Prostate Cancer, Walsh, Amanda discussed on The Peter Attia Drive
For protection when they're out and about functionally totally fine now for a fifty year old, man. I think there's a over ninety percent chance that you can recover sexual function. Yep. But with each deck member, you know, erectile dysfunction is a disease of the aging male. So for each decade that somebody gets older there's decline in sexual function. So he's been people say that they're totally potent and their seventy they'll tell you if you ask them, no miam-, not as good as I was when I was twenty. So there's that component of things in the other factor is prostate cancer. And it's not like, there's the prostate. There's five millimeters of tissue, and then there's this nerve bundle. There's the prostate. There's no capsule or lining encasing, the prostate. And then there's the neuro vascular bundle of Walsh named after Dr wolf. So you have prostate. The prostate itself has different zones or different regions prostate cancers develop in the peripheral region or perforate zone. So right at the edge of the prostate. So you have to Mer at the edge of the prostate, and then you have the nerve bundle. And so you're talking about one or two cruel trick of fate of of the cancer's not developed centrally. They don't develop centrally they develop Rivoli. So I understand why patients by listeners to say, why don't you don't you just you know, what I don't get it? Because it in many cases today, we I published on this a lot. Now. You know, there's prostate cancers that we pick up today are just bulkier. They're more aggressive and so. When you have a tumor that you know is going to be outside the prostate. You know, it's extra prosthetic it's involving the nerve bundle. A lot of the times. And so you have to remove part of it. You have to remove you know, the tissue around to try to clear your margins. And so when you do that in sixty five year old guy, and you take out half of his nerve on one side. It's unlikely that he'll be able to regain sat sexual function on his own. Now, these days I'd try to be very upfront about that. And I try to set appropriate expectations. We can we have special tools that we have in urology that will enable Amanda get don't total satisfaction sexually. So we can maneuver around out. So to speak. And these days many of the people I see have very aggressive cancers that are quote, unquote, the real deal. So we really have to be careful you our number one goal for doing cancer surgeries to get the tumor out. It's talk a little bit about prostate cancer because it's not a cancer that comes without its controversy to let's start with the biggest Connor is really one of the biggest controversies or things that would confuse the layperson because about every year, the advice changes on this thing called P S A. So what is the prostate specific antigen PSA is a protein it's made by the prostate. And it's normal function is to liquefy semen. So it's highly expressed in the process of the way, I explained the process of people the best analogy, I can come up with his if you think about it like a sewer system, you have the main sewer leaving the city, that's the urea three that's the tube that we normally urinate through. But this channel also deliver semen out. A tip of the penis off this main sewer are slightly smaller sewers had go to different neighborhoods within the neighborhood. There's a sewer that comes out of the individual house and the individual houses in this analogy are prostate epithelial cells, they make components of the semen, and the semen is used to give nutrients to the sperm while it's trying to fertilize an egg to enable the sperm to penetrate, the cervical mucus these different functions PSA is a protein that breaks down the semen and liquefies it and people think it's an important for for this whole process of fertilizing egg. So that's what it does. And if you look in the semen, the PSA numbers are hundred million per m l mean, the numbers they mount of this protein in the semen is astronomically high. So that's what it is..