there a certain age where I should start becoming more aware of it?

Dr. Jonathan Tward: Guidelines are kind of evolving right now in terms of what age people should really start concerning themselves with thinking more about it. As a general principle, we think that around age 50 men should start bringing it to the forefront of their thinking. Digital rectal examinations are one common way to screen for this cancer. The PSA test is another thing. We usually start advocating that at age 50. What is interesting is that if you look at autopsies on people, starting at age 30 10% of people will have prostate cancer in their prostate and won't know it. This is if you just happen to autopsy someone killed for another reason. The risk goes up by about 10% per decade of life, so by age 50 one would expect 30% of people to have cancer in their prostate, and it goes up by 10% each decade. Once you are in your 60s or 70s you almost have a greater than 50/50 chance that you harbor this cancer. Many of these cancers will not require treatment. Some of them can be safely observed. This is part of the problem with screening. We often detect cancers in men that can be safely observed and sometimes over-treat them, and on the opposite side of the coin we often pick up very aggressive cancers that absolutely need to be treated to preserve quality of life such as urologic bother.

Interviewer: It sounds like you could have prostate cancer and it's not a problem.

Dr. Jonathan Tward: That's true. In fact, the vast majority of people being diagnosed today have no physical symptoms of the cancer because it is being detected with this 10 to 15 year lead time from the PSA test.

Interviewer: So could I go my whole life having prostate cancer but never needing treatment because it just never turns into anything?

Dr. Jonathan Tward: Chances are you will do that.

Interviewer: Wow. Really? Should that concern me?

Dr. Jonathan Tward: Well, I do think it should concern you. It sort of goes back to this issue of one in six men are being diagnosed with cancer. But, if you want to talk about it from a different kind of number, we diagnose in the United States approximately 250,000 men with cancer each year. Maybe about 35,000 die of the disease. What that implies is that the majority of people are either cured or able to live well with their cancer although they might have to live with side effects of their treatments, and maybe only 10% or 15% actually die of the disease. But, part of the problem with prostate cancer, and I think the confusion especially when it talks to should we screen and should we treat it, is when you look at these statistics, death from prostate cancer, it's clear that we're very good at keeping men alive with prostate cancer. I argue that the reason we should try to screen it, and treat it, and cure it is to try to prevent men from living a lifetime of side effects from the cancer or from the treatment. To me that is really the utility in identifying this cancer.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 12, 2019
originally published: December 6, 2013