20 Episode results for "Prostate Cancer"

Prostate Cancer: Detection and Diagnosis

The Naked Scientists

59:30 min | 10 months ago

Prostate Cancer: Detection and Diagnosis

"Have you loud and clear? I welcome to Science Physics Medicine. Nature brain the universe. Hello welcome to the naked scientists. The show where we bring you the latest breakthroughs in science technology medicine. That's with me Chris. Smith and with Phil Sansom. This week we delve into the disease. That accounts for a quarter of all cancers in men prostate cancer will be finding out how the conditions picked up and diagnosed plus away to cut aeroplane emissions by flying just a bit higher and were dinosaurs hot or cold blooded how scientists can tell dinosaurs temperature just from it sakes the naked scientists poll cost is powered by UK Foss Dot Coach UK. The new corona virus from China has continued to dominate the headlines. This week on Thursday. The initial eighty-three people evacuated from one city in quarantine. Liverpool were confirmed disease-free. I'm released. I spoke to one of them about experience. My name is Khan lumber. I'm a PE teacher living in China. And I'm currently in quarantine on the world. We were evacuated by the British government. T. weeks ago. Have you seen much of the action when you were in women? Yes it was a lot of activity going on while I was there. People being taken to hospital overcrowding in hospitals people fighting doctors people fighting to get sued when the foods with low. Will you skit on a personal level? I wasn't scared. My biggest worry was my eighty year old grandmother who suffers we'd COPD and was caught all of this. And what was it like when you actually go to vent? Qa did how did that play out? It was chaos. We got phone call about an hour and a half before we have to be at the airport. I mean we wasn't fully prepared because we wasn't expecting to hear until the following day we were waiting around for four or five hours in the cold the meeting point because they kept pushing it back and then once we got inside the applet Taos. I mean there was no real organization. Slight tickets were blank with just a simple number on. Nobody really knew what they were doing. So we got on the flight actually and then once we were on the flight. You know the stuff we're fantastic. And when you touchdown apart from the enormous sense of finally made it home won't happen next. There must have sense of relief. Once we took down in Brize Norton but then we were obviously ferried them to Bush's on transported with police school. And how are they keeping an eye on you as other Menas in policing that you're there? I mean as in from a health point of view other very beginning. They were doing three times a day that we still okay that we weren't showing any signs or symptoms. They didn't actually test those at any point because I think advice from public health England was the is pointless testing anybody. That's not showing any signs or symptoms because it just wouldn't show on the test. They have since changed advice so we were tested for the first time yesterday. And we're just waiting for those results to come through and what about your future because if you work in wound you on the next plane back out there. No I'm not on the next flight. Obviously the add more honey closed I can't get back into now until these restrictions that the Chinese government of Paul Morono listed so I don't expect to go back to China for another four or five months. Maybe even six months. What does that mean for you then thankfully? I went for a reputable school in one so my job is safe. And all of the experts that work there. That jobs are safe. School still open or is basically everything off no school. These actually closed but they thought online classes yesterday. You're not going to do some exercise classes online then no It's difficult to do that. I think I've got a lucky break on that respects women city. Pe teacher and EX CORONA VIRUS CORN teeny call. Lambert one of the other major developments. This week was the sudden apparent surge in the numbers of people reported by China to have the infection in one day the rate of diagnoses increased almost tenfold. This John explained was because they'd alter the way they were diagnosing the disease so what might be the implications of these much bigger numbers of cases. My Name's Fair Jeff. Got And I'm a research fellow at the University of Cambridge where I study outbreaks of on nine ideology. Obviously the size of the outbreak has grown significantly. And that's because of how transmissible this virus looks to be even with some of the quite extreme control measures that have been put in place in China. I think what's interesting though is whilst the numbers have increased steadily within China with still only seeing limited cases in other countries. Do you think that's real or do you think it's a symptom of the fact that when you go looking you find if you don't look you don't get the answer to a question you don't want to ask? Oh I think that's the big question here. I would say considering what we know about the virus and actually a lot of what we don't know about the virus such is when people are infectious if it's before they've developed symptoms after. I would think that probably there is some unobserved transmission going on in other countries the China. This week have changed how they define a case. Does that tell us anything about the real numbers that are probably happening in China and therefore anything about what's probably happening elsewhere around the world? This one is quite interesting because obviously now that it's a broad case definition. We're GONNA be capturing a lot of other cases that previously were being missed. It's unclear if the reason that testing wasn't good enough proxy by itself is because the testing was giving negatives when it shouldn't have or they weren't enough tests or they could only run so many a day but this looks like a reasonable way now of getting a broader sense of it and potentially also capturing some of the milder cases to that might have been going under the radar previously. But we'll actually give us a better sense of actually. How many people do severe illness from this? And how many going to die which could be smaller than was initially thought and given these very big numbers being reported in China one therefore must presume that there were big numbers. Previous to now is well. What does that say about the likelihood of already being in countries like this one sir? It's unclear because I did. Quite strong lockdown measures quite early on but it does mean that probably some people were acting as if they thought they were negative and perhaps interacting closely with friends and family anyway and including outside of the areas. That were locked down. Which could have well lead to more of this unobserved transmission to other countries project got also this week. Scientists were racing to file bids for funding announced as part of an emergency response program to bankroll the development of vaccines against the new crown of ours. One of the applicants was Cambridge. University's Jonathan Haney. His team have developed a system to enable them to produce vaccines based on the genetic material of the virus krona viruses are named after what they look like round spherical objects with these little what we call spike proteins those spikes how the virus docks with invades ourselves so an effective vaccine has to produce antibodies. That can block them. But that's actually easier said than done because if you make Adam bodies to the Spike. Actually those antibodies can help drag this fires in Amman. Aside macintoshes very important inflammatory cell can be reprogrammed by these viruses. Making the disease much more severe than it would be so an ill-conceived vaccine could potentially pour fuel on the microbial fire and accelerate the infection. Paradoxically making the person even moral than if they'd never been vaccinated so the vaccine strategy really has to be laser specific targeting those domains that actually absolutely critical for docking with a cell. That's this new technology that we've developed. What their technique allows them to do is to screen using a computer model of the virus structure all of the components of the viral coat including those spikes that it uses to get into ourselves to find the crucial pieces that will work as a vaccine and disabled virus but without the risk of making the infection worse. This is a computational approach where we take the genetics of these viruses and we target those essential elements in laser guided missile type way so the antibodies attach only to those regions that is important for docking. The result is a piece of the viral genetic code that the virus uses to produce that part of its coat. This genetic sequence can be injected into the body where immune cells pick it up decode and then use the information to educate the rest of the immune system to produce antibodies against that discreet. Part of the virus. But how long crucially is this going to take? It has to then legally be manufactured in such a way that the regulatory authorities were allowed to go into humans. It needs to go for a separate safety and toxicity testing. That will take four months. Is this going to arrive on the scenes fast enough to make a dent in this outbreak? I think so. I think the cat is out of the bag. Meaning the viruses out of China. The Chinese are having great difficulty containing this virus has changed rulebook people who are not overtly. Ill sometimes don't even have fever yet can be contagious. So it's a different game. We do need to move quickly but the golden rule must be do no harm meaning. Don't be in a rush to make something. That's GonNa make the disease more Severe Jonathan Haney. Who is hoping to produce a vaccine against the new corona virus? Uk? Scientists have discovered a way to cut. The airline industry's contribution to global warming by as much as a third. The answer lies in minimizing the contrails that form when a plane flies through a Humid Patch of sky these contra clouds reflect he heading for space back down towards the planet's surface forcing up the temperature. Now a new technique is enabling scientists to spot which flight to the worst offenders? And how they can avoid the problem. Megan McGregor's been hearing how from Imperial College is Mark Stellar. What we were able to do is use a a high resolution data set of aircraft trajectories in the Japanese space. And what that showed us was that two percent of the flights contributed to eighty percent of the climate forcing. So it's a really skewed distribution where you have very small number of flights contributing to the vast majority of the warming effect and how does this control cloud cores warming? There's a balance between two processes the controversial if it persists and spreads it will both reflect incoming sunlight backout to space and that's a cooling effect but it also trump outgoing heat that would otherwise go out to space and that's woman effect now during the day that's sunlight and so the cooling effect on the woman. Volunteers other art but then overnight if a control persists does nurse sunlight so there's no cooling effect and so what we're left with is warming effect. Sir. It's really the ones that persist for a long period of time into the nighttime that have the woman effect if you wanted to take a targeted action towards this sort of small number of flights to reduce the control formation impact. What would it be that you could potentially could do because controls need this humidity in the atmosphere? Actually there's regions of the atmosphere. That a human enough. A relatively thin layers of the atmosphere and small altitude changes. Either up or down by two thousand feet. Which is what we simulated in. Our study would mean that an aircraft could fly outside of that contro forming region so an aircraft originally had formed a controversial if we just changed the altitude. By plus or minus two thousand feet may end up not forming a control and that's a different approach to mitigating for example carbon dioxide emission. The plane is still going to admit carbon dioxide. What we were careful to look out was whether the changes that we will make into the else due to fight would have a significant effect on the fuel consumption of the aircraft because see or two scales with fuel consumption and that effective sear to that we put into the atmosphere will persist for a few hundred years competitive with a control which lasts for less than a day. If we only made changes to the altitude flights this effective contrails is something that we could only switch off. Get rid of that effect on the climate system for aviation if these sort of high humidity areas are not that difficult to avoid. Why is it that that's not part of the sort of route planning now in the purchase of flight planning you have to rely on forecasted whether data and so one of the pieces of work that we're looking at now is how accurate weather forecasts are in terms of predicting whether it's that high levels of humidity controls to form what's encouraging is that pilots and air traffic controllers already have a discussion while a flight is ongoing so on route adding control set up? Discussion would be another dimension. Complicating the calculation slightly. But it's something that we could incorporate but we are working towards that and we're looking at engaging with a traffic management service providers an interesting discovery and they'd be playing daft not to use it surely marks Stettler. They're discussing work. That has just been published in the Journal. Environmental Science and technology. Hello sorry to Button Katie here from the naked scientists. Did you know we make other naked to the fraction of all humanity? Who has actually gotten a chance to see their own? Brain is very tiny and you are welcomed to that club. So if you enjoy musing over the mind reflecting on thought ought frankly you feel bamboozled by the brain checkout naked neuroscience blow? My face hurts now. So we don't go down into the creepy seller and turn the light on exactly access the full archive by a naked scientists dot com slash neuroscience subscribed to naked neuroscience. Wherever you get your podcast on the way new powers for the UK to regulate social media and our in depth look into prostate cancer now from very high altitudes to very high energies. Scientists have unlocked the next stage in the cutting edge that is experimental physics. This is an to facilities like the large Hadron collider where beams of tiny particles race around nearly the speed of light and then smashed into each other to reveal what they're made of the results shed light on the fundamental nature of the universe. The experiment is next step. Though is to up the ante using mules. These are essentially heavy electrons. Which can be collided at even higher energies but these have been very hard to make into a focused beam now. An international collaboration has managed to create that beam in what they call them you on is Asian cooling experiment or mice. I got some concise mice advice from research leader Chris Rogers. We've demonstrated a technique whereby we can take him of particles called Megan's we can squeeze them right down and accelerate them to really high energies because of the unique properties of millions. We can actually explore physics. Which is even beyond the scale which is available in the large Hadron Collider. Wow this is real futuristic. Yeah right that said An. No-one's developed a technique like this before which can really be used to handle moonbeams what exactly is immune to start with so it is like a really heavy electron have meals going through you pretty much. Every second of every day which come from cosmic rays. I've immune to me right now. That's pretty much right. What do they look like? Just like electrons except for a couple of special properties one. Is there much heavier than electrons. Almost two hundred times heavier than electrons and the other one is that they decay radioactively so they only live to millions of a second. That's bizarre. How'd you even deal with them? We have a special trick. Us leave if you accelerate particles to really high speeds as the particles get closer and closer to the speed of light. They live longer and longer. His Einstein's time dilation phenomenon. How do you make them you on your lap? We take a beam of protons accelerate those protons and then bash them into a target all sorts of other particles. Come out and some of these particles immunes and how have you been trying to deal with them in this particular experiment because the first time you've managed to get them into a beam correct? We've had millions in a beam before but we've never really managed to prepare a beam so that it would be suitable to accelerate them much more like a laser beam. If you like. We passed that meal and beam through absorbing medium and as the mules go through the absorb. They lose energy all of that hot gas slows down as it goes really absorb so then. We need to accelerate that being back up using a conventional. accelerates technique. What's this material? You're filtering them through. Is it something special in strange? We use I. The liquid hydrogen cooled down to a few tens of Kelvin always lithium metal with hydrogen embedded into the metal. Those are strange and weird. They're pretty cool. Bits of kit which we used to do it. Why does win? The meal ones go through the absorb they not the electrons of the atoms and when we not the electrons off the millions lose energy. That's what's called ionization. And that's why the techniques called on is Asian cooling. Now there's another thing which happens. They bashed into the center of the nucleus. And they scatter off flying off in all sorts of different durations. Now we don't want that so we have to pick special materials where the nucleus of the atom is as smooth as it possibly can be. Hydrogen has the smallest nucleus of any material and lithium has a pretty small nucleus as well. Is that why? It's taken so long to figure this out because you're trying to get materials with small enough nuclear nuclei nucleus Ukiah Nuclei. It's not just the material which we have to consider. We have to combine that with a possibly accelerator. Lattice and combining those two different things into one experiment was really tricky. What did it feel like when you finally managed it for the first time it was pretty cool? In fact we only cooled the beam by about ten percent of the full cooling channel which you would need a real meal collide facility but that was pretty cool. I'm what does this mean for physics? Is there really exciting? Science coming up that could potentially use. Mu On beams. The aim of our experiment then is to take this technique and then put it into a single immune collided where we collide beams of meals together. Mueller light is a really exciting because they let us reach much higher energies than are available using even existing facilities like large Hadron collider sern a large Hadron collider upgrade. It would be a large meal and Kaleida Large Mu on collider. That's cool should be. We'll have to wait and see what happens. When they try it Chris Russo from the Brotherhood appleton laboratory discussing the experiment. They call mice and which was published in the journal Nature. We're heading back in time because Adam Murphy's been looking at some cracking cutting edge science using eggshells to take a dinosaurs temperature Jurassic. Park is one of my favorite films. I watched it several times a year but as the years go on the picture on screen gets further and further from reality and the scary lizard like thing peering in the window of jeep probably didn't match what dinosaurs looked like as dinosaur expert. Robin Dawson was quick. To point out to me well you know. I think for as long as we like named dinosaurs. We've gone from thinking they're lizard like reptile liked to now over the years learning the group. Dinosaurs includes the scary velociraptor. That's an odd movies. This group of dinosaurs. That birds evolved from the more we learn about them. The more characters day seem to have that are kind of bird light. We Know T. rex hunt feathers for example. We also know the T. Rex was warm-blooded like a bird not cold-blooded like a crocodile but Robinson working on a different technique to measure dino temperature by looking at the eggshells of dinosaurs eggshells contain carbon on they contain oxygen and sometimes these elements will have an extra particle called neutron inside them and that makes them heavier if a heavy carbon binds with a heavy oxygen. It makes much stronger bond and it takes more heat to pull them apart. So if you look at the eggshell and it's got none of those kinds of bonds that means that when Mama dinosaur was making the eggs she must have been running hot enough to stop them forming and if she was cooler there'd be more of those bonds there's more energy in the system and so those bonds are able to break and move around and exchange in the lattice with each other so the thing that is really cool about this technique is sense or example. Dinosaur eggshell grows within the mother dinosaur the temperature at which that cal site mineral shell of the egg growling is internal body temperature of the mother. Dinosaur on recent work has shown that it's not just the dinosaurs that evolved into birds that were warm blooded other more distantly related. Dinosaurs were as well. But what does that mean for what we know of Dinosaur Revolution? Dinosaurs sits at this interesting evolutionary point between living reptiles living birds reptiles are cold. Blooded and birds are warm-blooded and so this question about why dinosaurs were extinct dinosaurs. I think people have been wondering for awhile and there have been various attempts to try to get this. What's really fascinating is that the the dinosaurs studied which represent all these major groups. We've actually found that. All of them had body temperatures warmer than their environment which suggests that they had capabilities to use their metabolism to raise their body temperatures above the ambient and so if all major groups of dinosaurs have this what it suggests what the most reasonable assumption. Then is that this is really something. They acquired early on in their man. Central Trading. If it's representative of the whole group Dawson speaking with Adam Murphy. There and that work. She did while she was at Yale. University has just been published in the Journal. Science advances. Finally the British government has just granted. It's communications watchdog off com sweeping new powers to police social media. The announcement is linked to the death of teenager. Molly Russell who took her own life in two thousand seventeen whose instagram feed was later found contained. Graphic suicide related content. Ofcom now gonNA Target Violence Cyber Bullying and child abuse. How effective can they actually be with us? Is Peter County our regular tech correspondent and local Angel Investors? So first of all. What a rough come gun do before we do that. Can we just be background? So what we have here is a spectrum between clamping down completely therefore removing the possibility of tragic case of Molly Russell. Full freedom of speech. Now we know is not a good idea to clamp down completely the other end this positive benefits for be able to communicate. This has been a problem for some time. Now for many years and the government published a white paper called online harms last year. The put it together. Some rules and the The moment the same things like Scott proportionate and risk-based who's got to rely on the platforms to self police etc. How forceful is this going to be there? Because the issue is that if I'm tech company and I am hanging out in the back of beyond somewhere and I got servers which are not located in the UK. I don't really care will often say well. The German system has fines of up to fifty million euros. We get it wrong. I don't think that's been invoked yet. But there's things they can do. They can switch off the domain at the ISP that can they because the thing is the domains are registered not in the UK. Some of the molly some of these domains are actually held in seven America. So you'd have to have some kind of bilateral relationship with the Americans is how WanNa turn facebook and then America. It might have antibodies about that and say no. That's not quite true because China manager. Isn't it with ten thousand estimates but China has this sort of firewall infrastructure in rusher? Talking about having one as well aren't they were basically? There's a ring fence on the Internet around territorial geography and they control and potentially probably inspect everything that's going backwards and forwards across that firewall. So they could just turn off talking about there for the Internet. Was this amazing free. Throw for many years. Are we now talking about carving it up exactly? I don't know I think the most likely going to have some forces to have a named individual who is responsible and they know guys ation who wants to put the handout within say facebook. Uk and say you know me out. This is imprisonable offence effectively. That will trigger some change intended because in the end. Switch you off the debate as you say is too extreme. Well let's say off come. Can these rules from the company's then say instagram or facebook? To what extent are they already set up such that when you look it a certain type of content the Algorithms? Then give you stuff. That's very related to the stuff you're looking at. They say. Oh you like this. We're going to give you more of that. To what extent are if they're trying to regulate certain types of content they fighting against their own internal exactly. So that gives you what you've got to look at is the problem that we don't know whether that content providers or just platform content from other people. They clearly are editing content coming. I mean I didn't even notice but today Mark Zuckerberg in Switzerland at. She said something he said. They have thirty five thousand people working on this problem causing five billion dollars a year the switching off a million accounts today at the moment so obviously trying to do something but clearly. How can they do enough presumably? That's one of the ways in which this problem can be solved because algorithms can be written to spot the very things that enable these sites to bring people together who have common interests and beliefs that whole technology could be turned to find the very things that we decide know an interest of an individual. It's already been done. There's no way a million accounts can be switched off by thirty five thousand people. They can't retail and easy to read it. How do you interpreters human being the problem is an? I've run into this where Google has decided certain pages on the naked. Scientists contain graphic content. And actually when you look at it because we're a medical side we've got pictures of bits the Bolton now now then they're not necessarily naughty bits of the body. There was one page the other day that Google had condemned. It was a wound being sued. It was very informative but they decided the image was not in the interests of people to see and in fact it was fundamental to explain. Lavelle speech again. And that's what I'm saying. I think there is a danger. We're going to take the wrong things down three of us in the studio all have our own views about this and all your listeners will have their own views and who how can we expect the government in whatever form to get it right. We can't but they must do something to prevent the sort of things that are causing harm and suicides. Lisa thank you very much. I guess that's one which will have to return to. Thanks very much Peter. Kelly and if you'd like to find out more about the new stories we've discussed the links to each of the referenced. Papers are on our website. Www dot naked scientists dot com along with the transcripts of every interview for every naked scientists? Show and why don't follow us on social media where at naked scientists and feel free to leave us a review. We love to hear from you wherever you get your podcasts. The naked scientists podcast is produced in association with Spitfire cost effective voice Internet and Ip Engineering Services League UK businesses. Find out how Spitfire can impale. Your company had Spitfire Dot Co dot. Uk Music in the program is sponsored by Epidemic Sound Pathak Music for audio and video productions in the second half of our program. Chris investigates a type of cancer. That unfortunately is all too common Every year about fifty thousand men diagnosed with prostate cancer in the UK. That's about a quarter of all cancer diagnoses in that period. It sounds alarming. Doesn't it but at the same time. People often say that this is something that you die. We've rather than off. So what is the bottom line. My Name's Dr Chris. Smith and in this program. I'M GONNA find out how prostate cancer presents in the first place. What it looks like down a microscope and how we diagnose it the first. Who's most at risk of this Vincent? Yana progress. Them is a urologist specializing in this topic of the University of Cambridge. Everyone is at risk and they used to say that. If you live to eighty eight percent of men will get prostate cancer. And that's probably true having said that certain groups at higher risk so particularly men of African descent a high risk or if you've inherited certain gene mutations in particular bracket mutation but that's only about one percent or so and we still don't quite understand why some men develop prostate cancer more rapidly than others do but what we do know is that when a man presents with prostate cancer. The older the are the more likely to have more advanced disease. So really prostate. Cancer is a disease that evolve over time and real challenge. Here is to not over diagnosed cancer. Which is early but at the same time. Not Picking up when it's too late and that's what we're going to explore as we go through the program but first let's back up very slightly. What is this gland that we're discussing? Well the prostates found only in men. It's it's below the bladder surrounding the re throw the tube that drains urine normally the prostates about the size of a small sat suma and his job is to produce many of the components of seminal fluid gets older his prostate naturally enlarges which can obstruct the flow of urine an although this enlargement usually has nothing to do with the development of cancer. It's nevertheless often. The trigger that sends a person to see their GP who then investigates further my name. As spinney that anger Naiad I'm McMillan lateness for urology and prostate cancer. Specialists nurse add in books they usually they usually symptoms are caused by the enlargement of the prostate. All men have their prostate getting enlarge from the forty years of age and when it gets bigger it causes obstruction to the water pipe because the prostate sits under bladder and the water pipe go through it and when it gets enlarge squeezes the water pipe which causes a restriction to pass urine which lead to the symptoms like getting up at night or frequency or urgency like that the enlargement of the prostate is majority of the time due to the nine enlargement but sometimes advanced prostate. Cancer can cause some of those symptoms as well which is wife someone has them. It's important that they should get checked. Yes are there any other symptoms? Because we'VE DWELLED ON URINARY SYMPTOMS. Are there any other ways? In which prostate cancer could present in the first instance that the person might not think anything to do with the system. The other symptoms is usually borne pain. And that's majority of the time and it is an advanced prostate cancer. Usually patients get born pain. And they're put it into their stretched all done something physical to their back core things like that so when the person goes to the GP with these symptoms what sorts of things would they expect the GP to have done or checked or have put in place before they would send them to you so usually if patient presented to the GP the GP should take the history especially the universe symptoms when it started. If it was a long-term udon array symptoms and getting worse it's usually because of the enlargement of the prostate but if it was sort of happened in short period of time could be usually infection and so it is important that Jay paychecks urine sample and then if there is no infection. Jp should do the blood test prostate specific antigen and usually the GP will explain what is the prostate specific antigen. What can make it go high and things like that. So that's what I'm expecting the GP to explain to the patient before they make that Ruffalo so significant emphasis placed on the PSA test. But what actually is prostate specific antigen and? How does it highlight the possible? Presence of prostate cancer and see protein secreted by the prostate gland in its natural functions. It just so happens that prostate cancer cells selectively secrete more of it. It's not a perfect marker and his accuracy is may be about sixty to seventy percents Studying the higher it is the more likely indicates prostate cancer when you say the accuracy sixty to seventy percent. What does that mean accuracy? For what the accuracy that it predicts the presence of a prostate cancer now is very important to remember that the bigger prostate is produce. So in fact if you naturally have a large cross state you're gonNA have a high. Pse how does it get from the prostate? And into the blood it's secreted into bloodstream from the prostate gland. So a person who has a tumor growing the reason it's higher is what because more of its leaking into the blood or because the cancer is actively making it. Yes exactly right. The type of cells that produce prostate cancer known as the epithelial cells and the cells of origin from prostate. Cancer tend to rise from this compartment. And that's why tends to produce more. Psc so the GP gets a PSA test result presumably. They don't just act on a one off if they saw a value that might be concerned. They'd repeat it before they did anything else. You would hope so. And the reason that's important is that A. Psa can be affected by other things. Sexual Activity and education elevate the PSE reflecting the function of the prostate gland produces secratary substances. And the message that we try to keep up is always a repeal because a single high level may not be indicative having said that You know we would always take any elevation seriously at least assessment. How do we interpret the results of a PSA test then given that it can be raised for many reasons other than just cancer? It's a challenging issue and so this idea of age reference. Psc's have come about. None of that means that you have brackets of better allowed to be higher. So it's got to do with the natural enlargement of the prostate and suction that. If you're in a higher age bracket you've got a bigger prostate. So these age reference are used as guides in screening programs where they look for prostate cancer said baseline cutoffs like for example a level of three. But of course the PSA can vary from zero point one up to four or five even six or seven or eight or ten depending on the size of the prostate and not have prostate cancer. So interpretation is difficult thing but primarily to do with what you would expect to be out of the norm for someone who's prostate is naturally enlarging and if that is the case under what circumstances then should someone be referred to a specialist prostate clinic to elevated PSA in four weeks apart that is the flow criteria or if it is one high PSA and if the examination of the prostate is abnormal then the GP should refer to secondly care on a two week bait basis. So that's a cancer part. We're basis in other words it's countr- until proven otherwise that person's coming your way or or at least to someone like you. Yes that's correct so usually majority of the hospital. There is a charging system where the doctor the specialist nurse look at the reference everyday and then directing to the right pathway and that system will look at individual and check things like you know. Make sure there's no other reasons like a urine infection which may have caused this but it was looking as though the PSA is elevated for each classically now the patient will be invited for an MRI scan first to see if we can pick up anything anything. Emory stands for magnetic resonance imaging a non invasive scanning technique that uses a powerful magnetic field to enable doctors to see the body's internal structure in three dimensions. Meaning they can measure the size and shape of the prostate with great accuracy and even see inside it and other tissues would MRI can do with. It gives you value of big due process as I mentioned to you that if your prostate is large any of your new. Psa's raise. It could just be. That's normal flu so in fact correcting the PSA for the size of the prostate something we call the PSA density. He's actually a much better test. And here's an interesting thing that if we were able to transfer that to primary care and actually we might be able to give more confidence about referring or not referring and that's something we're looking into. What proportion of prostate cancers all detectable straightaway on an MRI? What fraction do you subsequently think? Bullet looks negative. You do a biopsy and then finally do actually still nevertheless have a prostate cancer so these are very complex. Questions and in fact is part of the diagnostic pathway now but many issues still remain because in the end unlike PSA which is a blood test. You mention a lab the marine repetitious. Don't experience of the radiologist and if they are very good radiologists the ability to see things as much better. But if you're not then it may not be so good. So everything's always a balance of risk and benefit regards. Dama ride have come up with a scoring system known as the pirates system and his pirates system gives us coal between one in five in terms of how certain they are that there might be something? And if you have a lesion score see four or five. That's pretty sure. It looks abnormal. That doesn't mean it's cancer but it looks normal and the chances are that it will be cancel when you buy obscene scores of one to almost negative and so in that case is probably unlikely that they can see anything doesn't mean there's no cancer there but unlikely where the situation gets a bit more. Murkier is around the level of three because this is a bit of uncertainty now in general terms. If you were to biopsy men across that scale of one to five got likelihood of finding prostate cancer gets higher with each level and the other thing it does to see tells you wear these abnormal area so so you can actually talk your biopsy to those areas. Mri Scans can therefore help us to highlight areas of interest and predict the risk of finding a cancer but the diagnostic gold. Standard is a Trans Rectal. Biopsy. This is where guided by an ultrasound. Probe introduced into the rectum small pieces of tissue taken from the prostate including marriage. The judge to be both normal and those might be cancerous. Conflict Biopsies are done in outpatients in in our clinic and behalf special machine that sort of help us to outline the MRI and then target is outlined And then ultrasound helps. The comes out of the doctor to target those areas so it started biopsy which is done through back passe. Defeat is that that is what patient need so you use the scam to inform combined with ultrasound on on that day where you want to sample so you make sure you basically assaulting the bits that you spotted in the scammer interesting so we do targeted biopsy which means we take three or four samples from the target Batista suspicious eighty Ab in the prostate and do standard biopsies like six from the left side of the prostate and six from the right side of the prostate so the reason for that is majority of the time prostate cancer developing the area so to make sure you know we have not missing anything. We do target plus standard. What's involved in doing that boy? Let's see what they are expected to do. With sly on the left hand side then usually a probe got through their back passage. The probe itself is slightly bigger than the Tom. And that is all a fitted with equipment which guides the needle. Before the biopsy we numb the prostate gland to make shaw began. Take the somboon pain. Flea patients will feel obs- clutch like you're at the dentist but it's wrong. And after numbering the prostate they take the sample what I have heard from patients and they feel a habe touch like feeling when they fired that biopsy gun. That can be uncomfortable. So it's basically firing a needle through the gland on a trajectory that you've chosen to sample the right bits as it fires the needle through its grabbing core as it were of that tissue and pulling it back for you then sent to the pathologist. Yes that is right. What side effects were the patients experience? Afterwards a what do you warn people when you go home after this this is what to expect main side effects this bleeding through back passage and blood in urine usually tell patient make sure they bring plenty to flush the system. The other side effect is leading seamen began last Sometimes four to five weeks and it doesn't present us. Bright Red Blood didn't say many usually blackish old bledsoe be do. Say Get alarmed something normal to see the other side effects a infection so there is coffee or an infection and there is a risk of septicemia infection in the bloodstream. So we do give antibiotic for three days. Post procedure increasingly though. Practices are changing and it's possible to make better use of the scan data to achieve even more accurate sampling from the prostate. And so we are now starting to do much more recalled transparent neil biopsies and this is where we still have appropriate back passage but the needles themselves postured para neom the space between the rectum and the scrotum and there are many ways to do that the classical ways dude under general anaesthetic in theater. But that's expensive but you can get to front the size of the Prostate Much better than you can from the Trans rectal approach but we and others are starting to do local anesthetic transparent neil biases using new devices that have been developed and we have one in Cambridge which is going to be very cheap. And we think will revolutionize auto by ABC's done because you're doing it through the Perry neom but also on the local anesthetic and what for the same time as well? But in essence all these biopsy method designed to do one thing to take samples on the prostate to make a diagnosis. Now we used to do what's called systematic biopsies which means basically taking samples from different sectors to prostate. And now we do that. But also targeted by ABC's which means going to the area emory has defined and that is the samples we take then send off to the laboratory for histopathology. Salukis and tell us what they find the biopsy samples a small cylinders of tissue collected each of the biopsy sides in the prostate gland. These assent the laboratory where pathologist like Michael Jordan. Look carefully at each of them for the telltale signs of cancer. My role as a consultant histopathology is to diagnose prostate cancer after a certain taken. A sample of tissue from a patient that they suspect has prostate cancer. And when you receive these specimens how do you investigate them? We take each of those bits of tissue. That tissue is cut into very very thin sections because the cylinder of tissue contains thousands and thousands of cells but actually down the microscope. What we want to see is one or two cells at a time so we will cut very very thin sections and we can then stain it and then look at those cells which have been. Stein down the microscope. So a lot of your diagnosis is literally made by you. Look down a microscope. And you're looking for cells. That don't quite look right. Or ARRANGEMENTS OF CELLS. How they're organized inside the prostate. That doesn't quite look right. That's absolutely correct depending on the cancer that we'll be looking at. What are the Salads individuals? Look like what are they doing as a group? Are they growing together in a way? That looks abnormal. What can you say about the likely behavior of the cancer based on the appearance when you see it? Can you give some kind of insights into how likely it is to progress? Orb grow aggressively or more indolent disease. There are a number of things that we can look at to try and give an indication to the surgeon into the patient asks. Have that cancel. Behave the first thing we tried to work out is what type of cancer we dealing with. The second would be to assign what's known as soldiers. The great of cancer does it look very very aggressive. In which case. We think that this cancer is going to behave very badly or do we think that the greatest very very low in which case we think is behaving more like normal cells. So it's less worrying. The first thing we look at is. Do we have any evidence to show how far the cancer spread by that? I mean has it spread into other parts of the body. You go to escape sitting here do could you show me? What the specimens you look at look like absolutely so of course selection of prostate biopsies here typically prostate cancers are graded using a gleason school and the gleason school typically comprises two number which added together and the numbers can from one to five. We don't usually see grade one. In great too so typically looking at number ranging from three to five at a to another number ranging from three to five and that gives you a title number which will range from six which would be the lowest up to ten which would be the highest of the worst grade. So we'll show you now is a prostate cancer which is Gleason three plus three which equals six. Which is the lowest grade so as you can see here? The sack like spaces lined by two layers of cells. There is what's called an epithelial layer of cells which pretty secretions in the prostate. And underneath a Meyer. Epithelial layer of cells. Which are smooth muscle in origin? If we see these smooth muscle layer of cells can be fairly confident that this is probably benign so just to describe what I'm seeing here. We've got this strip of tissue and there are lots of little holes this is because the prostate gland. Isn't it so it's going to have the structures which you described as sackcloth which is where the secretions are going to be produced and then put into and then expelled from the prostate and around those sack-like areas are rows of cells which which have got Nice Purple Centers? Those the nuclei in the middle of the cells there. And they're all very nice. You organized and underneath oziel saying You can see them clearly. There's another layer of cells those the my fetal cells that you're saying if they're they're it's usually a sign of good health. That's that's absolutely right so my job is to look through systematically looking to see really. Is there anything in the architecture of cells? How the cells are arranged in relation to one another that would indicate this might be prostate cancer rather than benign prostate. Glands and one thing that does catch my eye which you get with many years of of training is that Ariza prostate cancer. Architecturally show glands which are quite closely spaced together and they look a bit smaller. This bit over here that you've now highlights and drummer pen on the slides or that. You must have been the hot spot that you noticed that's very compacted and squeezed together. It's subtle though as you zoom in on them you'll see the T. main feature is really one. Is that the mine. Epithelial cell Laya is missing from many of these glands. If not all of them and the nucleus of the cell in some you can see a little dot which would call the nucleus which is quite prominent at this magnification which you don't see innumerable prostate cells so that combined with the absence of my sales suggest to me that this is prostate cancer. And then at that point if I'm happiest prostate cancer then I'll be looking at trying to great it to see how aggressive it is preparing the tissue and then waiting while pathologist light Michael studied and report. The findings takes a week or two when the results are ready. The entire clinical team including the pathologist radiologists surgeons and nurses them meet to discuss each patient and the best way to manage their case. It depends on the biopsy type because if it is transparently biopsy we take more samples so that take long to expand if it is translated told standard by up say it usually take ten days and then be discussed the case in multi disciplinary team meeting. And we see the patient and gave that assaults and stage. What do you say to the patients? Or what information can you impart to them? And what's the next step so in duracell clinic? We will have the information about the biopsy yourself better. It is a cancer or note if it is a cancer what grade of the cancer and we would have discussed what treatment option is available for patients so when we see the patient be will discuss the findings of the biopsy say advance stories a locally advanced or early prostate cancer and we discussed the treatment options with the patient. We can now worker with quite good accuracy. Where the likely prognosis meeting to see the outcome is with or without treatment. And that's what we use together with the patient to work out what to do next. The first thing to know is that there is absolutely no evidence that rushing through a diagnosis of prostate. Cancer has any impact and survival. So it doesn't really matter how long it takes. The key thing is that he's done well in general terms from the minute somebody presents to say the hospital for investigations to get Anne Marie. Scan to be seen to have a biopsy and get a diagnosis. We try to do that within two or three weeks and then we can make decisions about what to do next. Some people listening to this may be wondering why it is that we have screening programs for certain diseases. But we don't have one for this given that you've said that eighty percent of men aged eighty may well have prostate cancer which argues perhaps would be worth looking for. It's it's therefore very common condition. Why is there no screening program for prostate cancer so the problem screening in prostate cancer is not the fact that it isn't save lives because he does the problem as that he picks up a lot of disease which is treatment and that over diagnosis can also lead over treatment because of poor understanding of the natural history of disease sort of instinct treat rather than monitor and if you look at the statistics as well is very hard to justify so for example in prostate cancer terms the lifetime risk of developing prostate? Cancer is nearly ten times risk of dying of it. You have to find an awful lot of men to save a single life but problem with screening is that its tended to rely on a single test at a single point in time and the test is in good. Psa Like I said is a nice test but it's just not good enough and so a lot of our work. A lot of work of others is actually trying to do two things. Define what is the right time point to pick it up and secondly trying to get a better test to pick it up. Are you having any luck? Yes there are actually a number of tests out there which already better than the pse. The problem is that the cost more as well. We are very interested in actually binding better tests with a much more evolving way of looking at this because the way we see it is that each man's risk changes with time and how put together as what we are exploring at the moment but. I do think we have the tools to be able to better detect Kansas which are going to spread for example and actually intervene enough and would that translate into a saving? And that's exactly what the Holy Grail is. Because in the end of the day screening low early detection for cancer actually has converse side which is not picking up things that you don't want to pick up and that in itself is a goal which I think is worth doing because if you can reduce the number of people you're going to be looking for something that means you can get your resources redirected to finding the ones which are important. Most of the time we're so fixated on finding and more and more cancers that's what we WANNA do. We forget about the fact that there's a lot of people who are investigated who turn out not to have chances And that is actually a big burden for the health economy for the individual and ultimately if you do diagnose something which too early you you do. Condemn someone to be monitored for something which didn't know about. It's a little bit lake saying if we started do genetic testing birth everyone what it tells us a potential. You might get something rather than you will get something and then you're going to end up stressed body for all your life and May or may not happen but obviously for some people. It does happen. My name is Michael. Langford Eighty eight and a half and I'm semi retired professor philosophy. Eighteen months ago I was diagnosed with prostate. Cancer and for time is really pretty sick but a combination of steroids and hormone treatment seems to make me a lot better at one point. I had to go in just over yet ago for blood transfusions because my Nimia got very serious but at the moment touch wood. I'm a lot better. How did you first detect. Something was was a bit of a history twenty three years ago while other than Canada. I had a flow problem with my urine and I had a little operation. Which made the prostrated much smaller than everything was fine until about eighteen months ago when I was diagnosed with a combination of Paula Myalgia and prostate cancer which they then discovered had spread the cancer spread to my fema and my ribs did the GP immediately suspect that it might be prostate cancer or was it because we should be clear a couple of years ago I mean you were doing martial arts fitting active person. I was until it eighteen months ago. The doctor diagnosed upon my Algebra and wasn't sure what else was then. I was sent for more blood tests. Stratton Brooks and there. They found that I had quite severe prostate cancer. What test did you have to make the diagnosis and confirm what it was I was sent for? Mri Scan and that showed that. I had secondary gross in the FEMUR in the ribs. You didn't have any biopsies deem necessary than I. I didn't have the opposite. They were quite short. I had contra anyway. And how did you take that? I was a bit shaken but being in having friends who've got prostate problems I knew the old saying almost oldman die with prostate cancer. But not all of it and I took constellation from that but a year ago when I was feeling really down I did begin to wonder whether I had to start rewriting. My will and so on. My family was very supportive. And what actually happened to you? Get the diagnosis. Is You're saying it it. Did you a bit hard but clearly? You've bounced back because you don't much better now. Well I was the lowest about a year ago and I had to have blood transfusions because of the anemia and then soon as I started on the hormone treatment I gradually began to feel better and apart from one bad week last summer which I think was an infection of some kind. I've been continually much better. I do have trouble if I walk than a Mile. I get out of breath and if I go up more than two or three flights of stairs I get out of breath so I pay myself and I did. I still teach and lecture of it but I try to take a lot of rest. And what have they told you about the prognosis? Well they were quite honest about this. When I first was diagnosed eighteen months ago one of the oncologists said the average life expectancy for someone presenting you did is about three years but it confetti from one year to twenty s. You know the other words. It's very very dependent on how you respond to the treatment. And how are they keeping an eye on you? I called in to see the oncologist about every two or three months and I have blood tests about once a month and by niemira level. I keep an eye on. Do they rescan you? I've had to scans are. They're very expensive so understandably into often. I had one about three weeks ago which I haven't had the result Soviet but they haven't phone me up so I'm hoping they know what they say? Ignorance is bliss. Yes that's probably true Thanks to Mike Langford for sharing his experience with me and also to Mike Ledin Vanita. Thank Kapoor Vincent. Yana progressive and do keep an eye out on the feed for a landmark look next the landscape of AI in healthcare the naked scientists comes to you from Cambridge University and supported by Rolls Royce. I'm Chris Smith. Thanks for listening and until the next time goodbye.

prostate cancer Cancer UK China British government University of Cambridge Dr Chris Jonathan Haney Liverpool COPD Smith Brize Norton Adam Murphy Cambridge PSA Science Physics Medicine Khan Michael Jordan Taos
Prostate cancer / exercise and the heart / headaches

Mayo Clinic Radio

38:47 min | 10 months ago

Prostate cancer / exercise and the heart / headaches

"It from the studios of the Mayo Clinic News Network. This is Mayo Clinic. Radio exploring the latest developments in health and medicine and what they mean to you. Welcome everyone to Mayo Clinic Radio. I'm Dr Tom Chives. And I'm Tracy mccray prostate. Cancer is one of the most common types of cancer in men now while some types of prostate cancer grow slowly and may need minimal or even no treatment other types are aggressive and can spread quickly if prostate cancer is suspected. A biopsy can confirm the diagnosis on today's program. We'll discuss prostate cancer. And a safer way to biopsy the prostate with a Mayo Clinic experts. Instead of passing the needle through the ultrasound through the rectum through the rectal wall into the prostate the needles going directly through the skin also on the program exercise and your heart and treatment for Migraines all that along with a health minute from Vivian Williams cancer of the prostate gland now other than skin cancer. It is the most common cancer in men in the year. Two Thousand Twenty. It's estimated that there will be about one hundred ninety thousand men who are diagnosed with prostate cancer in this country and about thirty three thousand deaths caused by prostate cancer. So it's it's a bad disease and affects a lot of gentlemen in this country but most men who are diagnosed with prostate cancer. Don't die from it now. That's the good news. That's right. There are more than three million men in the US who have been diagnosed with prostate cancer at some point and they are still alive today. Joining us in studio to talk about cancer of the prostate is Mayo Clinic urologist. Dr Derek Lomas. It's nice to meet you. Thanks for having me guys. It's good to have you on the program so I as I recall you were a resident here at Mayo Clinic and then you took a year or two and did additional training in what correct so I trained here in urology and then I was a male scholar for a year so I got to travel around to various institutions to to pick up skills. I spent six months in London in the UK. Training in Image Guided Diagnostics and prostate biopsy as well as focal therapies for prostate cancer. Pretty exciting time. Wasn't it yeah very much? What did you learn about prostate biopsies? What what has changed? Well the traditional way we biopsy prostates in the United States is with what we call a systematic trans rectal biopsy In this approach in a man that we've found to be at potentially elevated risk for for prostate cancer. We've recommended a biopsy. We use an ultrasound. Probe which is put in the rectum and then we systematically but kind of randomly Direct twelve secours throughout the prostate. Usually six on each side. Don't want to miss anything Correct but inherently you. Will you know the chance of you? Finding prostate cancer on the first time biopsy in Aman is probably about thirty to forty percent. That doesn't mean the remainder don't have prostate cancer because you might have missed it so one thing we've been doing here for a number of years and Expanded on my experience with that over London is. Mri guided biopsies so using imaging to find a specific part of the prostate that looks abnormal and then biopsy in that area in many cases. We're still doing the systematic course to complete out the biopsy but adding car Course directly to where we see the. Mr Is Abnormal The difference in the UK was. They were doing it. Transparent neely rather than translate what that means is instead of passing the needle through the ultrasound through the rectum through the rectal wall into the prostate. The needles going directly through the skin behind the scrotum skin can be cleaned much easier than the rectal wall My mentor over. There would call the Trans rectal. Biopsy the Trans fecal biopsy so you know carrying in some of that Bacteria into the prostate and lead to infection and severe infection called sepsis might impact upwards of three percent of of men undergoing biopsy now. Well that doesn't sound like that high of a number. If you think of the numbers you just quoted about prostate cancer. All those men had biopsies. Many more men had biopsies to rule out prostate cancer. And those numbers. Add UP THE COST OF ADMISSIONS. That could be potentially life-threatening by doing it through the skin. You know we're talking. Maybe one out of five hundred men might get something like that so much lower so have we changed the way that This is being done. Mayo Clinic because of what you learned I certainly have. I'm a convert in the UK. You might have heard of brexit happening then leaving the European Union and on the urology side. There was treks. It leaving Trans rectal to kind of coincide with it in a number hospitals were posting when their tracks. It date was and that's my goal for mail. It seems like a no brainer. Actually it does so Since coming back outside of a very few isolated clinical scenarios. I have not done a trans rectal. Biopsy done probably several hundred now the transparent Neil my other two partners in my group in outpatient practice have started to convert their practice over and the ultimate goal would be to phase out the Trans rectal. You're teaching the old guys tricks. That's how do you decide who needs a biopsy? Well we have a number of tools. Historically it's been. Psa that's prostate specific antigen. That's a blood test. That many men get as part of screening for prostate cancer. If that's elevated or rising that should trigger discussion for a biopsy and then a physical exam examination of the prostate rectum. It feeling any lumps or bumps could also trigger a biopsy historically if you had either of those it would be boom onto biopsy but Times ARE CHANGING. We now have prostate. Mri which is very good. At both finding areas that look suspicious but also helping to rule out potentially prostate cancer. So that the scan is very accurate It's very good negative values very good at ruling out prostate cancer if I get an MRI on a patient. That's maybe borderline and the MREs clean. I will many times. Avoid the biopsy. If it shows me something it's not a slam dunk that it's prostate cancer. We have to go in and biopsy and still get tissues so we can't make a diagnosis of prostate cancer based on imaging but it raises the suspicion and more importantly tells us where to aim the needles. Instead of twelve you know kind of spaced out. Scattershot and areas of the prostate. That we wouldn't hit well. From the rectum the top of the prostate. The tip of the prostate. If we know where to aim. And we're doing it through the skin. We can hit those areas very well. So you're much more accurate than you used to be in in getting things and then what happens if it's positive. Prostate cancer is a spectrum of disease. You mentioned earlier that just because you get prostate. Cancer doesn't mean you're going to die from a in fact most men won't die from their prostate cancer. We patients into what? We call risk categories. The primary driver of your risk category is the What we call gleason score. It's a score. A pathologist gives to the cells when they look at it under the microscope and for various reasons. These scores go from six. To Ten. Six is generally low risk prostate cancer. There's other factors that go into that. As well. Seven is an intermediate or middle risk prostate cancer eight or higher is typically a high risk like I said. Psa PHYSICAL EXAM. Things can factor into that in general men with low risk prostate cancer. The favored treatment at this point. Is surveillance watching them closely to see if their prostate cancer? Maybe behaves more aggressively in the future. Or if it's going to be a prostate cancer that are going to die with rather than die of. Is it getting easier for patients to do that? As as more people are being you know we're gonNA watchful wait anything. Yeah and I'll clarify here so watchful waiting is a is a another term us. That's kind of an older term because It's watchful waiting as you have cancer. We know about it. We're just gonNA leave it alone. Forget about it and you might do that. If you incidentally or find prostate cancer and eighty-five year old gentlemen with other diseases. You might say. Forget about this. Never look again but in a younger man. It's really active. And it's really surveillance so we are talking Frequent PSA's usually every six months. To start a repeat confirmatory biopsy typically at about a year to make sure that we didn't miss an area and then we confirm that it's still a little risk and then if they haven't had an MRI getting an MRI to make sure that fits so patients are getting more comfortable when we can give them more information and more tools and we can share the data that if we find something we move you onto the treatment pathway and we really haven't found that it negatively impacts your overall survival or cancer specific survival and in fact looking at the big series. Maybe a third of men up ten years. Maybe even half might go onto having something. But they've avoided that many years without any treatment related side effects and we're able to still treat with curative intent at that time. So you categorize these gentlemen into low risk intermediate risk and high risk and that helps you determine what the appropriate treatment would be corrected. How quickly we need to act Generally most urologists will treat intermediate risk or higher but it's all in context of the patient's situation their overall health their goals and so forth our topic prostate cancer. Our guest is a Mayo Clinic. Urologist actor Derek. Eric Lomas now. We want to talk about treatment options and I know there are a multitude of them and it's radiation in the surgery and it's limited surgery How you how do you make the decision? You sat down with the patient has the cancer and go over all the options and the two of you decide together. What's best absolutely? It's really a patient center discussion. They certainly have a choice in what treatment. They want if any but we use a lot of the data. We've obtained during the diagnostic pathway to help us make help them. Make that decision so Looking at their risk category looking at the features of the pathology looking at the imaging looking at their overall health looking at their current levels of function whether that be from a urinary standpoint or erectile standpoint because those are things that are going to get impacted with various treatments in general when you look at the guidelines specifically guidelines for the American Urological Association for intermediate risk or high risk prostate cancers. The Standard of Care Treatments are radical prostatectomy. Which is removal of the prostate gland as well as lymph nodes around the prostate. The bladder back to the Aretha to maintain the urinary function and Radiation therapy and there's different ways to give that external beam. Proton Ricky therapy seed implants usually in combination with hormone treatment. And those are really the mainstays of treatment adding to that. There's increasingly interest in this country and especially in Europe for using focal treatments of the prostate and to kind of put it into context of what might be happening in other diseases. If you think about kidney cancers it's now common practice if you have a small kidney cancer to do a partial enough rectum where the urologists removes only the portion of fragile me-meeting. Remove the kidney up on your skin that Kinney that contains the cancer or breast cancer. Maybe a lumpectomy removing the tumor but not the whole breast and very few solid organ malignancies remove the whole Oregon for for just a tumor so in prostate. That's the idea behind focal therapy. Does that have less complications? As as opposed to remove radical prostatectomy. Absolutely since we are able to treat an area or the half of the prostate. That has the tumor. Were able to stay. Well away from The nerves that run along the side of the prostate that helped with directions. Especially on the other side that we're not treating and near the tip of the prostate is the aretha finger which helps hold urine and in many cases we're able to stay away from that as well so less incidence of incontinence and erectile dysfunction with focal therapy always too radical prostatectomy. Kind of sounds like what is happening with the thyroid. Like instead of taking the whole thyroid out we just take out the partial thyroid. But then the part of the thyroid that's left or the part of the prostate. That's left isn't that then. Still at risk of developing prostate cancer. It is and that's why we have to follow these patients very closely. So if you were to have your prostate removed the follow up is fairly straightforward your. Psa BLOOD TEST PSA is only produced by the prostate your PSA should go to zero or undetectable and then we can follow that if it starts creeping up that could either main diseases maybe coming back. Or maybe there's just a little piece a normal prostate still in there. So it's simple and radiation has come up. Radiation oncologists have come up with a criteria for what they mean for recurrence in focal therapy. It's it's more challenging because there's different degrees of focal therapy whether you're just treating the lesion itself with a little bit of margin or area additionally around it whether you're treating the half of the prostate quarter of the prostate so there's no set. Psa number that things are going to go to so we really have to do an individualized patient trend find out what the PSA goes down to typically checking every three months for the first two years or so we have to do imaging MRI here. We typically do it. Every six months for the first two years but there's various protocols and then also a confirmatory biopsy generally at one year. After treatment of of the area. We treat it as well as the other side because if someone were to fail we WANNA be able to pick that up early and move them onto a whole gland treatment Without many negative effects now you have. I presume haven't been doing this all that long. But the question is what's the recurrence rate. Absolutely there's various definitions out there and every paper seems to use Deford. Different definition of what failure is after focal therapy? The most common definitions are finding clinically significant prostate cancer gleason seven intermediate risk or higher in the area that you treated or the patient moves on to either a whole gland therapy or cancer spreads or they die of cancer very uncommon that a patient would die from cancer after a focal therapy but large study out of the UK at the centers. I trained at found that at five years about eighty eight percent of the men met that definition for failure. Free Survival eight percent percent. Pretty good pretty good. Now that does allow that study did allow for a repeat touchup focal therapy in about a quarter of men got that now just a few days ago in the Journal of Urology there was another study out of France which the numbers weren't as favorable at five years. They said maybe fifty to sixty percent of men went on but I think that highlights the wide variety and techniques. And you know it's not clear from their study. How how they were treating. How hyper focal. The equipment was different. So there's a lot of variety out there and we just need more data. But what's clear? Is that if we do find? These patients recur. We can move them onto another treatment usually without any other Any greater difficulty of doing a surgery or doing radiation and still overall survival from cancer standpoint as fine as good and the majority of the patients don't move onto that so if they do get a recurrence though even though you might detect it fairly early on isn't there a risk prostate cancer could spread elsewhere before you get it out. There is but that risk is low on the order of a few percent and really hasn't been significant in the study. So what you're saying. Is that when men get cancer of the Prostate? It rarely involves the whole gland. There's h usually just a part of the gland in you can use focal therapy to just treat that In some men so that that highlights the importance of patient selection. Not every man with prostate. Cancer can get vocal therapy. The ideal patient has maybe one tumor in on one side of the prostate. I want the MRI to match up with my biopsy data so my targeted cores. That I aimed at the lesion should be positive there might be a few systematic or random cores on the same side of the prostate cancer on both sides and multiple spots. Then they're probably better off with a whole gland Glenn Treatment so not. Everyone's able to get this but in a properly selected man Treatment all right. And let's compare that that three with regard to the complications that every man fears that is erectile dysfunction incontinence so let's compare radical prostatectomy Focal therapy and radiation therapy. Sure so lowest complication rate So erectile dysfunction and incontinence is with vocal therapy in the studies large studies Hifu which is high intensity focused ultrasound. One way we treat prostate with vocal therapy and cryotherapy freezing. The the area of the prostate incontinence rates have been less than one percent with Hifu with a focal treatment. Less than five percent with cryotherapy erectile function rates about fifteen dysfunction rates about fifteen percent or less with their even with vocal. But this depends a lot on patient selection. If you're treating mainly older men than they're going to have worse outcomes if you're treating mainly younger men they're gonNa have better outcomes because they have more reserved to begin with if you look at erectile dysfunction with Surgery or radiation. Maybe you're talking. Twenty five to thirty percent really mad. I and and that's across everyone. You know if you do it in a surgery and a fifty year old He has much lower chance of helping erectile dysfunction because he has more reserved. View it in an eight year old Probably fifty percent of them are going to have worsening erectile function and the same goes for continence so definitely lower lower rates with the treatment. All right you got lots of options portray but it's good to have one in nine men will be diagnosed with prostate cancer during his lifetime. And it's good to know that there are multiple treatment options these days including focal therapy. Absolutely our guest urologist. Dr Derek Lomas. Thanks so much ring a buzzer. We're GONNA take a short break when we come back exercise and your heart and treatment for Migraines I ended the Williams to the Mayo Clinic News networks frequent hand washing one of the best ways. Avoid getting sick and spreading illness as you touch people services and objects throughout the day you accumulate germs. Your hands you can infect yourself with these germs by touching your eyes nose or mouth or spread them to others. Although it's important to keep your hands germ-free. It's impossible to keep them completely germ-free. But washing your hands frequently can help limit. The transfer of bacteria viruses and other microbes. Always wash your hands before preparing food or eating treating wounds or caring for a sick person. Inserting or removing contact lenses. And always wash your hands after you prepare food. You use the toilet or change diaper you touch an animal. Animal feed or animal. Waste you blow your nose cough or sneeze rea- treat wounds or care for sick person and definitely wash them after handling garbage. Also wash your hands when they are visibly dirty. It's generally best to wash your hands with soap and water over the counter. Antibacterial soaps are no more effective at killing germs. Then is regular soap. Now when you wash us clean running water either warm or cold. Apply the soap and lather up well rubbing hands for about twenty seconds getting in between fingers and under nails and then rinse and Dr Alcohol based sanitizers. Which don't require water are an acceptable alternative. When soap and water aren't available if you use a hand sanitizer make sure. The product contains at least sixty percent. Alcohol handwashing is a simple effective way to help you stay healthy for the Mayo Clinic. News Network. I'm Vivian Williams Tracy. How many times have we heard in the past few years? That exercise is good for your health. Longtime almost forever. It's all it's good for you in many ways including lowering your risk of heart disease. What's an expert's opinion you might ask will join us in? Studio is the CO director of the sports cardiology clinic at Mayo Clinic. Dr Todd Miller. He's also my hero. He's a longtime runner and has completed over twenty marathons detrimental good to have you on the program. Tell us about this. Sports Cardiology clinic. Mayo has a long tradition of teaching people about exercise. And the way that has generally evolved as people who generally have been sedentary are encouraged to exercise. And that's part of the executive health program but it also applies to people who might have new onset coronary disease. If you've got a heart attack your place on a Cardiac Rehab program and that's been a supervised exercise approach that applies to people who generally been sedentary the sports cardiology clinic that we have been performing for the past half dozen years relates to people who consider themselves athletes. So it's more than just the recreational exerciser. Somebody who's entering competitive events and we generally break this up into two camps. There's the pediatric sports cardiology clinic. Which mainly applies to high school and collegiate athletes much of what goes on their screening people for underlying heart problems. It's become a big issue and in the older adult athlete. It applies to people who might be entering a five K. Or A ten K. And they will continue participating but they have some concern about their heart or they've actually been diagnosed with heart disease and they're wondering can continue these activities so you said that you're trying to screen them for an underlying cardiac problem so that they wouldn't get into trouble when they did compete that's correct. And how do you do that? Well most of the screening goes on and the younger athletes so if you look at a backwards each year in the United States. There's about eighty cardiac events on the athletic field or shortly thereafter. That occur in the younger athletes. And when you look at what? Cardiac conditions are causing those deaths. They can be identified as a few underlying abnormalities. Something called hypertrophic cardiomyopathy. It's an over over development of the heart muscle heart muscle that's excessively thick. Or some of these people are prone to certain arrhythmias of the heart because they have congenital conditions. Call Long Queue T- syndrome or some Individuals have an artery that the corey instead of taking the usual path takes an abnormal pathway. That can also be associated with sudden death in young people. She you can screen for these conditions. The trouble is our screening. Tests are not very good for applying to large populations at least the cheap tests. And if you want to apply the more accurate tests becomes a very expensive proposition. I read recently. That there's evidence that extreme athletes marathoners ironman etcetera might be increasing their risk for developing an arrhythmia atrial fibrillation and possibly even coronary artery disease through that's correct. There's been a lot of concern about that so the way these studies are usually done. They identify a big population and community population. And they look at the prevalence of coronary artery disease or atrial fibrillation and then within that population they can identify a handful of extreme athletes. Maybe hundred athletes out of several thousand people and what they'll do then is take the athletes and match them to other members of the population by age and gender who are not athletes. And they look at the prevalence of these conditions atrial fibrillation or coronary artery disease. And in these cross sectional studies that are perform that way the prevalence data for relations about been about five times higher than similar sedentary people. Why Oh there's a lot of Plausible mechanisms for that. When you exercise you develop. Let's call that led a Cart Syndrome so your heart chambers getting bigger and the atrial fibrillation arises from the upper chambers. The heart the a tra- so they will also enlarge as part of the Athletic Training. And it is you stretch heart muscle. It makes it more ARRHYTHMIA PRONE. So that's one of the more common mechanisms why this is felt to be more common in the athletes. Have you ever Studied whether or not marathoners or those who have done. High intensity exercise live longer or don't live as long as the general population. It's hard to tease out that data but there are studies that have looked at it and probably the best study was done in France and they looked at Cyclists who had been in the Tour de France and they found that again compared to age match controls and all that who are sedentary. The cyclists were living longer than the people who weren't physically active. Well let's talk about the average people. Use The word athlete in the beginning and it seems to meet a lot of people get confused about the word athlete. I'd love to know what a cardiologists definition of what an athlete means. We consider someone in athlete. Who's entering formal organized events and for the adult crowd. It's mainly distance running or triathletes. There are some other sports. But that's most of it and the Upper Midwest here we also see some cross country skiers etcetera. So that's how we define an athlete. Part of the reason why this has become such a prominent issue is if you lookit entrance so some of these are repeat people but if you'll get entrance into distant events of five K. or longer each year. It's twenty million in the United States right now. So as population's aging more and more people seem to be doing this type of thing and then these cardiac issues arise so for the most of us if we want to do a good for our heart and we want to be heart healthy. How much exercise do we need? What should we do right? So the emphasis. These days has been on not just exercise but physical activity so exercise falls under the larger umbrella of physical activity and the reason. There's such an emphasis on physical activity is we're in the middle of this. Obesity epidemic forty percent of the country is now medically obese and the new physical activity guidelines for Americans the second edition of these just released in two thousand eighteen and they put a strong emphasis on just being active at any point in time. So the old version of the guidelines said. Oh you need to do ten minutes of some type of exercise type of activity at least at a particular time. The new version says forget all that just get around and move more so it's the old take the stairs instead of the elevator absolutely but it is it still true that thirty minutes of vigorous exercise most days of the week is is recommended. Yes so these activity guidelines emphasise emphasize this activity that we usually think of as exercise just being more active with daily life. That's called NEAT. Non Exercise Activity Thermo Genesis. That's new buzzword but in addition to that I also want to do half an hour five days a week of endurance or aerobic exercise like Brisk Walking Jogging. And addition to that you should be doing a couple of days a week of strength training to improve your overall muscle tone which in older people in particular has been shown to help reduce the risk of falls. Cetera is bigger as exercise meaning. You're breathing heavy. Vigorous exercise means. You're breathing heavy so you don't need a formal exercise tests to check this out. You can basically do that by using the simple breath test so when you're out exercising with somebody should be doing enough exercise so that you're starting to feel. Miley dismissed are shorter breath. You might even break out into a little bit of a sweat but you should still be able to carry on a conversation full sentences all right no question about it. Exercise is good for you and it's especially good for your heart. It's that simple. Thanks to Mayo Clinic Heart specialist in the CO director of the sports cardiology clinic. Dr Todd Miller thanks again Dr Miller thank you. We're going to take a short break when we come back. We'll learn about the latest in treatment for headaches. You're listening to Mayo Clinic. Radio and the Mayo Clinic News Network. Download the Mayo Clinic. Podcast today for the latest complete versions of interviews. You hear on Mayo Clinic Radio Fine Mayo. Clinic QNA podcasts. On your favorite podcast providers. Welcome back to Mayo Clinic Radio. I'm Dr Tom Jives Tracy mccray is as you know. Headaches are really common in fact in the United States over fifteen percent of adults complained of a severe headache or a Migraine and in fact migraines affect some forty million people in the United States headaches are twice as common among women that among men and interestingly headaches are more common in younger people than those age sixty five and older here to talk about headaches including the latest treatments is Mayo Clinic neurologist Dr Beth Robertson. Welcome to the program. Thank you for inviting me. So let me ask you about your job. Do you spend all day every day. Seeing people who have had it. I do I deal so I have a background in both nerve and headaches but I'm interested only in the nerves above the neck all day every day. Those are my patients and are most of these. People have migraines or less strong. Majority of our patients do have migraines often very severe migraines that have been hard to treat with their local physicians. So they've had years of of difficult to treat headaches before we see them. You know before we talk about Migraines. Tell us about the headaches that most of us get from time to time the ordinary headed do call tension headaches a wider. We get common head so I think yeah. So what most people refer to talking about that ordinary or normal headache would be a tension headache. That's more of a a mild dull pressure type sensation on both sides of the head sometimes triggered by stress. Sometimes not sleeping enough the night before. And those are often treated with over the counter medicines. Which one's best so most patients prefer insides non-steroidal anti-inflammatory medicines like ibuprofen or a leave in the over the counter? Pain Medicine might be held for the suit of it opens. Okay do whatever works. That's right and most of the time people are able to function with those they take the medicine they go about their day and I never see them clinic when my kids complain about headaches or even for myself I just say drink some water and that seems to help. Maybe it's just get it gives you a little bit of time. Does do people get headaches? Because they don't drink enough water so dehydration can be a trigger for headaches often a trigger for migraine headaches and my son who struggles with migraine. I also tell him to drink some water as a first line but it's less common to trigger the tension type headache. I was surprised to learn that their forty million Americans or whatever. You're so busy kind of lucky. We got you in the studio forty million Americans who have migraines and it's eighteen percent of women and six percent of men much more common in women any reason for that so I wanna say to for those almost forty million patients. There's only about five hundred headache specialists. So we are quite busy but As far as why women? So the brain doesn't like change and Migraine. Brands are particularly vulnerable to changes in sleep changes in stress and changes in hormones. So women have those cyclic changes in estrogen around their obligation and menstrual cycles and then around pregnancies and as they get close to menopause. There's this roller coaster over their lives and that tends to contribute to triggering the headache. What can you do to fix or to help people who suffer from Migraines so there are a number of treatment options and would he would divide treatments into acute treatment so a treatment that you would take the onset of the headache and then a that they might take every day to reduce the frequency or the severity of the headaches? Those are preventative medicines? That you've got some new in both categories right. We do. Yeah it's a very exciting time for migraine. It's nice to be a headache practitioner these days because we have so many new options are classic options for the acute treatments have been as I mentioned sort of over the counter and then non steroidal anti inflammatory drugs. And then we've had trip. Dan's for many years now that we would use for patients but more recently. We've some newer classes so we have something called a g. Pant. We just came out you bro. Japan is the first one that's been. Fda approved that came out over the holidays and that is focused on a different pathway. So instead of our classic migraine paths that. We're trying to address now. We're focused on something called the siege. Erp or Calcitonin gene related peptide molecule. So right right. I know. It's a long road but see. Drp We've known for decades has been involved in Migraine. So we know that during a migraine. Cgip goes up when you treat the migraine. Cgip comes down and if you inject CGIP it will cause a migraine. So we've wanted to figure out how to disrupt that. Cgip pathway for quite some time and the preventive that we can talk about a little bit. If you'd like have been focused on that pathway. But in our acute medicines that's u-b-e-r Japan has been designed to block the receptor for C. Gop and seems like this is able to bring down the headaches in a way similar to the trip downs that we've been using for headache in the past but maybe better tolerated and maybe a little safer for some of our patients so our trip. Dan's were an issue for anybody with a heart attack or stroke because they constrict blood vessels and this new class this. Gps class does not constrict blood vessels. All right and the exciting thing also is those Three new drugs approved in two thousand eighteen to prevent my grades. Three different ones Do they work? Yes because no drug works in every patient but yes. These are also trying to address. Cgip pathway so there are three what we call monoclonal. Antibodies that are out so these are antibodies that are targeting in two of the cases. They're targeting the CGIP protein and one of them is targeting again. The receptor trying to interfere with that pain signal that we think is going on during migraine. And then there's another one that should come out later this year and so these have been given in a monthly injection form. There's also a potential for an every three month injection form if people are taking them over. Time about half of patients will have a fifty percent reduction in their headaches so it was pretty good. It's pretty good. It's pretty if someone has migraines they get find something that works. Then does that efficacy. Where away and after the move onto something else or if you find something that works. Are you set both can happen? Some patients do find that magic drug. Maybe one that we've already been using for many years. And they do well for years and then other patients may find that the effectiveness wears off over time and they require something else. And I don't want to miss lead. You know these see. Gop medicines are very glamorous but we do have a lot of other weapons in our arsenal as well. That can also help such as. There's another new one that I really feel obligated to mention. That's in the acute medicines. Category called last minute. Danettes a cousin of the trip towns but also does not constrict blood vessels so again. It's about finding something that's safer for. These patients that have really been untreated for migrant population. And then we also use bow talks injections quite regularly as preventative with good. Success Counseling Also part of the treatment for patients with migraine. Many of our patients do have associated anxiety and depression. And maybe they started anxious and depressed or maybe just being in pain all day every day which many of our patients are has lead to anxiety and depression. The problem is that that feeds back and that can worsen headache over time. So sometimes patients do require additional help addressing that either with additional medicines for depression or with cognitive behavioral therapy Sometimes Stress Relieving Activities Exercise Meditation Yoga. Things to help address that acupuncture overwork ever. Yes absolutely no question sometimes. Always know we're just have one more question the hang overhead. What do you recommend Blah Blah in clinic but You know hangovers are a multifactorial. So you have the alcohol toxins floating around actually triggering headache and then you have the associated dehydration that needs to be addressed separately. Drink some water. That's right and then You know alcohol interferes with the quality of sleep. The sleep architecture so sleep deprivation can sometimes worse than the headaches. Obviously you sleep it off. Drink water or maybe. Avoid the alcohol entirely time headaches and migraines common problems in a source of disability for a lot of Americans now fortunately treatments for Migraines are better and they're even some newer medications out there that will actually prevent migraines are thanks to neurologist Dr Beth Robertson from the Mayo Clinic thanks much. And that's our program for this week for more information. Visit the Mayo Clinic News Network for today's podcast and previously aired programs. Tweet your health and medicine questions to Hashtag male clinic radio. You've been listening to Mayo Clinic Radio on the Mayo Clinic. News Network producer for the program is Jennifer O'Hara for Mayo Clinic Radio. I'm Dr Tom Chives. I'm Tracy mccray. Thanks for joining us. Any medical information conveyed during this program is not intended as a substitute for personal medical advice. And you should not take any action before consulting a health care professional for more information. Please go to our website news network DOT Mayoclinic Dot. Org please join US each week on this station for more as a medical information you want from Mayo Clinic Specialists No.

prostate cancer Migraines Mayo Clinic Mayo Clinic Cancer Mayo Clinic News Network Headaches United States Mayo Clinic Radio Dr Derek Lomas UK kidney cancer Sports Cardiology clinic Dr Tom Chives Tracy mccray London Mayo Clinic Heart Dr Todd Miller France
In 'Mr. 80 Percent,' An Intimate Portrayal Of Surviving Prostate Cancer

On Point with Tom Ashbrook | Podcasts

47:58 min | 2 months ago

In 'Mr. 80 Percent,' An Intimate Portrayal Of Surviving Prostate Cancer

"Support for on point and the following message come from vertex driven by the promise and potential of science innovation and people vertex is dedicated to making a difference in the lives of people living with serious diseases like cystic fibrosis, sickle, cell disease type one diabetes, and more learn more at VRT x dot com. From, NPR. In you are Boston I'm Anthony Brooks and this is on point I was forty seven with two young kids and a good job plus my wife was devouring romance novels. So we were doing it again a lot. And then Bang. Prostate cancer. Two. Things. Die. If I live might not be the same man. What? I'm. Not. That's Mark Shanahan, the host of Mr, eighty percent a brand new podcast from the Boston Globe NPR ex. It tells the story, the deeply personal story of his battle with prostate cancer cancer Shanahan calls it a ridiculously common disease, but he realized men rarely talk about it because that requires uncomfortable conversations about impotence about incontinence and about men's private parts, which most men prefer to keep well private. But as mark learned if you have a prostate, you'll either die with or from the disease think about that. And prostate cancer diagnosis doesn't just affect men the lives of their partners, their children, their families change too. So if you were born with the prostate or if you love someone who has won. This story is for you to mark Shanahan is an entertainment reporter for the Boston. Globe has new podcast is called Mr Abrahams percent and launch. Just yesterday you can link to his story about prostate about his prostate cancer journey in the Boston Globe at our website on point radio, dot org and Mark Shannon welcomed on point it's great to have you. I mean, how are you? I'm very well, thank you and I'm very excited and happy to have this conversation. But before we start I've got off for a couple of disclaimers. Eighty percent was written and produced by Kelly Horn who I'm happy to say is my wife we also want to say that on points on Tim Skoog are talented, sound engineer, mix the podcast, and finally this for the next fifty minutes or so we're GONNA be talking frankly about prostate cancer and among other things how it affects sexual function and other related matters. which might not be appropriate conversation for our younger listeners. So with that out of the way mark, let me just dive right in first of all congratulations. It's a great piece of work congratulations to you too Kelly to everybody who had a hand in putting this together. I really appreciate that why on Earth did you want to tell this very personal story so publicly? Lt Honest I'm I'm starting to wonder myself. But truly Anthony My job is to tell stories and that's That's Paid that's how I make my living and so I'm always interested in good story. And of course, the sort of one of the the signature features of good stories, a surprising story and. I, you know when I was diagnosed with prostate cancer I was I was really floored. And I was Florida in part because I didn't know anything about. Prostate. I didn't know what the prostate was didn't aware was I didn't I didn't understand what the what the implications of prostate cancer were. It was just it was a completely new thing for me and what I discovered is that this is not a this is not a unique phenomenon to me. Prostate. Cancer is something that guy's. General? Public. People. Don't talk about. So I just I guess. At the end of the day I realize that if I was able to tell the story. In a way that was compelling and captured all of the absurdity and and and. Terror that. I should do this thing and thanks to Kelly, your wife and to Scott. Helman. Who worked on this as well? Enter, the the whole team and I think we didn't talk to I think it's a great and important story I to play just a couple of pieces of tape from the first episode. So this is Urine colleges Dr Anthony. Talking about this point that you just mentioned. Men's reluctance to talk about prostate cancer. Here it is. Suddenly. Men who were raised during the second war came of age in the nineteen fifties will keep down there. So choir, it just wasn't a subject for discussion not in. Nice Society you. Certainly share your experience with your buddies in share with women and you want to march on the streets advocating on your own behalf, but silence equals ignorance. And it's can kill prostate cancer was always I won't Clinton orphan disease, but it was always well behind breast cancer women march on Washington DC raised the profile of breast cancer in the eyes of Capitol Hill arranged funding, and then we just late to the game. and. Mark One more cut from episode. One British actor comedian and author. Stephen Fry when very public about being treated for prostate cancer in two thousand, eighteen in his candor. Led to a spike in diagnosis of the disease in the UK. So many men were inspired to get prostate exam. Here's a Frie- from episode one of Mr Eighty percent. There are so many things that human beings should be ashamed of cruelty lies deceit, duplicity, betrayal, abuse, and so on. All the things we do wrong but having a bottom genitals and all the goes and potatoes there too is not something which we should. Ever. Be Ashamed and for which we should ever apologize like mushrooms. These things thrive in the dock and the mold light you cast on anything to do with the genital urinary area. The mall chance people have of forestalling any disasters that Stephen Fry, who shows up in. Mr Eighty percent mark Shanahan's a brand new podcast about his journey with prostate cancer mark. One of the things you taught me in this is just how. To Use your language how absurdly? This disease is for disease that nobody wants to talk about. Tell me how common it is. well, at a you said in the setup that. Doctors like to say that most men will either die with prostate cancer from it one and nine men are diagnosed in their lifetime with prostate cancer. But many more men have it and don't know it prostate cancers extremely a treatable. We should say extremely a treatable disease and very slow growing. So you know I, it's I don't want to say I was not psyched to get prostate cancer but. You know there's been a just an enormous. Progress made in the research and treatment of prostate cancer but indeed it is and that's what makes the whole thing. So ironic is that we don't it is so common my father fifteen years ago was treated for prostate cancer. We never spoke about it. We didn't talk about the treatment we didn't talk about the effects that it had on his body. And it's a guy thing. It really is a guy thing right? It's a guy thing and I it sort of gets to the biggest fear about prostate cancer. So let's talk about that. When found out that you had it after your diagnosis you did what any good reporter does and you started googling like mad and learning about it. What was your biggest fear? Well. So. I'm what you discover is that the reason men don't talk about it is because prostate cancer treatment can have a catastrophic effect. On Your continents and your sexual function it just so happened that I was I was twenty years younger the average age diagnosis for prostate cancer sixty, six, I was forty seven. Treated forty, eight and And I you know. My wife and I. You know we have A. Healthy sex life in fact at that time. We. were. We were having sex again anthony if I just say, no, we put. Out there we're going to. Sex and. Also with me. and. Michelle was Reggie was reading romance novels and was totally great and so to be diagnosed with something a that you didn't do anything about and then. Disease that can really ruin. US actually It was tough I understand. So this gets to the question that I have to ask Mr Eighty percent where does the title come from the tell the story about how you arrived at this? So. So I think that you know one of the features of this podcast, we don't want to scare people who don't want to sort of. You know make them said. Even though there are certainly parts of this story that are sad and scary there also parts that are funny and absurd. Not, only after I was diagnosed with prostate cancer en. Mass General Hospital has a program for newly diagnosed prostate cancer patients where they have you come. In fact, they sit down with a a radiation oncologist and a surgeon I think there was an oncologist there as well and you know they basically they trot out there are various alternative treatments and you are meant to decide. But before we get to that point there's a nurse there and she asked me and Michelle is there with me sitting by my side and the nurse said before we. Get going here. Can you just? And this is a small office with you know, a lot of doctors nurse, my wife and myself and she said, can you rate your sexual function? How would you rate your sexual function today? At forty eight relative to when you were twenty one. And I said I don't know ninety on a scale of one to one hundred I said ninety. And nobody said anything. and. I looked at Michelle and. She was looking at the floor. and. She said A. Low. Eighties. So we. So we decided you know what Mr Eighty percent. And so that is but but it also speaks to this issue of you know. This is how men measure themselves. This is how men sort of identify. Themselves, as sort of the quality of their erections and in and that's a that's. That gets to be very difficult proposition, the older you get, and certainly when intervenes right absolutely MR eighty percent. So mark standby, we're coming up on a break and when we return one of the subjects I want to sort of pick up with you is just how this diagnosis didn't just affect you. This became a sort of family wide issue and it's a very powerful part of the story So stand by this hour, we're talking about prostate cancer with the Boston Globe Mark Shanahan whose new podcast is all about his experience with the disease. we're also going to talk to one of Mark's doctors a little later in the hour. So stay with US I'm Anthony Brooks. This is on point. This message comes from an points sponsor vertex fueled by the needs of patients, families, doctors, and nurses vertex drives innovation in every aspect of their business for a single purpose to transform lives from investing in new approaches and sell and genetic therapies to using a to support their research and day-to-day operations. Everyone at Vertex is committed to innovation. Innovation is how VERTEX will strike at the core of serious diseases to change people's lives and why they won't stop until they discover cures learn more at VRT DOT com. This is on point I'm Anthony Brooks. This hour we're talking about prostate cancer why we don't talk about it because of issues like incontinence, impotence, men's private parts, and so forth I'm joined by Boston Globe Mark Shanahan who is out with a new podcast Mr Eighty percent, which tells the very personal story about his own prostate cancer and a warning again to listeners, we are talking a very frankly about this disease about sexual function and so on and so forth, and so this might not be suitable for younger listeners. We just want to put that warning out there. mark I want to talk a little bit about how this diagnosis it didn't just affect you affected your loved ones too. So your audio, your daughter Julia was in junior high when you were first diagnosed. So I want to hear a little bit of the two of you talking in episode one of Mr Eighty percent. I think I just took it to like. Like he actually died I would basically lose my best friend. This is my daughter Julia she's in college. Now they say like we're not your best friend like where your parents by. Having. Cancer means you get a preview of what your kid might say at your funeral. You're the funniest person I've ever met I. Think one of the most supportive and hardworking people I've ever met and. I also think you one of the most intense people I've ever met and you have a very impressive career, and so I always like looked up to that and by impressive you mean I have talked to Bj. Novak. You took me to Taylor concert. She gave me her bracelet, right? So. So that's a cut from Mr Eighty percent I'm here with Mr, with Shanahan and mark that's really touching moment. But say a little more about that because you make this, you spend a lot of time in this podcast talking about. The effect that this has on your entire family, and by the way the way your wife stepped up in heroic ways and supported you and this is a huge theme about in this story. It's true Anthony that You know you just can't anticipate something like this and and again it's the nature of this disease that you know. This was something that as my surgeon says, at some point in the podcast, you know when you're when you're treating. Prostate cancer patient, you're really treating the couple. And So Michelle had a heavy lift Michelle, your wife correct. I should say right Michelle. My Wife. And she was Extraordinary and But so it's a learning process. For she and then in terms of our children. You well, I Beckett we would like to get back into the podcast but your son as fifty s fifteen year old boy now and You know we wanted him to say, well, we're going to have to talk about our penises and that was. He he just wasn't willing to go there. So again, it's it is. You know we say in the podcast that you get the cancer but everybody's life changes and you know I I don't think that unless you go through something like this, you can really appreciate what that means but I. Certainly do i WanNa talk a little bit about Get get you to talk a little bit about the course of treatment that you opted to follow. So so walk us through first of all the options that you had to consider. When you were first diagnosed well. So we want to also say that because prostate cancer. So slow growing and because many men who are diagnosed are much older I think that people should think very very carefully before embarking on any treatment that there is something called active surveillance, which means we watch it we pay attention to it. And but but. For Myself I was young I had two kids. I had forty years may be to live and. I had a gleason score, which is a score after they give you your biopsy and take a look at what's happening they grade basically of the severity of the intensity of your cancer in mind was seven. Out of ten that's considered to be intermediate I guess you know the options for me were to watch it to have surgery. Or to a radiate my prostate and. In, the end there have been enormous advances in the treatment of prostate cancer over just thirty years. If I had gotten prostate cancer fifty years ago. I. would be rough rough rough. And not just for me every man who had a prostatectomy which is surgical procedure to remove your prostate. before nine, hundred, eighty, two, left the hospital impotent every single Guy which is just incredible to me because nineteen eighty two is not that long ago. Right, it is incredible. So you went for the surgery but I did but that wasn't the end of your ordeal surgery. It turns out we learned didn't get all the cancer. So you had to go back and sign up for pretty radical course of hormone therapy, and this is really the most excruciating part of your journey to read into here about you describe it essentially as a kind of. Chemical. Castration. Well. Indeed and I don't just describe it that way. That's in fact what it is It removes the testosterone from your body and the reason that we do that is because it's the thing that feeds the cancer prostate cancer. Grows Thanks to to Saas thrown. So if you removed from your body to cells cancer cells week in some cases they die and then when they're at their weakest blast them with radiation. The problem is that when you take a testosterone out of a man's body it is a as you say excruciating I became a different person. ahead you know the the euphemism is mood swings. I didn't have mood swings had a I had tantrums and I will say that I was on the phone this morning, the guy who listened to the first three episodes of the podcast and. He. said, he'd never talked to anybody about his course blueprint and he was arrested he actually got arrested. Because a parking garage. because. He could he he got completely out of control. So it's scary. And and you know now as I sit here. There's you know at this surgery if if the prostate cancer should return, there is no surgery there is no radiation. Those are no longer alternatives. and. The prospect of more loop ron or any kind of hormone therapy is really terrifying mark. You're honest in this podcast in and you tell a story in there and we heard from your daughter Julia just about how difficult this became when you were on this loop Ron Therapy and you tell the story of her eighth Grade Graduation and where you pretty much. Fall apart and and She loses this moment to be photographed in her right of passage. It's a it's a very, very sad story, but I'm just wondering what it was like for you to make that decision to go public with that to hear your family and friends describe. What an unbearable person you became. Well. You know. Here's the thing I really don't have a lot of. You know. Again it's a good story and I'm interested I'm interested in A. After a drinker to these are the stories that I tell and So when somebody at the globe said, you know you got an idea for a podcast I said you bet I do. But I in terms of like. How others will view me and? That sort of thing. I I really don't care. It doesn't that doesn't concern me what's really weird also is that. I didn't do the podcast right the story really yet of any. Sense of. Its crusade that I'm on at all however now that it's out there and emails that I'm getting in on the phone calls and the and the feedback, it's it really is very gratifying. To think that there are guys who were like me. But have no outlet to and no desire to they won't talk about it but they WanNa talk about me. Mark, I want to bring in Dr Mark pomerantz. He's an oncologist. He's one of your doctors through this ordeal and he joins us from the Dana Farber Cancer Institute in Boston Dr Pomeranz Welcome to on point. Thanks for joining us. Oh. Hello my my pleasure and I want to congratulate mark on such a terrific piece I been seeing patients all morning here and everybody's talking about it and at the peace already has been very helpful for some of my patients they're bringing up things that that we hadn't talked about until today such as. Such as. Some of the side effects that they're they're feeling on hormonal therapy I had a patient this morning. Say You know? I have noticed that I've been a little bit. I've had a shorter fuse and and I probably my wife and I should probably talk this through a little bit more and. And and and. I made a referral. They're going to see our social work team and it's something that I don't think would have happened without without your work mark. It's really congratulations doctor. I want to ask you about some of the stuff that you say in the podcast which. Is Really Mind Blowing I. Think it was you that has this amazing quote where you say if you took a collection of average guys off the street and could magically sort of pull out pieces of their prostate and chop them up and look at them under a microscope most of them would have prostate cancer. That's right. We know this from the old days when we used to to routinely do do autopsies on on people who die in the Hospital of natural causes, and we know that when we look at at prostates, in American men who live long enough most of them are harboring of prostate cancer and this is what makes this disease so tricky and makes the idea of screening for the disease tricky because we know. If we go around looking for it, we're going to find it but also know that as we walked down the street, we don't see men dropping dead left and right of prostate cancer even though they have it because most men die with it not of it and have to be very careful if we are actively looking for it, we know that that a substantial proportion of the time we're going to find it unnecessarily. On the other hand, prostate cancer is the second leading cause of cancer death among men. In the United States we really need to find those cases out there that are curable and need to be cured. So this idea that's very dramatic that the that mark articulates in the podcast that will that we will either die of prostate cancer or with prostate cancer. How should that inform how we check for it? I? Mean, my guess is that most men listening have had a prostate exam, a physical exam but there are also PSA test Tell us sort of how we need to be thinking about that. That's right and The thinking is evolving and has been evolving for decades now since since the PSA test of blood test. That you just mentioned, and that's Damn survey prostate specific. Specific Antigen prostitutes marker that prostate said, all prostate cells normal and tumor prostate cells have and gets spilled a little bit into the bloodstream. Its exact function is not entirely clear but it is a very good marker of the volume of prostate tissue in the body. What makes it a little? Fraught. Is that because normal prostate tissue makes it, it's very difficult to distinguish the PSA that's made from normal prostate tissue in PSA it's made from from tumor tissue. So it's not a simple test and does require a little bit of sophistication and judgments when whenever we see a PSA a result, we have to take into consideration the size of a man's prostate, the man's age on the man's family history, and so it's not a test that is as straightforward as are other, very important cancer screening tools like a colonoscopy or even as as challenging as it sometimes is mammography of for for for women. We asked listeners to leave us a voicemail sharing their own experience with prostate cancer and I want to share at least one. This is listener Bob Porteous Portland Maine he left us a voicemail and he said years ago he started showing high levels of prostate specific antigen or PSA here's what he said. I had several biopsies done. You know the showed? No cancer. And the doctor checked my prostate every year. And the PSA test kept coming in much higher than normal, which normally means that they're likely have cancer. But after all this time, the doctor has become very comfortable that I do not have our nose on cancer and unlike the get it and it's my understanding that about ten percent of men have high PSA's but don't have prostate cancer. Doctor Palmer's that sound to you ten percent have high. Cancer. That is correct. All men's prostates get bigger as we get older A condition called BPH happens to most men some more than others and we know about this because we can't avoid the commercials for it on television. Win The prosecutes big. It makes PSA and when we when we see in the PSA need to make certain that we're not dealing with a potentially dangerous prostate cancer. So the in in the in the case that that we just heard that the search was on that unfortunately often means of biopsies which are are not pleasant to to to biopsy. It's never pleasant of that biopsy the. Prostate we do we we. We do have new improving tools to help us out in cases like this imaging of the prostate gland is getting better and better and The MRI's are often helping us out in cases like this, where we can use the MRI image to direct where a biopsy may go or to provide reassurance that we're not missing some some big tumor on our blind biopsies. So mark. I WanNa ask you I mean and work. We'll get the sort of medical response to this question from Dr Pomeranz but what's the prostate four because I mean that was sort of questioned one or two or three that you had to answer when you were first diagnosed. Truly and it's shocking the answer shocking shocking that you don't know Anthony and frankly. Because I've listened to the. Okay. So So yes. I. Had no idea that it actually. Creates ejaculate the the sort of the component parts of semen. Not, the sperm the semen and so I had no idea what that meant if you remove the prostate. The significance of that. Well, we'll talk about that. After the break, we're talking about prostate cancer and a new podcast from Boston Globes Mark Shanahan about his experience with the disease. It's called Mr Eighty percent. You can lick to link to it at our website on point radio. You can also linked to a fabulous piece mark wrote yesterday in the Boston Globe about this experience Mark Standby, Mark Pomerantz, standby We're going to come back after a short break. I'm Anthony Brooks. This is on point. This is on point I'm Anthony Brooks were talking to the Boston Globe Mark Shanahan host of the new podcast Mr Eighty percent about his experience with prostate cancer. We're also joined by Dr, Mark pomeranz oncologist at Dana Farber Cancer Institute in Boston and mark pomerantz before the break mark. Shanahan. was talking about what we understand what the prostate actually does but I understand as well that there's still some mystery surrounding it I mean do we understand everything about it or what questions do we still have about? Mark is right that it does provide some of the critical fluids that go into the semen that helped the sperm, make it to its destination. Helps the the sperm survive. and that that seems to be its most important function. It's. Pretty big in US compared to to to other mammals and why that is is. Is, is interesting WE WE? Amend of Homo Sapien, men certainly compete with one another for made. So we do want the best most high quality seem possible in that may account for some of the the increase in size of the prostate and it may be. Our big prostates that that puts us at such high risk for prostate cancer as we age interestingly, the only other species that that naturally gets prostate cancer at any appreciable rate or dogs who share our lifestyle and diet, and so they're certainly maybe a component they're contributing to our our cancer risk but. A other than those functions there isn't a an important role that were aware of. Well I want to talk a little bit about risk for prostate cancer. We know that family history is a significant re actor Mark's Dad had it mark? Had IT We know that race is a significant risk factor as well. Black men are seventy six percent more likely to get it than white men and twice as likely to die from it. So we're going to bring in one more gas in this conversation Tom I often he's a former it executive who lost his father uncles and grandfather prostate cancer. But before time joins US I WANNA play a bit more from the podcast when Tom reflects on his own prostate cancer diagnosis. I really blame myself as a man that was supposed to be pretty smart knowledgeable for having such a lack of knowledge about the disease that have been so rampant within my family. Finding at you have cancers like being kicked finding that you should have been looking for it is like being kicked when you're down. What did you know about this thing literally nothing Literally nothing and never had a conversation with my doctor about prostate cancer or prostate cancer risk. So when I was diagnosed I didn't know what it all meant I didn't know anything about. The, different prostate cancer treatments. Farrington was alarmed. What else did he need to know about the disease? What else did Blackman tomorrow we data rate to three times greater I did not have the knowledge before I was diagnosed and even when I was diagnosed. So. Joining us now is Tom Farrington. He joins us from Quincy Massachusetts President and founder of the prostate health education network Tom Farrington. Thanks so much for joining us. Anthony Thank you for having me sure you're on with Mark Shanahan as well as Dr Mark Par Pomeranz but tell us a little bit about your experience and really what's become a clause for you getting the word out about prostate cancer. What's your message? When my messages that knowledge is the best defense against prostate cancer. And when I was diagnosed, I had zero knowledge about the disease. And, my father had died three months before nine those with the disease I my father died Christmas Eve. Nineteen, ninety nine I was diagnosed with the disease in March of two thousand. and prior to that, I had actually lost both my grandfather prostate cancer but you know we never spoke about it and as I indicated in podcast. Another never had a conversation with my doctor about the disease So I was diagnosed I was actually floor and because of my family history I looked at it is kind of you know this is this is the end of the line I will probably travel the same path. As as my forefathers and anti from prostate cancer right. So so it's interesting mark hearing Tom talk about it I mean I want to get to the issues that are specific to the African American community and how the risk is higher but he described the same thing that you dealt with your dad had it. You're at risk you didn't talk about it. You didn't know about it until it afflicted you correct and and you know and I think I also. Did. Say that it's just it's it's it's a common phenomenon. That men who had every reason to know about it I mean whether you have a family history or not given how common diseases you really ought to know about it or you just pay attention and then they the notion that you have a family history and you still don't own anything. And it's not good. Right. So Tom, Farrington, can you talk a little bit about? Is it your experience that most black men? No this appreciate these facts or is there reluctance to talk about it? What's what's your experience? Well, there is a lack of knowledge and a reluctance to talk about it and I think. To go hand in hand. because. If as a population that is at highest risk have the highest incident and different We weren't to talk about it and really really sound the along within our communities. I think more black men with know about it and be prepared with enough knowledge to kind of navigate treatment and living with the disease my situation is is. Is Very similar to mocked I was diagnosed with a would would with a what a gleason seven s he was I had chosen to have surgery His daughter was graduating from high school. My daughter graduated from college enter time I put off surgery for a couple of months until my daughter would graduate. But during that time I decided to study prostate cancer. And learn as much as I could and in doing. So on the day that I was to enter the hospital at my babe was prepared on the day that I was ended. I spoke with my doctor told him that I was going to have surgery because based on my analysis it was less than fifty percent certain that surgery alone would carry me. So therefore, I was walk away from the surgery and studying the disease more, and then I ended up taking a dual radiation program. Can I, how how are you doing today? Well, I am I am twenty. What how many years? I am it is now. It's a it's two thousand twenty survivor congratulates doing fine north I'm really glad to hear that. Mark Com pomerance. I'd like you to talk to this issue. Black men are seventy six percent more likely to get it than white men. Do We know why? We. Are. Learning a lot in fact Tom and I were just talking about this this week. We we know that men of West African ancestry are at higher risk for prostate cancer than any group we've looked at around the world. There does seem to be a genetic component to this risk. There are genetic markers that have been discovered that seem to be uniquely associated with a West African ancestry associated prostate cancer. However. We also know that African American men. Do not get PSA screening at the same rates as the rest of the population, the United States, and often don't receive the same upfront treatments which is A. Tragic shortcoming. in in our system that said and Tom, and I just had we were just discussing this. The response rates to treatment are just as good and and the effectiveness of surgery radiation. Downstream treatments are just as potent in African American men as any other group on. So there is an issue with access to care as a wet as well as a genetic component to increase risk of developing the disease. Tom Before I let you go I. Know You're committed to spreading the word about this in your the founder of the prostate health education network. Tell us a little bit about what that does. Well When I was being treated Anthony I I. Talk to many other men who like made didn't know anything about prostate cancer. So I decided to write a book. and and I interviewed a number of those men that were in treatment, woodmen and one year after I was treated I released my first book called battling the killed with them and and isn't that book I have a whole chapter on Salads and the system flawed and So one of the things that we do at Fan PROC- hit education that work is really trying to increase the awareness and understanding about disease So we have a number of initiatives that we undertake a the country within African American communities working with community organizations, churches, and Other. Organizations pulling together survivors and other leaders to help get the word out about the risk for prostate cancer, the word out about treatments for the disease, and also the word out about an including clinical trials So we've been doing this I've found it fan in two thousand and three, and so we've been doing this now for seventeen years we we see a lot of progress being made, but they're still just a tremendous amount of need there you when you look at the different disparity ban more than twice that all man, we have much work to do but. We out every day trying to make a difference, Tom Farrington president and founder of the prostate health education network, a survivor of prostate cancer. Thank you for joining us today and good luck to you. Thanks for being on the program. We really appreciate you. Dr pomerance. I'd love to come back to you and just ask you generally one of the points we've made and mark makes it. So well in the PODCAST is how treatable this disease is in general? Can you talk a little bit about the prognosis for people who are treated? How does it work out generally? Generally speaking when we diagnose new prostate cancer. The first question we ask and and and part of the initial surges deterrent is to determine as best we can whether the disease is confined to the prostate or the disease has spread or metastasized beyond the prostate. If the disease is confined to the prostate, it is generally curable. Some prostate cancers even when confined to the prostate or more aggressive than others. But generally when when the disease is all corralled within the prostate gland. We can cure it with surgery. and. Radiation Therapy. On It's a the radiation therapy can get a little bit more complicated because as mark described so. Accurately and. With great depth in his in his in his piece in his podcast radiation therapy a is augmented by hormonal therapy. And those are the general tools that we have for curing prostate cancer that's confined to the prostate when Their win when the disease metastasized beyond the prostate we rely on a an array of medicines, a much wider array of medicines than than we had when mark and Tom were both diagnosed but but it's no longer curable at that point I see well Dr Arnn Pomeranz they're going to let you go I've got important work to do. We're really grateful that you're joining us today. Thanks so much and my pleasure. Thanks for about this really good having you and Mark Shanahan. We've got a few more minutes left and I want to just. Here's a spoiler alert you live. So, how are you doing? Well I'm I'm okay. I have to go. And make sure I'm OK every six months I have to go to dinner farber and. And have my blood checked and I will tell you that the experience of going to Dana Farber Cancer Institute is. It is. Enlightening and it gives me a great deal of perspective on my own situation It's. I'm never excited to go but when I am there I, see the. Children in many cases, children. At a six thirty and seven o'clock in the morning there in the lab. A.. Either Post treatment pre-treatment, whatever it is and their commitment to living It's it's incredible. So it so You know I'm okay. Okay can I? Can I ask this question is Mr Eighty percent back. Well. So yeah of course Mr Eighty. Kidding me I contend that I was not mr eighty percent with. Mr Ninety percent has been. You've got it. Got It. Okay. How did this experience change you? Good question. I don't know. That the experience of. Telling, this story. was part and parcel of the experience of getting the cancer. And going through the treatment I do feel as though it's all part of the same deal. Cancer. You know people like to. Say. You. Know a F- cancer and that sort of thing and I feel as though by telling this story, I'm getting the last word here. And that's that that feels important to me to to to share the story with guys anybody who has a prostate. Anybody who loves somebody with the prostate and you know just just talk about it I mean really it's crazy. The number of people who've checked in and said, I can't believe you did this I mean. It's it wasn't that hard it's a good story well. I'm into that. It's a great story Mark Shanahan Boston, Globe reporter. He's host of the new podcast Mr Eighty percent you can link to it at on Point Radio Dot Org was written and produced by Kelli Horan mark. Shanahan thanks so much for joining us. Thanks for the PODCAST. Thanks for getting this word out it was really great having you on the program. Thank you. Thank you Anthony. And good, luck to you and listeners You can continue the conversation. You can get the on point podcast at our website on point radio DOT org. You can also follow us on twitter. Find US on facebook at on point radio. The program is produced by Anna Bauman Jonathan, Chang Melissa Egan Lena Mata Martin Kessler Britney Knots Liam knocks Steffano. Katsoulas Hillary mcquilken James Ross Tori Shammar Tim Scott Grace Chatter and Sydney wartime a talented crew. I'm Anthony Brooks this is on point.

Prostate cancer Cancer Mark Shanahan Disease Mark One Dr Anthony Mr Eighty Dana Farber Cancer Institute Anthony Brooks Boston Boston Globe United States reporter Mark Shannon Tom Michelle President and founder Mark Dr Mark pomerantz Kelly Horn
New Non-Invasive Surgery for Prostate Cancer Using UltraSound

OC Talk Radio

34:38 min | 1 year ago

New Non-Invasive Surgery for Prostate Cancer Using UltraSound

"Hi It's Jamie progressive's number one number two employee leave a message at the Hey Jamie. It's me Jamie this. Is Your daily Pep Talk. I know it's been rough going ever since people found out about cappella group mad harmony but you will bounce back. I mean you're the guy always helping people find coverage options with the name your price tool. It should be you giving me the pep talk now. Get out there hit that high note and take mad harmony all the way to nationals this year sorry it was pitchy. Progressive Casualty Insurance Company and affiliates price and coverage match limited by State Law. Hey welcome back. It's time for another episode of the O C spotlight. The one show that takes a look at the most incredible people doing the most. It's amazing things right here in your own backyard and today well. Is You WANNA listen up on this one because this is something that if it just affects guys certainly on our minds as we get older here. We're talking about a serious subject but a positive unique way to handle that surgery subject. You're talking about prostate cancer. Yes don't turn off your tunes yet here. We got some hope for you here. If you've experienced any of that or the fear of it or are wondering about how to treat we've got some experts in the house today here starting with Dr Robert Puga from the Pacific Coast Urology Center right here in our sky. Welcome Sir thank you. Thanks for having me. Why do I have to call Dr Sir. I'm dating myself. Your doctor is somebody we look up to. We respect and you certainly have achieved saved a lot. Tell us about the Pacific coast to rollins center overall before we get into the specifics of what you're doing. Their Pacific Coast Urology Medical Center is over thirty thirty years old I've been practicing urology for thirty four years now and several years ago we also have formed an organization called Western States Hifu I fu to help guys deal with prostate cancer and it is focused on minimally invasive or noninvasive ways of treating neurological conditions and so we avoid large surgical procedures we avoid the side effects and complications of many of the older therapies and allow guys to have treatments that it really have minimal interference with normal life and getting back to normal activities quickly. I can't think of any surgery I would fear more than prostate. Take Cancer here my dad. My late father suffered from it. So many men do is it. It's something that more were more likely to experience during the older we get I'm in my sixties here and my doctor's always saying Oh. We better test for that every year here. It's good that your doctor says that you're right. It does happen as we get older but but interestingly the youngest record case right now is in someone who is thirty three years old so we seem to be diagnosing it at earlier ages question is because were better at diagnosis or is there something in the environment that is causing that and I think it's probably a bit of both okay so when it appears the normal procedure is what you go in and operate on the most sensitive part of a man's body here we do but we have tobacco up a little bit. The first issue is how to find out if you do have prostate cancer okay and September is actually national prostate cancer awareness month. It has been that for decades and it's a way to encourage guys to come in and have the proper testing to see if they do have prostate cancer and there's two things that need to be done one is a blood test called the PSA or prostate specific antigen and it's an imperfect test. If it's not normal doesn't mean someone has cancer but it means. There's a possibility but there are other causes that make it abnormal and in addition we need to do an examination of the prostate call the digital rectal exam which most guys shy away from politicians the name of it scares me here now. At least it's digital not analog but it takes about five seconds to do and the reason and we wanna do that as many prostate cancers have normal. PSA blood test so we could miss them if we didn't do an examination because that's normally what they do the what's PSA stand for energy remembered that somehow you gotta get a PSA test in tough above a certain level you're in a risk of having prostate can't exactly actually it's not a very good had named prostate specific antigen number one. It's not specific to the prostate and to it's not an antigen but otherwise it's a great name but nevertheless it's the best that we have right now and it does allow us to diagnose a lot of men with prostate cancers at an early stage when they're easily treatable and curable so again the normal process process is what you go in hateem say the word because everybody will will giggle but it's you take your penis new stick something in there and clean it out my dad crudely described it as a as a rim job or something or you know he was he went in there and just cleaned it all out here. It was horrible well well. What you're describing is the odor procedure yes right and that's actually for something else. That's for the benign growth prostates that caused us to wake up at night to urinate and give us a slow stream. Maybe leaks Muren right. This is different. This is prostate cancer and actually one of the problems of prostate cancer. One of the challenges is at it doesn't give us any of the symptoms that we see with traditional benign prostate grow so it's a silent cancer and oftentimes not experiencing. I typically say suddenly there's something blocking the flow. You can't p very well here. It's hard to go at night here exactly and so because of that that's why screening is important because if we wait until their symptoms which often times is bone pain because it spread to the bones or other structures it's too late and too late means today way it means that you can't be cured from cancer and in the United States this year. We're going to lose about thirty two thousand men to prostate cancer death see I find that amazing. It's similar to what my wife always talks about with breast cancer. It is something that easily didn't not all cancers are that but there are some that you can detect and get at early and if you get to them early enough. The chances are survival or high right but we don't do it. Is it just because we're afraid to know I kind of fall into. Oh that category if I don't know I can't be sick. I think guys are a lot more reluctant to find out if something's wrong than women. I think women are much more proactive when it comes to health both issues a lot of the guys that I see in my office. Are there because women have said to them. I want you to go in and get screened right. Right and guys are tough and is nothing wrong with me. I'm okay and I'm just going to gut it out and so I don't know if it's the little kid nece doesn't want to know or the big adult that things were tough and strong and brave and don't WanNa do it or is it the fear of having to do this. I mean you're going to have to operate on something that I don't really want anybody to touch and operate. I'm here that sounds a horrible to me so the idea that you guys have come up with his what you've come up with this hot this you call it. Hifu which sounds like a Japanese acronym in Him but really stands for high intensity focused ultrasound ultrasound. You're using to dissolve it as a break it up and how does this work well. It's interesting that you said it sounds like a Japanese acronym because the urologist who I taught us that we could use Hifu for prostate cancer was professor Assu Cheetah in Tokyo three. I knew he's a very wise individual because Hifu was actually invented for benign prostate stake growth but he taught us back in nineteen ninety nine benign meaning. It's not growing anymore is at define those try. Another is saying benign or I forgot the other. The term that's growing so noncancerous is probably a good definition of benign okay but it is a growth so he taught us that we could use this for prostate cancer and one of the challenges with prostate cancer is number one is you just alluded to getting guys in to be tested because of concerns about the effects of treatment and to the effectiveness of the treatment so the traditional ways of dealing with prostate cancer have been either radical surgery and radicals always a scary word yeah right right or various forms of radiation and with radical surgery at a minimum guys have a thirty five percent chance of permanent urine leakage afterwards. God God about the other one. Maybe I'm being too scary here. Something guys are so frightened of erectile dysfunction and not being able to be you know this true guy. Does that does that affect any too. I mean are are we damaging your your gear how to describe this in a polite way or Here's an interesting word. We'll go with that so let's say there's an automotive guy over the years and functioned well. Let's have a fifty to ninety percent chance of year malfunction afterwards awards and that's permanent. That's the problem so we may joke about it a little bit but stopped to think about facing a treatment that Yes could cure your cancer but for the next twenty twenty thirty forty years you're bring pads or diapers and you can't have any intimacy yeah. that's huge with has caused a lot of guys to look for alternatives. Yes the more traditional traditional ones being some form of radiation and radiation comes in many different forms protons to seeds. Something called a gamma knife for cyber knife. There's about seven seven different types and and the thing I'll stop you there for a second because somebody described this once that I thought it was an effective way and I hope this doesn't offend you because your doctor but it seems like we're we're using radiation of some sort to treat most cancers to try and what what does it do with a tax breaks down somehow or whatever it it it destroys is them in some sense but it's like using a sledgehammer to get out a sliver. I mean it's not very focused. You're trying to get something you're over radiating in the section of the body and that's what makes people so sick in large measure you're spot on certainly in the pelvis where prostate cancers cancer live because of scattered radiation and because of fairly Whitefield that we treat we can damage other structures and it's hard to get enough radiation directly flee into the prostate to give a permanent cure so the recurrence rates with radiation can be quite significant and the problem is afraid of nation comes back actually prostate. Just a cancer comes back after radiation. We don't have any good answers Jerry Brown. Our last governor was good example that Yeah Jerry's cancer was diagnosed. Prostate cancer was diagnosed in two thousand twelve five five years later as PSA was going up he had biopsy showing more cancer and he said at the time that he was going to have more radiation but that wasn't true because you can't have more radiation. Let me give you the maximum dose so if you have surgery after radiation you have no control of urination just pours out in your in diapers all day long yeah so you end up going on medication that takes away all of your testosterone imagine waking up every morning without testosterone. You don't want to get out of debt know exactly who is no energy. There's no focus so my radiation. That fails is terrible situation. Which is why treatments like. Hifu are such a wonderful alternative now okay so you scared me about the traditional wait. Give me some hope for this new technology. Is this something that you guys are. Pioneering is is something that you do unique here in Orange County or is this become an accepted alternative to a widespread alternative to traditional invasive surgery going back to nineteen ninety nine when professor who Cheetah said we could use this for prostate cancer little by little. It's been accepted throughout the world and over the decades that ensued dozens dozens and dozens and dozens of countries adopted the treatment of hyphen. We were kind of late to the game. The United States for a variety of reasons are. FDA took a while to approve. It and it wasn't wasn't until late two thousand fifteen when they said it was okay. Wow recently okay. We were at that time. I believe the forty six country to adopt it so I I am let me seem to lag in lots of things. I don't know specific empath always saying there are alternatives available in other countries and people sometimes go to Canada Mexico. Soco's someplace or whatever to see treatments that we still have an accepted here that do work in and are accepted not places and indeed. That's exactly what I did and not a lot but several other urologist did so on a monthly basis we would literally literally leave the country and traveled to Canada Mexico the Caribbean Europe and treat our patients. They would fly with us. We will treat them and then come back with them because we were not allowed to do the procedure here and so I started doing in this almost fifteen years ago and amassed a fair amount of experience now and it's been a lot of time spent working with the folks folks the engineers who make this equipment to help them improve upon it and get it to the point where we have a pretty amazing technology today all right well. Your partner in in this process here has been silently sitting here and listening to all this. Let's welcome him in for a moment Ross and his Balsano Africa Dazzling Elson say real quickly Bolton. Yep you do what you're the you're on the HIFU part of it. You guys somehow manufacture produce the equipment to do this. We actually bought it from the manufacturer we we own it in conjunction with partners and we provide got it for our physicians to be able to use to treat patients and is there anybody else in Orange County doing this or you the the the lone pilgrim in this process here I mean for for the Doctor Sense. Are there are lots of doctors doing this now or is this still pretty unique to what you're doing. I think it's safe to say we do ninety nine percent of Haifa okay now. Let's talk about Hifu because I like the idea high intensity but focused because that's what I fear about most cancer treatments sits a sledgehammer. You'RE GONNA not just go after the the small section where this cancer growth is happening but you're gonNA radiate everything and I'm GonNa get sick and damage and problems talk about the high intensity focused ultrasound to us. What is it. How's it work? Okay so instead of getting the scattered that you get with radiation creation and a good example of that is if you ever look at a drop of water as it hits a puddle. You'll see that the radiating droplets that that doesn't happen with Hifu Hifu takes an energy beam initially shaped like a triangle. The base of the triangle has a lot of diffuse energy and the phenomenal all software and transducers that we have will then focus that to the top of triangle and that's where the heat is produced. If you think of what you might I have done a child where you're outside on Sunday with a magnifying glass in a lengthy Roberson suggests you're taking magnifying glass you taking the light near focusing into this beam and you're burning something thing. Elif or whatever exactly but you're not burn anything in between and if you put your hand under the magnifying glass just to get out that's true yeah. I've never thought about that yeah exactly right well. This does the same thanks so it passes harmlessly through tissues until it gets to the area that you're aiming for 'cause. It's finally when it's focused. It's that end of the being that gets hot. It's not the not the accumulated top of the funnel here exactly and the top of that triangle is approximately the size of a grain of rice. We can actually move that grain of rice infractions of millimeters. That's how precise this is and so I'm not over radiating. I'm not over burning. I'm not over attacking the rest of the body here. You're exactly you're treating exactly what you're focused on and nothing more now that can be the entire prostate if there's a lot of cancer the throughout the prostate based on biopsy results or an MRI that can be half of prostate a quarter of a prostate a the size of a p area area prostate prostate. I don't even know it varies when we're at age. Twenty five is like what gland or something yeah. It's the prostate and really what it is for reproduction. It's a common channel offer urine and for semen okay once we're past our reproductive years it has no particular function and at age twenty five. It's roughly the size of a walnut and little by little it starts growing and it can grow ten percent fifty percent can go to the size of a grapefruit some goodness yes burn it does dissolve it as a break it up what is. Ado with that focused end of the beam here. Every three second burst of ultrasound energy will raise the target temperature to somewhere between ninety and one hundred degrees centigrade so we are super heating the tissue and there are no cells of any type B they cancer cells benign housing can withstand and survive the kind of Sir. You're breaking it down your dissolving destroying. It disappears break. We're destroying it but it doesn't disappear so after each three second burst. We have of an area the size of a grain of rice. That's now dead that there's no viable tissue in there okay little by little that goes away either when somebody urinate settled pieces can come out or the lymphatic assistant will digest that and excrete it and at the end the area that we've treated is just two cavity. It's gone I gotta think about that image because that just seems so the amazing and so obvious as opposed to going in with a knife and trying to cut it out or going in with dangerous radiation and trying to kill it that way it seems so much more logical to focus your energy focus your beam on a small part and you're doing this through the body saw. Am I correct. There is no incision which means there's no blood loss zero and there is no incision so we're able now to move ahead move forward with technology in the old days when surgery was all that we had that's what we did. We'd advanced from large open operations to robotic surgery but it was still surgery surgery. I we've gone through all these different types of radiation but what you've seen is because of the recurrence rates with Radiation Asian because of the side effects of surgery guys have reluctantly said. I don't really want to know if I have prostate cancer and many have said if I do have it. I don't want treatment yeah. No that sounds unbelievable but I know guys I I might fall into that category myself here. The treatment sounds hyphen. You'RE GONNA die. I don't know why it just seems so horrible so awful so many side effects and so many downsides that you just can't deal with it. I don't know any urologist in myself included who do not have patients whose cancer we cured twenty years ago but they've hated us ever since because of what we've done to their lifestyle yeah now with Hifu Hifu that changes now you have something that allows some to have their cancer treated cured and they move on with the rest of their life and my family is a good example that I had a very close family member for twelve years ago with prostate cancer who had Hifu twelve years later he's cancer free and everything works and I followed in his footsteps two and a half years ago when my prostate cancer was diagnosed and I was sure I was going to get it because a family member had had it yeah right so my risk was higher. When my cancer was diagnosed I had my Hifu treatment treatment. the day after treatment. I was on an airplane flying home the following day. My wife and I just took it easy at home. The next day we were on a plane to the East Coast for family family event no pain no downtime because there's no incision this incision as we get older determined to recover from insures okay so you went through this yourself. What do your friends say in the industry. Come on the other the other people who follow your profession here well one of the unfortunate thing. Some of them said was she. Maybe I should be tested for prostate cancer because docs think were immune from thinks some superman you know so some of them fortunately did get tested some some of them. I know had had radical surgery and had the side effects of surgery. There is another physician who also works with Hifu prostate services who who did what I did. We we're apart group of Docs who have had cancer and had hifu treatment four because we believe in the technology and know that it works so why by by the technology was it because it I'm sure there was an economic opportunity here you can sell it to others or was it something that you wanted to perfect and make AAC even better or you couldn't get access to the equipment so we gotta do it ourselves or what led you into producing this other company here which is Hifu prostate services the company that actually makes the equipment actually hifu prostate services is a company that purchases machines from the manufacturer when you factor and then they set up individual centers throughout the country they're the largest provider of Hifu services. I think in the world right now you're like a distributor of the equipment Antara I'll let Ross entered I say more of a service provider than a distributor distributors actually selling the product on and we're actually owning the equipment and and letting people rent and use it so they they lease it from you because I'm sure not cheap. All these machines are quite expensive and they were made it cost is prohibitive for people to buy into them and so you know nobody wants to pay for a big expensive piece of equipment on their own typically so you know we may may Martin train of the other stuff. Yes we provide all the services technical services behind it and the financial services behind it that that go along with running a piece of equipment and running a small business. Each one of these little pieces of equipment is basically its own business unit. Give me rough idea with the cost ballpark here ballpark. You're looking about a half a million dollars for one little piece of equipment and how big and I don't know what it looks like. It's you know it's the size of a I would say. It's the size of a small mall refrigerator turned on its side. Okay so you know it's big. It's big. It weighs about three hundred pounds. It's not like something you could throw in your and it has some sort of tackle arm. I'm I'm trying to picture what it looks like. It is actually a couple pieces involved. There's there's the big computer system which is a giant box with a with a keyboard and a screen attached to it and then the actual actual arm itself is attached to the surgical bed and that is sort of a robotically controlled piece. That's in contact with the patient and that's where the transducer there is that the sound waves come out of and no pain no problems assistant coach have any other side effects or symptoms that that we should be aware of here at this point in time the answer is no in the early years we had all kinds of issues and we worked through those and as technology got better and better we saw patients having any experiences like I had and so when you look at a surgical procedure new say that the minimum risk of leakage is thirty five percent with a Hifu procedures between one and three percent while when you say that the chance of erectile dysfunction after surgery is fifty to ninety percent fifty to ninety percent okay another reason everybody's afraid to to do this but under your process it's one to five percent in so the average carson walks away without cancer dry potent and moves onto the next chapter of their life US before about why got involved with this Pacific coast urology when I found it was founded on the concept of minimally invasive treatments is for urological conditions I started years ago doing freezing procedure called Kreil ablation for prostate hurry that I was going to mention that one yeah and it it in its time it was a good procedure. We still do those occasionally but like most things it's you have to kind of. Look at what's available and say we've evolved all from freezing. We've evolved from radiation. We've evolved from surgery into something now that we can offer patients and so that they won't be afraid of having a diagnosis dismayed and equally or more importantly won't be afraid of having a treatment yeah exactly and it again. I just focus on the word focused because even freezing talk. Radio Station seems like you're just treating an entire region to get at once specific small spot whereas with this it sounds like if took us that magnifying analogy here your magnifying beam of light on a very specific tiny part that just seems like so much more logical you're you're targeting the area in a much more focused way you are and that also raises another interesting issue with Hifu. That's not applicable right now but there are literally one hundred and one proposed juices for hyphen out well for other things they can treat her attack or something. Y- There are clinical trials underway in this country and in China for breast cancer. It's been proposed for thyroid cancer. it has been used for deep brain stimulation for patients with seizures wow instead of having an invasive brain procedure. I in particular like there. Don't they do that with Parkinson's and stuff here. They're trying to go in and they're actually trying to. There's some I know Michael. J. Fox talked about a lot he had at some controversial procedure they actually went into his brain and cut something did something but what most people have had in the past as you're describing with him him as they've had an implantable device put out of rain right now literally and this has been done in many many many patients some of whom I have met you just aim a high beam in an area destroyed that focus where the seizures are coming from or the Parkinson's focus and you have pretty remarkable results so hifu is in its infancy when you look at other areas but it is a absolutely accepted treatment now here in Europe and so many of the countries a lot brought manufacturers are the lots of people what you're doing or you pioneering this whole process. ASAKUSA was only approved a couple of years ago here in this country right there are two manufacturers as a French machine and and there is a machine made in the US by focus surgical. We most of us here feel that the US machine has superior technology which is why we use that exclusively we continue to see improvements little by little as we treat more and more patients with this so Ross. Where do you think this goes. You've obviously he bought into the program and become a partner in this thing taking this equipment and getting it widespread use overcoming the economic obstacles testicles making it affordable for everybody here and supporting him and teaching him is the community embracing him or are they still we always think of doctors is kind of. I'm sorry to say kind kind of stuck in the whatever last technology is you know that you get that with. There's always going to be an early adopter side of the physician and you've got the the rest of the people that sort of follow along later and so we're still I think in our infancy at this point. It's just GonNa grow from here and it's been growing from here every single year a year over year. we treat a lot of patients every single month. We've got you know we're nationwide. We've got machines spread out across the country. We've got a couple here in southern California and it continues to grow every single year and more physicians get involved every single year and the Nice thing about the machine is that doesn't know who sitting down at it whether it's Dr Poo Gasser or me or B. I the next person exactly it's a repeatable process and you know we use doctors like Dr Poo guys who have a lot of experience to proctor the other guys right as a repeatable process and obviously it just takes experience in you're dealing with years of experience Dr Prudish offshore for years doing this and has a lot of experience and so we can tap into that here locally or around the country we we have physicians actually fly in to Southern California to actually watch him provide this service to understand you know how to talk to their patients about it and provide it in. They're in their market how to use it. It's a tool some training and it's probably about medical schools. Are they embracing this yet or are they teaching this. When I don't know where you you go to underwear for example doctor who studied but must be someplace you go to learn to be a urologist here and so that takes it to the residency level after medical school and once treatments like this become accepted at the university level that's when you start teaching shing residents about it so we have universities throughout the country now from the East Coast in New York to several sites in the west coast and many in between and that are now providing services like high or like Hifu and as a result the residents are being exposed to this and it gives people like me a chance to go there and help the stand how to use this a little bit better. We'll Hallelujah because I'm of the age. I'm in my sixties here. In Prostate. Let just as women fear breast cancer for men fear prostate cancer as we get older and I'm sorry to say I probably don't have protested often enough because it sounds the alternative sounds so horrible and so often I somehow WANNA stick my head in the sand and say I want to know if I don't know I can't be sick. That's not the correct way to approach life here and if you made it as you have not as frightening not as fearful of the results not as invasive and much more focused. I breathe much easier and be much more willing to find out earlier what I've got an address at here Paul. Don't take this the wrong way but I look forward to seeing you in the yeah yeah. No I appreciate where do we go. How did they reach you. And how did they get more information to start with the your clinic here locally the make sure to get this right. What's the name of the clinic here again so there's a couple of great sites to go to the western states with S Hifu h. I F. U. DOT COM which is very very rich with content from patient interview about the process and the and the technology and just great patient comments including a great focus group on guys suit had the procedure and talked about it afterwards together and also Pacific Coast Urology Dot Com has information about Hifu as well as many the the other service natural clinic where we can actually get this treatment across the street. Yeah we do surgery center but through you through this this facility and then if I don't know we were a business channel. We have lots of investors looking for next rounds of money or anything but if they want to know about the technology itself in this way that you're providing the service to other physicians. How do they learn about Hifu prostate services while you can go to our website hyper prostate services or you can call us. We've got an eight hundred number. You find it on their call our office and just talk to us about it. We actually have nurses as well on nursing line. So if somebody just has a clinical question yeah I understand or maybe they're watching this or looks at listening to this online in some other part of the country they can call eight hundred number and talked to a nurse and they'll direct to somebody local in their community or if they want to fly back home and see who actually can do that and again all of these to me just overwhelming an unwanted level they sound and so fantastic. I it's hard to take it all in but that's what technology does for us. Take and I'll give you a classic example. My my both my father and my mother other my aunt all have passed away in their nineties years ago but many years ago my dad had his what's the thing that typically bursts and it doesn't have much each function in your body here. Appendix Appendix. He had his appendix. I couldn't think of the word he had his appendix out. All my goodness it was just horrendous. It was like the invasive and it took him forever to recover and a couple of years ago before she died my aunt had done and they just stuck a needle in and blew it up and dissolve the thing and it was an outpatient surgery surgery so what seemed horrible twenty years ago became almost minor in routine due to technology. It sounds like you're moving in that same direction we are. I just just WANNA mention one thing I I when you contact us. Ross mentioned the phone numbers are is eight four four Hifu. Doc Diaz in Haifa was just like it sounds h Jeff you just like the Japanese spell is okay. It's not a it's a Haiku say all right well. Thank you for coming in. I applaud you for what you're doing. I welcome that there's a noninvasive easier. less intrusive less problematic way to deal what we're all frightened about and. I hope we all learn from that and me included. Go Get yourself tested here and find out. There's no reason to avoid this anymore. Technology has taken to places that we we couldn't imagine a couple of years ago all right. Thanks so much for coming. You've heard another one here on orange. County's only community radio stations bringing you the most interesting stories right here in your own backyard brighter and Orange County community radio station. OC Talk Radio. It's cutting into your exercise nine. Signed it stabbing you in the back nine and it's attacking your peace of mind. It's pain and it's getting in between you and a life you want to live CD medic targets your pain at its source. It's fast acting relief with active. OTC ingredients plus the added benefits of THC FREE HEMP oil get back to your life with CBD Medic Attic Available Online and at CBS. These statements have not been evaluated by the FDA. This product is not intended to diagnose treat cure or prevent any disease Trojan and Man Trojan man answering questions from every sex having human helium dislike and erotic gbi s navigating us to sex. Don't be embarrassed. Don't be shy. Children Man's always here jewelry PLA. Uh It's a big sexy world. Trojan condoms explore with confidence.

prostate cancer Cancer Hifu Hifu Hifu breast cancer United States Hifu Ross Hifu Hifu Orange County FDA Canada partner Jamie progressive Pacific Pacific Coast Urology Medical Haifa East Coast O
Qualy #53 -  Screening for prostate cancer

The Peter Attia Drive

16:37 min | 1 year ago

Qualy #53 - Screening for prostate cancer

"Broken to the qualities a subscriber exclusive podcast qualities. Just shorthand slang playing for a qualification round. which is something you do? Prior to the race just a little bit quicker qualities podcast features episodes that are short. And we're hoping for less than ten minutes. Each which highlight the best questions topics tactics etcetera disgust on previous episodes of the drive. We recognize many of you as new listeners. To The podcast may not have have a time to go back and listen to every episode. Those of you have already listened may have forgotten so the new episodes of the qualities are going to be released Tuesday through Friday and they're going to be published exclusively in our private subscriber. Only podcast feed now occasionally. We're going to release quality episodes in the main fee. which is what you're about to hear now if you enjoy these episodes and if you're you're interested in hearing more as well as receiving all the other subscriber exclusive content which is growing by the month you can visit us at PTA DOT com forward slash subscribe without further delay? I hope you enjoy today's quality stock a little bit about prostate cancer. Because it's not a cancer that comes without its controversy traversee to. Let's start with the biggest originally wanted. The biggest controversies or things that would confuse the lay person because about every year. The advice changes on this thing called. MP 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 or the way I explained the process of people. It's the best analogy. I can come up. What does if you think about it like a sewer system? You have the main sewer leaving the city. That's the urethra. That's the tube that we normally urinate through. But this channel also delivers seem out the 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 gifts these different functions. PSA is a protein at breaks down the semen and liquefies it. And people think it's an important for for this whole process of fertilizing brutalizing and 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. The amount of this protein in the semen is astronomically high. So that's what it is. That's what it does. So how do we use it. As a tool to screen for prostate cancer. Answer while we check the values of the PSA in the blood so since the prostate is sexual gland if you check the values of a PSA and a eight year old boy it would be zero. Because there's no testosterone and that boy there's no sexual development in that boy and therefore there's you know there's some but affectively no before puberty there for a little levels of testosterone there's no effectively prostate epithelium and there's no PSA as a boy eight goes through puberty to become a young man and then as he goes through the aging process his prostate develops and the then it starts to produce PSA as part components of the seamen. Now there is a certain amount of leakage of the PSA fluid into the bloodstream. It's not quote unquote supposed to leak into the bloodstream. But it can and as the prostate gets bigger so think about this concept of this underground sewer system The New York City sewers right right. They're getting older. They're getting leakier. And the bigger the prostate gets in the prostate gets larger as we get older. Some of these pipes get leaky and some by the. PSA leaks into the blood so it was discovered in the eighties that there's this prostate specific protein that you can pick up then the seaman and you can also see in the blood and so it is not cancer specific it's prostate specific and is actually very good biomarker L. Marker for prostate size the bigger the prostate. The more leaky it is so to speak and the leered is the higher the numbers can go in the bloodstream. So there's two variables that can progress over time the size itself which you could talk about that independent of size so to thirty year olds one guy's got a five grand prostate. The other guy has got a hundred grand prostate just to make it seem you should see a difference but also to guys with the same size prostate that are two decades apart you might see a higher hire psa you coined the older. That's right so and so and if you do for example like we were always taught in residence. Even though I wasn't urologist you still once in a while have to you. You know we still did a urology rotation if I recall you wouldn't check a PSA on a man right after doing a rectal examination because in theory that could artificially have raised the PSA presumably by creating more of an insult and increasing that flow wishing some of it into the blood the bloodstream. So what can make the PSA rise besides just having getting older and having a larger prostate. Well if you get an infection in your prostate so think about that like you got your city. You have her sewer network and there's an earthquake all all the pipes are rat a little bit and they all are extra leaky. And that's what an infection is is not a infections in the prostate or either all or none really they're not focal so the whole prostate gets more leaky in the. PSA number can go way up the other way to think about it as if you have cancer and the the analogy would be lulled. There's there's a city block that has the pipes pipes you know the sewer systems clogged. There's more backflow into the bloodstream. And that's how I pick it up. That's not really how it happens. But that's a good way for patients to think about it. So what is a normal. PSA well a normal PSA is age adjusted so normal PSA for a forty year old is around point five two point six nanograms per aml for fifty year old normal meaning. This is the median for all the population for a fifty year old. It's one and so it kind of goes up stepwise by by decade so there are eight adjustments that we do for the PSA number now what are PSA numbers that tell you you don't have a cancer there's no. PSA number that that is one hundred percent no cancer but there is a proportional rise in cancer detection with rising PSA numbers so originally the cutoff set a PSA of four. We do you know we think about things more based on the individual scenario so if you're a younger person and if your PSA more than two point five that usually considered to be abnormal and may want you may need further work. You don't need a biopsy right away these days in my opinion but you need further workup. So depends on the age of the patient and depends on how also their prostates announce how many guys will go and when they get their PSA check. There's another thing that gets checked. Checked called the free. PSA and then a number is reported. which is the percentage free which is obviously that if their? PSA is three and they're free PSA is one the percent free free is reported thirty three percent. What does that mean? These are different ways for urologist. Try to fine tune this prostate specific antigen test to make it more a cancer specific test so again. PSA goes up when you have an every man has it's not cancer specific so so percent free. PSA was the first way that urologist began to look at what. What's the chance that A? PSA of four is coming from cancer sir versus a PS four coming from just benign overgrowth. So remember there's a lot of factors in play one would be if you had a man who's prostate volume was eighty grams that big and his. PSA was four well. That's of low ratio that's something called. PSA density how much PSA's made per gram of tissue issue. So you'd say well that guy. It's very low chance that he has a cancer that guy would also have a high percent free free. PSA So percent free PSA is another way to just look at what how much of the PSA's produced from benign cells versus cancerous cells. So if two guys have A. Psa of four and one has a free of one. He's twenty five percent free and the other guy has a free of three which is seventy five percent free. What's the different physiologically in those situations? Well there's less bound. PSA and the lower percent free and that's more often associated with prostate cancer her so that just a correlation so it's not like it means that in other words we can't infer what 'cause I I would. I would assume that the binding protein is in the periphery. It's it's in the plasma. Yeah it's it bound up when it comes out of the epithelial cells so I just how it's processed so. PSA's process is not a full length protein when it's born and so the other way that we now so just for the listener so we have absent cutoffs for PSA four in older man two point five and younger remember. They're all really case specific in my opinion percent free. PSA was the first way to say. Let's try to fine tune what the PSA means so a high percent free PSA's associated with the big prostate less of a chance of prostate cancer. A low percent fee. PSA is associated with a higher likelihood that that PSA's produced from gland with prostate cancer in it the other variables that we use our PSA density. So that's highly predictive. We have of what's going on in the prostate so easy threshold or cut off or for for you. Peter we talk on the phone about some of your patients percent free. PSA density more than then point one it raises a little bit of a red flag a PSA density of more than point one five that raises a red flags with think about it in median prostate ostad volume for a a six year. Old Guys forty grams so forty grand prostate. PSA Four. It's probably it's pretty safe a PSA of six six that raises red flags. And you know this from your patients that okay the guy probably has something going on. So that's how I think about but now think about the eighty grand prostate with. PSA Four. Oh you have these patients in your practice. They don't have cancer on average right percent free. PSA helps with that. There are two other new test that yes so you got me onto the four K.. Two years ago and I really consider it a game changer for for for the guys like me who were in the peanut gallery so I don't you know I. I make it my job to know as much as is knowable with the time that I have about every possible disease Aziza could afflict my patients but that means I need to spend as much time thinking about colon cancer as I do coronary artery disease as I do prostate cancer. So for me. The four four K.. which again you didn't you did? A great service. Not only did you get interested in. But you introduced me to Andrew at Memorial sloan-kettering blank on slander vickers vickers. Yeah Amazing Guy. I and I mean I couldn't have been more generous with his time. I mean just gave me the schooling on this topic so good and we put together a patient hand and out on this thing and he even edited it for us I feel like not an. I'm worried not enough. Patients understand that and I'm worried not enough primary care. Physicians understand the importance of the four K.. Test can you explain how that has changed the way we do things. So this test you're listening to. And there's another test that performs equally well called the prostate state health index or Ph test these both leverage off this idea that prostate cancer cells make. PSA differently then then benign prostate cells. And so the four K.. Score is the fork Calico Ryan tests it takes. PSA PERCENT FREE PSA INTACT PSA ASA and H K to takes those four prostate specific proteins produced and it has a calculator really just discriminate between tween a cancerous cell and benign l. p. h. i.. Uses the similar concept it uses something called minus two pro. PSA WHICH IS PSA pay for all the scientists out there plus two amino acids on the five prime side of it so minus two pro PSA right and you you measure those specific PSA AAC based proteins in the blood and the four K.. Scores great because Andrew Vickers and Hans Leah developed it with this other great urologist. Peter Scardino Memorial. And what they they looked at was will. What's the chance that this person is? Diagnosed with an has high-grade aggressive lethal prostate cancer. And it gives you a percentile percentile chance so when you get the fork airport. It's actually really nice report. It'll say two percent chance twenty percent chance and so forth and so now as you start using this in your practice canal also give you the PSA so you can see the PSA and then you can say wait a second disguise PSA six but his forecast course to. It's safe. What I really like about it is is an and so when we do our usually with our patients in their second year sometimes in the first year but using their second year we do cancer screening program where we kind of walked them through every single cancer that you could possibly die of and then we go cancer by cancer risk by risk and we we did a very lengthy process on the back end and For the patient we simplified it takes about ninety minutes to go through it but for the males when we come to this I always view this as one of the better. I said I wish every free cancer had a test like this because as we'll come back to you know pretty much every guy is GonNa die with prostate cancer. But fortunately most men will not die from prostate cancer answer but their job is to figure out when a guy has prostate cancer as you alluded to earlier resist the bad one. Yeah or is this the one that if you around too much and so what I guess yes vickers and his team have been able to figure out that there's now enough data that you can basically turn this into a binary test you know which so that the so. PSA would be a continuous variable right and when you want to test the sensitivity and specificity but continuous variable. You have to use something called a receiver operating characteristic curve and it becomes quite complicated because the question becomes what cough and as you alluded to. It's very difficult with PSA because it has to be age volume adjusted so now it's a three dimensional receiver operating characteristic curve where you would have a different a UC area under the curve for each point in time and volume I mean that becomes was almost inconceivable and yet the the four K. has basically allowed us to say the following if you're four K.. Score is less than seven point five percent and and I might butcher the numbers a little bit. That's right number eight. If it's less than two point five percent the probability that you will be alive at the probably that you will die of metastatic. Prostate cancer is one point six percent in the next twenty years. Yeah that was the the lifetime of the patient. And that's based on this data from Andrews partner a CO developer Hons Lucia where they had this incredible database Mamo Sweden so they could track and then the reverse is. If you're greater than seven point five percent I think it's like sixteen or seventeen percent chance in twenty years. They that's the the binary cutoff is seven point five percent but it's a continuous variable but above that it's continuous. It's not like if you're Bob. aww Berries based on the number. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general Enron informational purposes only and does not constitute the practice of medicine nursing or other professional healthcare services including the giving of medical advice and note. No Oh doctor. Patient relationship is for the use of this information and the materials linked to the podcast is at the user's own risk. The content of this

PSA prostate cancer cancer A. Psa vickers vickers New York City colon cancer Andrew testosterone Bob. Individual House Peter Peter Scardino Memorial Mamo Sweden Aziza Hons Lucia Memorial sloan-kettering blank
2.22.19 Prostate cancer awareness; Clark Stinks

Clark Howard Show

36:57 min | 1 year ago

2.22.19 Prostate cancer awareness; Clark Stinks

"This episode is by Comcast business. Every industry will see some form of digital transformation. When Comcast built the nation's largest gig speed network. Most businesses were fixated on megabits per second. Now would new needs to be met. Comcast business is moving beyond beyond connecting business to applications that help you create innovative new experiences beyond network complexity to the efficiency of zero touch one box world beyond the best products for your money to the best solutions for your business at an even greater value. The company that delivers unrelenting speed in more places is also the company making digital transformation possible for more businesses. Comcast business beyond fast. Take your business beyond at Comcast business dot com. My pleasure to have you here on the Clark Howard show where we're devoted to you. Having information that allows you to have more control in your life. So you can save more and spend less and don't let anyone ever rip you off coming up later this hour Clark stakes where you get to here where people feel I haven't done my job. It's my favorite segment at the week. So. The you may know, you may not know I was diagnosed with cancer more than ten years ago. And I was diagnosed with prostate cancer. And at the time, I was diagnosed there was not a lot of easy to access information about prostate cancer you could trust. And when I as I do in my life. When I was diagnosed in addition to consulting, the doctors the urologist, the I met with the surgeon the various things you do with medical professionals. I read independently medical journals to understand my cancer, and what it all meant and what I had to do. So at that time ten plus years ago. The only place I could find extensive writing and medical journals in English happen to be from a British medical journal called Lancet. And it was inland said that I learned having to look up terminology and all that because it's all written to doctors learned what I needed to know that I was not going to learn in the brief time you sit with Dr. And I took control of my own care now when I was diagnosed. Any diagnosis of prostate cancer? And just a short time ago less than eleven years ago. The automatic answer was that you were going to have to have treatment, and the choice you then had to make which form a treatment. You would have. Well, what medicine has learned sense in this country? And what they already knew in Europe is that a lot of prostate cancers are slow growing and are not at least in the immediate term in any way life threatening. So here I am. More than a decade out. Not having had any treatment at all. But I follow a very strict medical regimen that I attended to in Los Angeles. And so I go through having blood tests. Urine tests every so often, and then I was on a six months cycle. Now more than ten years out every two years. I have a special form of MRI where I have to live in the machine for minimum seventy five minutes. Now, exactly the most fun. And then that's followed by my next test, which is a biopsy. Which some men find not painful at all others. Find extremely painful. I find it painful ebony anyway, it's better than me and dad, right? So I do that as required by my doctor. I had to search for a doctor that would do what is now referred to as active surveillance, and for men who meet my profile with the cancer. I have the percent that are doing actor surveillance now is approaching fifty percent because again prostate cancer explained in the most simple terms. It's very different than other cancers. And it has many genetic makeup 's and many of us diagnosed with prostate cancer early stage or what could be referred to as turtles. We have extremely slow growing cancer that at least in the period you're in. At the time. You're diagnosed is not in any way dangerous or by threatening. Then there are rabbits, those are people who have a makeup of their cancer that is potentially dangerous and not attended to immediately can be life threatening. And may in fact, cost your life. Then there are eagles people that are diagnosed with prostate cancer point where it's a fight for your life from the first day of diagnosis. So what makes it unique is with so many cancers, you don't have the genetic issues. Breast cancer, by the way, when they're also has the genetic issues where some people with breast cancer are at great risk and others not much at all. But it's all looked at as one cancer and prostate cancer looked at his one cancer. But it really does have this swing of seriousness depending on the genetic makeup. There are companies racing to develop simple tests, either by urine or by blood tests that will be able to specifically Mark what kind of genetic form you have. In the same research is going on the breast cancer as well. And then be able to distinguish who has what's going to be an aggressive dangerous cancer versus one that is not necessarily dangerous at all. And certainly not aggressive. And that will be a big change in a big help to people. So I want to say something for you that we put together for you that if you are diagnosed or you have a family member or loved one who's been diagnosed, and you're overwhelmed and confused, and you wanna know information you can trust. I have a direct link for you now at Clark dot com. If you go Clark dot com slash prostate cancer. You'll see a direct link there to a page at the prostate Cancer Foundation. Specially set up for me, I've got a video on there. And I've got a guide for you. What to do when you're diagnosed how to know how to approach it. Right. And that the resources the information I had to search outside the United States defined medical journal information more than a decade ago. Today is available for you would just. Clicks from a source. I know you can trust the prostate Cancer Foundation. So again, this may not be information you need or anybody in your family needs right now. But the time will come with prostate cancer being the second most common cancer in men that someone, you know, someone you love or a family member, you tolerate Kazura family member that they're going to need that information, and you're going to have a resource available to you. Brian is with us on the Clark Howard show. Hello, brian. Hi clark. How you doing good? Thank you, Brian. And I gather I should thank you for your service our country. All thank you for your support. What branch are you in the you? Well, I'm a former US navy sailor in the submarine force. Man. You heard me tell the story about my brother who is a navy, man. No. I don't believe I have. So my brother during Vietnam was a naval officer went to OCS in Rhode Island and finishes OC s and he's assigned to submarine duty. And he marvelous well, he reports were his first day a submarine duty and discovered something about himself. He never knew. Oh boy. Claustrophobia? I that was exactly what I was about to guess. This was again during Vietnam. So what happens in the military when you turn down on an assignment. Well, I'm giving understand that they generally redirect you to something a little less agreeable. Exactly he was sent into combat zone in Vietnam and had a little boat that he took marines into combat. Oh boy. Wow. So. So. Cost Koby cost in big time. But he came home all in one piece. Well, that's an understatement. Wow. Well, how can I serve you Bryant? We'll have a quick question for you regarding housing. I was actually a submariner in Kratie, Connecticut. So not too far from where the CS goes on out there in Rhode Island, but I've since separated from the military with an honorable discharge and I've been out for a couple of years now, and I've been going to school going to college at university in New York City using my post nine eleven GI Bill benefit. Now, there's a housing Sipe and a monthly stipend associated with that benefit. And I've been taking advantage of that to cover my expenses while I do school full time. So I guess my question to you is being that my career sees me. My major is human resources oriented in HR professional generally make fifty to sixty thousand a year starting salary. How can I may? Maintain in urban lifestyle or try to tempt to remain in the New York City metropolitan area on a salary like that is it viable, and it really I mean, you know, in the New York metro area in and as, you know, having lived in Connecticut with virtues the tri-state area, you have to be an extremely long distance commuter more. You have to live in very tiny housing or not very nice housing or not very nice tiny housing. To be able to stay in the tri-state area. I mean, it's a brutal problem. And when you're done with school, are you willing to live somewhere else in America where that paycheck will go so much further. Was it stands I live in a well. The answer is. Yes, I am. And just say, you know, I right now live in a two hundred square foot micro studio in I pay an astronaut article sixteen fifty a month, which in many places in the United States, you'd be able to buy a multi bedroom home that cost actually live one per. So I would say because when you finish school first things first, I would I would if you're willing to let the country be your choice, you know, that wherever you can find the best job opportunity, and that you be willing to live somewhere else. If you don't have. Have strong family roots in the New York metro area. Why don't you go where you'll find the best opportunity and along with that you stay out of the most congested cities in the northeast and on the west coast, you'll find housing completely different isn't equation. I will take your advice. I'm very interested in Indianapolis as a viable option. People love moving to Indianapolis. They love going to Kansas City. Both of those markets are very n right now. And and you have people moving from the coast into the heartland to big cities big metro areas in the heartland where they can have quality of life affordability. And there's a lot going on. I was just in Andy in the in. I noticed the population was similar to Boston. But you know, it really didn't feel that way. In terms of traffic and the congestion. Indianapolis is really spread out. Yeah. Exactly. And. And I think about Boston everything was built before the automobile. And so you got those narrow streets, and you've got people triple parking, and so it's a different kind of environment. But I love Indianapolis. Well, thank you for your help Clark. And thank you for your years of service. All well. You take care now. Sure. And I'm thinking about you living in the two hundred and whatever square feet, so since you did submarine duty that probably feels like you're in a mansion now versus what you are in on that submarine Phillips with us on the Clark Howard show. Hello, philip. How you doing? Great clark's. Thank you very much for taking my call. Certainly. How can I serve you Philip? So my wife, and I recently hit a cool milestone in we're getting ready to make an investment for which I I love your advice. So my wife had a grad school loan and having just paid that off we are now debt free outside of our mortgage. But we're looking to now look at our kitchen appliances for two reasons we've been in their home for a few years, but the house is a ten year old home with original places and both the dishwasher have failed and the microwave is breaking in several places. So we've actually been washing dishes by hand for over a year just to save costs. But now, we're at the point where we'd like to buy a kitchen suite in cash, I understand that, you know, as sweet skin get well over five thousand dollars or so, but anyways, we're looking to say your sweet, you mean, get a new side by side. Refrigerator? Get a new dishwasher, get a new oven or stove. Is that what you mean? Yes. The work, so so dishwasher microwave, and they come individually what I've read over the years in consumer reports, you're not gonna find that one particular brand is suddenly going to be the best your best off getting appliances that in each category, they've tested, and they rate is being very reliable. I'm into reliability with appliances, and you'll be able to get a similar look even across brands. But the one area you're going to be frustrated by is a lot of kitchen appliances are not extremely reliable. You a subscriber to consumer reports. No one really thought about getting it because I can see consistently reference when I when we do purchasing research, especially with things like appliances, you know, that's not an area you go look at electron IX. And there's eighty million bloggers reviewing them. You don't I mean, nobody gets up in the morning and say, hey, I wanna be a famous blogger of dishwashers. So consumer reports as it always did now fills that with the same authority as before and you can pay for temporary online access. You can subscribe whatever you want, but go to stores online go to their online sites. If you go to physical stores and try to cross reference the ones that are a good deal with the ones that also have good ratings. So my only concern there would be we're looking to get the stainless steel color. No wrong. The look of the kitchen and so product about different shades of this. And now you'll be. I'm what imagine I wouldn't worry at all. I mean when you go look in stores, you'll see that the shades are just fine looking at the style from different manufacturers. Although you may you may be able to come up with a cross reference. The gets you okay across the same brand. But I would rather you be more free agent. Just make sure the stainless steel close enough. You're not gonna freak out life insurance is one of those topics that everyone knows a little bit about. But do you understand it well enough to feel comfortable buying it? Whether you're an insurance expert or a newbie policy genius created a website that makes it easy for you to compare quotes. Get advice and get covered policy genius. Is the easy way to get life insurance in minutes. You can compare quotes from top insurers to find the coverage. You need at a price. You can afford from there. Just apply online and the advisors at policy genius will handle all the. Red tape. They'll even ago, she ate your rate with the insurance company, those no extra fees and no commission sales agents, just helpful advice and personalized service. So no matter how much or how little you know, about life insurance. You can find the right policy in minutes at policy genius dot com. Policy genius the easy way to compare and buy life insurance. I'm so glad you're with us here on the Clark Howard show where it's all about you. And that Walla yours, I want you to learn ideas to me, so you can save more and spend less and don't let anyone ever rip you off. There are times you feel ripped off by me. I answer a question. I make a statement or I started out talking about a topic. And you feel like a missed the point gay bad guidance. Whatever it is. And so that's why we have Clark dot com slash Clark stinks. Where you can go post where you feel. I just blew it. Or now, we have like a form you can do either way. You can you it through our message boards, or when you go to that. You're Al Clark dot com slash Clark stinks. There's also a form just quickly fill out if you don't want to register for the. Message boards how easy because I need your feedback. So you post on Clark stinks others. See what you posted? They can comment on it. They can agree. They can disagree whatever they do once a week. Our producer Krista goes through your posts on Clark stinks and shares highlights with you right here. I should've never touched to speak which think I'm pretty stupid. Maybe maybe maybe a right? Clark. Yes. With all due respect. You are giving the wrong advice on dealing with hospital slash doctors. Bells hospital social workers or patient advocates cannot reduce bills. They can give advice or information on programs. Available patients have to qualify, according to incomes for financial relief. The health care crisis in this country hits middle income people with insurance the worst approximately sixty percent of all bankruptcies in this country involved medical bills, two out of every three people with health insurance have been referred to collection agencies. I've heard these statistics from cable news shows, this is how out of control healthcare is in the United States. And that was from Randy. Thank you. Randy on the issue of going to a hospital, social worker patient advocate. It depends on the hospital system. Whether or not the answer I've given woodwork maybe some hospital systems they cannot. Do that for you one thing, you should know is if you have an issue with the Bill with a hospital, and they are nonprofit they're under or should be under a microscope to make sure then return for the tens or hundreds of millions of dollars of tax. They avoid paying they are required to provide a reasonable amount of what's knows uncompensated care. And so if it is a nonprofit hospital, you certainly want to ask about that angle as well because in order for them to maintain that massive benefit of having a tax holiday. They are supposed to intern work with their patients when someone is a victim of identity theft of their tax return, and they expect a large refund. Don't tell them it will take up to fourteen months to get their refund. Tell them to apply their expected refund to next year's taxes and scale back with they are currently withhold. Adding that way, they will get all their refund. A lot sooner David David bet is a fantastic suggestion. No one has ever made it won't get somebody. Let's say two thousand four hundred dollar check quicker. But it means that by reducing their withholding. They're able to have the effective use of the money whole lot quicker. I love that idea Clark's folksy charm is generally endearing, but I believe he should cease his frequent incantations of the dated and tone-deaf expression. Happy wife happy life. I the phrase can now seem condescending and patronizing implying that women need to be indulged by default to be contented. Instead of finding satisfaction through equal debate compromise and decision making with their partners second with many marriages now, including only husbands the message has exclusionary overtones. It's time to leave this throwback face behind. But thanks for your and your team's great. Work aside from this oppressively odiferous factory offense, signed an English major who retired at thirty six but still this to Clark every Clark Howard episode. Well, thank you very much for your loyalty. And I hear what you're saying. And I appreciate the fact that it is a dated phrase. One of the reasons that I use that phrase is it's a gentle way for me. A lot of times to. Get men who maybe are not listening to a wife to listen better to her. And maybe I need to come up with a better more modern way to say it Clark e mentioned on your radio show numerous times that you aren't in favor of lifelock yet in my real life situation. Lifelock did save me from a fraudulent account being opened using my credit. I was able to shut down the fraud immediately. Because I got a text as it was happening. Credit karma credit sesame, do not have this ability, nor will they do anything as far as cleaning up, the stolen identity. Stop banging on them. Yes. Lifelock costs money, but I found it is was well worth it. Pat, pat. Thank you. And I'm so glad that lifelock was able to do something fantastic for you. My preference over lifelock or any credit monitoring is that you take advantage of the federal law. That allows you to freeze your credit files for free. It is far more effective than even the lucky circumstance. You have lifelock or any other which usually with a credit monitoring service, you're going to know about something after the damage has already occurred, and this lucky circumstance, you were able to stop something before real trouble began, but the best most effective strategy is to do credit freeze, which very quickly allows you to shut down access to your credit until you need it. And then also extremely quickly open up access to your credit again when you need access. I Clark I'm a longtime listener of your show. I listened to your show whenever my day is not going. Well, the most of the time I hear you and listen to you for money advice. Sometimes I hear you not to listen to your money advice. But to hear your polite. Voice somehow that will make me motivated you stunk when you gave advice for Valentine's Day flowers. You always say that to present the flowers to your wife before the price hike for Valentine's Day, if it's family. We can't do it this way we can do it this way you forgot about organize parties and events at school room. Moms arranges arrange on February fourteenth to surprise the teacher. It's similar for the school bus driver. Also, we cannot avoid these situations. We cannot celebrate Valentine's Day in the school on February first or in the last week of January since I'm not from Clark Howard university. I bought this. I bought this time. I bought white daisy flowers for all of the schoolteachers. I appreciate your service. Please keep doing what you're doing civil sort of a thank you. And so I need to reveal something after Valentine's Day, I was in Aldy, and they had these Valentine's Day. Flower arrangements that were like they're the kind that that have soil to them. What do you call that? When they're not cut flowers that can that keep living plants planted. Will they were? Yeah. I guess so I I mean, I'm somebody who prefers asked to real grass, and what can I tell you? But anyway, I bought her this really cool flower arrangement for half price because it was right after Valentine's Day and. It was one of those things I'd already given her roses two weeks out. And then I never really thought about the angle of giving flowers immediately afterwards on clearance. But I hear you that there are times you can't do it too early. And you can't wait till after high Clark, we are mortgage debt free. I don't like it. When you say, quote, you can't eat your house. It is so much cheaper to find food to eat than to find a place to live. If you get into financial trouble people can live on less than five dollars a day of food if they have to but try and find a place to live for anywhere near that amount. My parents lost their house when I was young. And the first thing I wanted to do as an adult was to pay off our mortgage, I think focusing on getting mortgage debt free trumps everything financially. Thanks for everything. You're big part of why we are mortgage debt, free, Patty, Patty. Thank you for that. And you know, I don't know if you know mine life story, but the. Reason that I have always lived on so much less than what I've made is. Because of what happened to my parents when I was a teenager when my dad lost his job, and I really learned then the value of living on less than what you make you learn that lesson for what happened in your family circumstance, also and wanting to know that the house is your house, and you don't have to ever worry about it. The psychology of that is great. You know, I own my home free and clear, and I don't I don't like debt for anything. So I get it. It's just when I'm talking to somebody, and there are different priorities and typically they're in their let's say forties or fifties. And they're accelerating paying off on a home, but they're not really saving to have cash to live on in retirement. That's when I start talking about the priorities mortgage interest. Late in the rest. But I certainly not only can I not fall you for owning your home free and clear, I praise you for it. And I'm right there with you. Hey clark. Although I enjoy listening to your podcast for interesting consumer tips and tricks. I am not a fan of some of your financial advice, especially with regards to investing. But I digress. Your advice to a gentleman whose mother earns a low income should contribute to a Roth to should contribute to a Roth in intern be eligible for the savers credit with sound advice. However, you mentioned that she would receive money back it exceeded her tax liability sorry to burst your bubble. But the savers is a non refundable credit. It can only reduce the tax liability to zero sincerely Brian. I'm not gonna try your last name CPA, Brian. Thank you. And I'll go read on that. Because that would be very important information. If I have that wrong that it's not a refund. Credit? So thank you for putting that information out there, and I will correct that if in fact, you're right, I'm wrong on it. A collar said he was thinking of opening an online Bank account and asked how he could deposit cash you told him. There was no way to do that technically. That is correct. However, the work around to not being able to deposit cash online is to purchase a money order. They cost around a dollar or less, which is a fraction of what a traditional Bank charges just in monthly maintenance fees. I did the exact same thing while I was traveling and was given several hundred dollars in cash from a friend instead of carrying around that amount of money. I bought a money order for fifty cents. And then deposited it to my credit union using my phone alternatively. The caller could use cash in an old fashioned way and purchase groceries gasoline, etc. With it. Great suggestion followed by another great suggestion and that money order idea. You have I will obviously steal it and use that as a way to encourage people to do online banking. All right. One more real quick Clark. You don't really smell like a gym bag with sweaty clothes. That's been left in the trunk for a few days. However, you missed the Mark with a cut when a car asked if they still needed credit karma now they received their credit score through a credit card you fail to tell the caller that most credit card companies will only provide you with the score while credit karma will also provide you with a bevy of other useful information, including credit utilization accounts and payment history and number of hard increase. This additional information gives you a much better idea of the things impacting your credit than just the score. Love the show keep up the good work, Derek indirect. Thank you. The other wonderful thing about using the credit karma dashboard is it will tutor you based on your own situation. What you need to do to raise your score. I appreciate all your posts. Please. When you feel I've missed the Mark miss the facts, go to Clark dot com slash Clark stinks. Please let me know. Brinda is with us on the Clark Howard show. Hi, brenda. Hi there. How are you? Great. Thank you, Brenda. You worked for one company for how long thirty three years. Wow. And you're not quitting that company. They're quitting. You. Yes, sir. They are. My store has closed down retreats. If you've been with for that long. I'm sorry. Which retailer have you been with for that long? Here's. Okay. So I hope I have good answers for you. I'm sure you do I just have one actually I have a 4._0._1._K, obviously. And it's been in there for about at least thirty one years. So I just want to know what to do with my my my 4._0._1., my retirement, please tell me none of it is in any of Eddie Lampert stock now, I don't have any here. Stop. Okay. So it's all in diversified kind of funds. Yes, it's one on SMP five hundred the other one said, I had a large cap growth, and there's there's a substantial amount of money in there. So I just don't want to. I don't know if I lead it and see what it does. Or if I need to move it out, first of all that's outstanding that you're diversified like that and you have classic diversification being in the five hundred largest companies in the country. So you're not betting on any one company and. Is whether you should leave it in what's gonna become an orphan plan with what's going on with Sears. I think that I would move it potentially to your own IRA. And that's really easier to do than that might sound. You know, usually, I tell people, you know, why don't you just leave the money behind in your old 4._0._1._K, but with everything that's gone on with Sears. And all the tumult. I think I'd put some space between you and them with it. Thought process. So I figured I would call you and see what your recommendation was or so we do you prefer dealing with people face to face or you. Okay. Do stuff online on. Okay. Doing stuff online. Right. So if you go to my investment guide at Clark dot com Younessi information there about rolling that over with the big three which are of the low cost companies, which are Charles Schwab. Fidelity Investments in vanguard and all three of them have retirement professionals. If you call and you say, you need to talk with a retirement specialist, they'll get you with one, and they'll help you set up the paperwork, and they'll handle moving the money from Sears as 4._0._1._K into having your own IRA, no tax will be due and the money will just be there for you in in your own account. Now, also. Recommendations what I'd like you to put the money in once you get it to Schwab, fidelity or vanguard. Now, you one of the Sears individuals who qualified for a pension as well. Yes, I didn't get into the pension till late. So there's not really much in there on. All right. Well, thank you for your loyalty to one company for such a long time that makes you a really good candidate for somebody else to take advantage of your experience. Yes there. Thank you. So best to you in the job market. Yes, sir. I appreciate it. I will definitely go on your investment guide and get that move. I I mean, I know I have a certain amount of time. But I think I'm gonna try to do it it sooner than later. Exactly since you since you were your store is now closed at rather you get that in action. Now, you're listening to the Clark Howard show. Thanks for joining us today. The Clark Howard show is produced by Kim droves. Joel LARs guard, Debra Reese and gem airs and remember twenty four hours a day where there to serve you at Clark dot com and Clark deals dot com.

Clark Howard Great clark Clark prostate cancer Clark dot United States Comcast Brian Valentine prostate Cancer Foundation lifelock Breast cancer Indianapolis Sears New York City Los Angeles Europe intern
Movember movement raises prostate cancer awareness

Mayo Clinic Q&A

23:42 min | 3 weeks ago

Movember movement raises prostate cancer awareness

"Welcome to maitland acuna. i'm dr sanjay. Caca off to skin cancer. Prostate cancer is the most common cancer among men. The good news is that it can often be treated. Successfully movement will movember which combines a mustache november us meant to grow a mustache and raise awareness for mental health topics including prostate cancer. Joining us today to discuss. This is mayo clinic urologist. dr raymond. Pack thanks for joining us today to pack. Thank you sent you for the invitation to be here today to talk to pack just intended prostate cancer. Can you tell us who's at risk for developing this. In the united states about one in nine men in their lifetime can develop prostate cancer and certainly around the age. Group of men in their sixties is the most typical age for men to be diagnosed with prostate cancer. So we've just heard about the screening for colorectal cancer. For example in decrease in the age for when men should be screened what about prostate cancer that age specific recommendation for screening has changed over the years. Currently the american urologic association supports screening for minute average risk between the ages of fifty five and sixty nine and then prior to fifty five. Is she really a shared. Decision and discussion based on risk factors. So what are those risk factors so men with a family. History of prostate cancer significant family history would be a first degree relative such as a father or brother with prostate cancer or a more distant relative but at least to distant relatives with prostate cancer. And then any other strong family history of hereditary colon breast cancers as well as prostate. Of course Should be considered in a younger age group. So between forty and fifty five is at a high risk group that we need to screen for a strong family history or race. African american men should be considered screened earlier under fifty five and so in terms of screening. Then how how do you do that. If you determine that somebody should be tested for this is this an invasive test what do oftentimes prostate cancer has no symptoms by the time men developed symptoms of prostate cancer. It's usually a at an advanced stage. So symptoms such as blood in the urine painful urination inability to urinate or pain In the hips and spine those can all be a very advanced presentations of prostate cancer. So that's that's exactly the reason why we screen men actively in that specific age groups because there are no symptoms whatsoever so to answer your question too. How do we screen men. I includes a combination of a prostate exam Usually done at the time of a physical and is usually done with a digital finger. through the rectum. And so that can be done by a family practitioner. A primary care physician. And of course you're allergists. That's a lot do physical on physical exams in the office. And then of course. The blood tests the psa blood test. Which is the prostate specific antigen tests and this test has been widely available for many years And this blood tests has significantly contributed to the detection of prostate cancer but also successful early identification of men with cancer. Obviously in with the movie we want to sort of decrease any fear for men. When i'm when. I'm listening to this Physical examination at sounds a little bit painful. Is it such. Depends on your point of view but you know certainly a prostate exam. It can be very painless. It's simply a a finger in index finger usually during the physical exam and Once a year is what we recommend minimally And so that can be a barrier for some men A i won't lie that you know some men fret come in the office about that exam. submit actively seek me out because i do tend to have smaller fingers so i. If you're concerned it's important as important. So there's any concern about this comfort from a prostate exam. You might want to look at your physicians index finger to determine if there's something you want to sign up for a certainly if your physician is a linebacker and has a finger that's the size of someone's thumb you might want to seek another healthcare provider. But now al joking. Aside a prostate exams are are very well tolerated this more psychological barrier than actual physical harm or pain. She mentioned the physical exam and the The blood test the the psa. If are elevated. Or you're suspicious. How do you then move onto the next stage of diagnosis. So if there's a level of suspicion based on the prostate exam or an abnormal. psa value for a man's age or history Then we certainly would take the next steps to determine a what the underlying risk of prostate cancer is so for many years as standard of care was to proceed with a prostate biopsy with ultrasound guidance. And that's still the vast majority of the way we still proceed with men today With the advent of advanced imaging technology we do have the availability of mri. For instance to help give us a very detailed. A picture of the prostate. Now i always remind men that. Mri technology is wonderful. It does allow us to see the prostate in potentially detect visible cancer. Lesions in the prostate. So emery is very important for that visible detection of suspicious lesion. However i always remind men that. Mri is not one hundred percent Sensitive or specific and therefore biopsies are still a recommended despite Emery findings so if an mri shows a lesion we most certainly would recommend proceeding with the mr fusion. Biopsy which means we're going to take the mr images. In perform a very accurate biopsy of the prostate if the mri is negative normal appearing We oftentimes still proceed with a biopsy based on other rece- parameters in that situation. We then rely on the traditional trans rectal ultrasound. Guidance imaging for those biopsies. That's what i was going to ask you. When you talk about biopsy which is simply taking a piece of tissue in the needles you can analyze it in the lab. How do you physically do that. It does require a needle core biopsy. These are small needles. that will Penetrate the rectal wall If you're doing a trans. Rectal approach The needle penetrate the rock the wall and enter the prostate and retrieve or retrieve a sliver of prostate tissue. A small enough to not be a problem but You know large enough to allow us to make a diagnosis based on tissue sampling. And i'm sure as you're aware most cancers are diagnosed with tissue sampling and cannot be you cannot rely on imaging alone We do offer other alternative routes of biopsy of the prostate such as a transit approach during a sustauskas but the other more common approach that is also very popular among patients now is a transparent neil approach the transparent neil approach reduces the risk of infection tremendously for men which is one of the biggest fears of having a by ups trans. Recklessly one thing. I've heard about prostate cancer as if you're going to get a cancer this is one of the ones to get in in terms of. It's a better cancer treatment. Can you tell us a little bit about that. Because some people don't have treatments some people do and the prognosis can be favorable if quarterly. That's absolutely correct. So prostate cancer can present in patients in a wide spectrum. A certainly if the cancer is detected early in hence the purpose of screening a we can usually formulate a plan if it's detected early stage and it still localized in non-aggressive appearing we can oftentimes just survey the cancer over time. We call that active surveillance. We can follow With imaging and blood testing and exams and men do not need treatment at all a close monitoring and then there are times when men have lapsed in their screening Were never been screened at all due to various reasons whether access to healthcare or free fear of being seen by urologist. Dr in that area So when men present Without any history of screening prior they tend to present with more advanced cancers so In fact historically you know a few years back. The us preventative task. Force determined that prostate cancer screening was not recommended and we actually as urologist saw an increase or in a stage of presentation of cancer back to before. The psa test was invented so when the psa test was released for widespread use we saw a down staging a lot of cancer presentation because we were detecting cancers earlier and then with the change in the recommendation. It confused a lot of physicians especially primary care physicians to the point where they stopped checking the psa test and that allowed some men to fall through the cracks and present with more advanced cancers. So a lot of my colleagues who treat prostate cancer have been the recent. You're seeing men. at presentation. With more advanced forms of prostate cancer. In those situations it can be very difficult. Essentially get them cancer free or make them a cancer survivor. However prostate cancer unlike many cancers has a long pro can be a long process in when you look at At your survivals. And that's a metric that most organization use to determine a prostate cancer aggressiveness in prostate cancer. even some of the ages still has nearly one hundred percent five year survival and that's different than the perspective of someone having pancreatic cancer brain cancer where the five year survival Not even fifteen percent time. So you know. I do counsel patients of based on that and tell them to put things in perspective. I encourage all my patients to make long-term plans still into the positive outlook because the dynamic is also the landscape of prostate cancer. Treatment is also being. it's a dynamic process. A one of the things that you mentioned. That was about the stage of diagnosis. Can you just mentioned Described trust to pack. What do you mean by the stage. So the stage of the cancer is the extent of the cancer within the prostate itself so when the cancer is localized to the prostate. We usually say that's oregon confined or stage two when it's a stage three cancer. It simply means that the cancer has gone beyond the capsule or the surface of the prostate. And so that means the Cancers tumors actually penetrated the surface of the prostate in gone beyond its out a nearby structures Outside of the prostate wall stage four prostate cancer means that the cancer has grown into a lymph node or has grown far away from the prostate distant until liver surrounding organs Bones so that would make it a stage four cancer. I see and then obviously i'm assuming depending on the stage. The treatments vary. Can you talk to us a little bit about the treatments that patients can expect when we say localized cancer were simply focused on cancer. That has not left. The prostate has not penetrated the surface of the prostate has not gone into the bones or lymph nodes so for localized prostate cancer. Depending on the gleason grade Den determine the appropriate treatment for men with diagnosed with will be called gleason six or grade group one or low risk to very low risk prostate. Cancer We oftentimes recommend active surveillance and access raelians for a man should be the first line of consideration when diagnosed with this type of cancer of course when the cancer is more advanced than we certainly taylor the the focus to actually treating the cancer so any man with a pardon all the lingo but gleason score seven or higher a great group to or higher prostate cancer and You know somebody with what i would consider. Intermediate risk parameters really should be encouraged to treat intermediate responders or higher should really be encouraged to focus on treating the prostate cancer. Especially if they have a life expectancy of more than ten to fifteen years and that's an important topic to mention is that because prostate cancer can present very advanced stages or ages. Life expectancy is a consideration to in part of the discussion because if a man is in his eighty s and has competing Medical problems sometimes even with significant prostate cancer. We may not treat that cancer because our goal is to do no harm. You mentioned the gleason grade Just for the listeners. And the view is. Can you explain a little bit what that is. Gleason grading is a pathologic grading system. That really looks at the actual cell structure of the cancer under a microscope in the look at the cell structures determine the aggressiveness of the cancer. So the gleason grading system starts from six or three three equals six to five. Plus five equals ten on the extreme advanced presentation form so They've tried to shift away from this gleason pattern to what they call a great groups. Great group one through five and simply for the fact that when men here a gleason six cancer to them they hear six out of ten and they get very concerned that the cancer is beyond five notes to them. It sounds more advanced. So we've changed the nomenclature over the years to accommodate for the fact that gleason six prostate cancer is actually a very slow growing cancer and very early detected non-aggressive other times we think for example patients should seek a second opinion. I think oftentimes when you use the basic minimum to make a diagnosis in stage patient I think that's that is all that's required for most providers. I think for patients who want more information to ensure that they are accurately staged and accurately diagnosed. I think a second opinion at center of excellence is important because there are various things we can offer such as a second opinion. Review of the pathology slides. You'd be surprised. How often pathologist will disagree looking under a microscope looking at the same exact cell and tissue and they may disagree about the the grading of the cancer so gleason grading can be somewhat subjective. And it's based on that physicians experience and opinions. So i think mayo clinic. Of course we have very experienced with Most of the day they spend looking at prostate cancer so they really become specifically interested also experts on prostate cancer so they can be better qualified to make some of those calls when when there is a kind of a a know a subjective situation the other reason why people come for second opinions to a prostate cancer specialist is also to ensure that there are no other tests that could be run that may improve the staging of the cancer so one example of staging imaging. That is really helped over the years. Mri surprised to help patients who are diagnosed with prostate cancer. Oftentimes don't have an mri to help a visually stage that cancer now not. I'm not saying that every patient was prostate. Cancer needs an mri. but i certainly Feel that some patients would benefit from mariah to ensure the cancer was not under staged so if a patient has not had an mri prior to or after a biopsy. That often makes me concern that we could be a under staging the cancer. It could be a non of like the tip of an iceberg. Heidi no there's not more in the prostate than what that one needle picked up that those two needles picked up so i think accurate staging. The cancer will really help determine an help. Patients make a better decision about their future treatment. Plans or active surveillance plans. But i i think we're we're blessed here. Americans have experts like yourself but also said the pathologist who really honed in on the diagnosis as you see many patients can be said under diagnosed and and that is very helpful information with the coronavirus pandemic Ongoing have you seen any changes in terms of treatments for example for patients or how patients have presenting to. We've been fortunate mayo. To have a very robust testing for the virus and and we used at testing in our everyday practice to protect patients but also to protect care provider so that we can continue to do what we do. And i think what we've seen especially during the height of the pandemic united states. Is that a lot of patients weren't able to get access to care for their prostate cancers whether it be for diagnosis for an elevated. Psa the concern looming of a potential cancer diagnosis or somebody who has confirmed cancer that once that prostate treated and their local providers haven't been able to reopen in a normal fashion. So we've been fortunate we've been able to continue to offer the full breadth of Prostate cancer related treatments or diagnoses To allow the continuity of care but also expediting care for patients. Who really need to be treated in a timely fashion. One of the things that we are aware of is about healthcare disparity and i think earlier on you. Mention certain groups are a higher risk of prostate cancer. What what are we doing to get that message out to them about screening and the diagnosis and what the actual condition is. That's a great question. And they've looked at Economic socioeconomic factors that help Or prevent the diagnosis of prostate cancer. And i think that's why Awareness campaigns like movember are important to get that message out to men as men. Were very reluctant to seek care on our own oftentimes We have to rely on a spouse or family member to really bring that person in to get screen or checked. Even children of of men also can sometimes be advocates. But you know there are men out there That want to be healthy and but aren't aware that there's access most cities. Most areas do have what we would consider yearly free campaigns or programs to to offer prostate cancer screening. The american cancer society and they will have campaigns for prostate cancer screening. Of course movember is a big national movement to raise awareness. What if you look around the course of the year and in within the country there are a lot of resources that men who have a limited access to healthcare where they can actually get free screening. Whether that's a combination of the prostate exam with psa or with a psa alone or prostate exam changes in treatments for prostate cancer. We touched upon a little bit. Anything In the horizon. That's coming up on new that we're doing today. One of the reasons why i decided to focus on prostate cancer there is a tremendous amount of innovation around how we treat prostate cancer whether it surgically whether it using energy to ablaze the prostate or even some drug therapy So it's a very exciting Sub-field i simply start with surgical treatment of prostate cancer. Since i started as your allergists we used to open surgery commonly and then now the standard of care has really become a minimally invasive laproscopy surgery with robotic assistance in for me My bread and butter procedure that is performed all the time at mayo clinic as robotic assisted laproscopy prostatectomy and with that technology. It's fascinating you know. When i turn on the robot and operate i feel like a science fiction movie because it really is an amazing piece of technology that has allow allowed us to perform very complicated a surgeries but in a fashion that allows patients to suffer less with less pain smaller. Incisions the recover. Their recovery period is remarkably quick. We can really get effective treatment of the cancer also affected preservation of of mail function. You know one of the biggest fears of having surgery is a man may potentially lose Sexual function and lose ability to control urine some of the tools that we have available to us now. Such as the robotic technology we can actually really improve our ability to preserve some of those critical male structures and functions on the forefront of ablation. There's a lot of technology now to a blake prostate. Answer so ablation. Simply means you're gonna apply energy to destroy the tissue whether it's normal or cancers y- apply the energy in a very focused targeted way so there are a lot of exciting technologies such as a high intensity focused ultrasound Laser ablation In cryotherapy so that's also being commonly used in treatment of prostate cancer as well My radiation oncology colleagues have very exciting developments with traditional external beam radiation and also proton beam therapies and then for advanced prostate cancers. We have exciting new medications That can manage or effectively control. The cancers and allow patients did live longer with more advanced cases of prostate cancer. So we've come a long way. I mean obviously you're talking. Futuristic lasers and robots so obviously be. The treatment has advanced significantly over the last several years. Absolutely it's very exciting. And i think it's a true benefit to patients and what's really exciting is defeat what the future holds because all this will only continue to improve and give men more and outcomes though to pack anything else that you'd like to add that we haven't addressed. He raised a lot of important points about prostate cancer. And i just want to make sure that all men listening an all you know any anybody listening really If you feel you have a family member or a person you care about at risk I would highly advise him to get checked at least once a year if they're in those age groups that we talked about there that are at risk or if they have a strong family history. It's a shame. When i meet a man who's never been checked before and presents at a very advanced stage and i think when you talk to those patients. There's a lot of regret about not doing a simple screening test because these screening tests were talking about a very simple. It's a blood test. It's a process exam with a finger. And i think they're simple enough and less invasive than some other modalities modalities of screening such as colonoscopy. Frankly for me. A colonoscopy is a little bit more intimidating than just a finger exam so and it's much easier to do a prostate exam with the finger. There's no anesthesia required especially with your hands especially with my hands. That's a thanks to my clinic. Urologist to raymond pack for joining us today to highlight the importance of prostate screening. Thanks for being with us today. To pack mayo. Clinic is a production of the mayo clinic. News network and is available. Wherever you get and subscribe to your favorite podcasts to see a list of all mayo clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well.

prostate cancer cancer prostate five year maitland acuna dr sanjay Caca dr raymond american urologic association colon breast cancers one hundred percent psa advanced cancers Cancers tumors gleason mayo clinic colorectal cancer skin cancer united states prostate cancers
Episode 103: Abe Morgentaler talks about mens health, sex drive and the benefits of testosterone therapy

STEM-Talk

1:48:19 hr | 10 months ago

Episode 103: Abe Morgentaler talks about mens health, sex drive and the benefits of testosterone therapy

"Welcome to stem talk stem stem talk. Welcome to stem. Talk for introduce you to fascinating. People who passionately inhabit the scientific and technical frontiers of our society. Hi I'm your host Don Cornelius and joining me to introduce today's podcast as man behind the curtain. Dr. Ken Ford Agency's Director and the chairman of the Double Secret Sexy Committee that selects all the guests who your parents. Don't talk put on great to be here today. So our guest today is Dr. Abraham Morganthaler the author of the truth about men and sex and the founder of the nation's first comprehensive men's health center which is called Men's Health Boston so abe is a practicing physician and associate clinical professor of urology at Harvard. Medical School whose work has challenged Andrew versed decades concepts about testosterone prostate cancer and male sexuality in his practice specializes in. Hypo gonads them. Which is low testosterone sexual dysfunction male infertility prostate disorders vasectomy and microsurgical Reversal Abe regularly appears in the media on the topic of men's health and has appeared on NBC nightly news. Cbs Evening News CNN with Anderson Cooper and the connection on NPR Kaz clinical work testosterone was featured in the New Yorker and in journals including Newsweek and US News and World Report. But before we get to today's interview with Abe we have some housekeeping to take care of. I we really appreciate all of you. Who have subscribed to stem talk and we are especially appreciative of all the wonderful five star reviews as always the double secret selection committee has been continually carefully reviewing I tunes Google stitcher and other podcast. Apps for the wittiest and most lavishly praised reviews to read on stem. Talk as always. If you hear your review read on stem talk. Just contact us at stem talk at I. H Mc us to claim your officials stem. Talk T shirt. Today our winning review was posted by someone. Who goes by the MONIKER? Banana Lover One. Seven eight eight nine and the review is titled Superfan. It reads I discovered stem talk only a few weeks ago and I've been listening to the episode every chance I get. I actually look forward to drive now. It is such a wonderful and unique opportunity to be able to hear about the most recent discoveries in science right from the source as I listened to this podcast. I'm reminded why I am working so hard. Hope that one day I too can be a guest on stem talk. Well we did too and thank you. Banana Lover Seventeen. Eight eight nine and thank you to all of our other stem talk listeners. Who've helped some talk become such a great success. Okay and now onto our interview with Dr Abe Morganthaler Stem Talk Stem Talk. Hi Welcome to stem talk. I'm your host Don Cornelius and joining us today as Dr Abe. Morganthaler Abe. Welcome to the PODCAST. Nice to be with you and also joining us Ken. Ford Hello Don in Hello Abe. So Abe you grew up in Canada and like all good Canadians. You love hockey other than spending a lot of time and skates on a hockey rink. What were you like as a kid? I did like hockey and unlike now I live in Boston. And our winter Well there are a little tough. But they're not as bad as Montreal but back then when I was a kid. Winter was fantastic. He just to like skating and skiing and tobogganing and whatever else in snowball fights and snow forts. So what was I like his little kid? Well I thought I was going to be a hockey player. That was the dream. I thought I was reasonably good. I played on my high school team. I played on sort of my town. What we call the travel team. We played other towns. And when I got when I got accepted And went to Harvard undergraduate. I just figured I was GonNa play hockey and I thought I'd walk on and I'd be the best player and of course that wasn't exactly right and you find out you know. Big Fish. Little Pond and And then you go to a big pond you find out how good people really are and My goodness I was proud to make the in the end. I was proud to make the freshman team which was a big deal. Harvard was good Good hockey school. Yeah absolutely but I had to give. I gave it up after year. I realized that this was really not my ticket to stardom. And I wasn't that good and I had to really rethink and figure out who I was and what I wanted to do in life so after high school actually just stepping back for just a second. You took a gap year and travelled around Europe. And you even went to work on a kibbutz and in Israel. It sounds as if you had an interesting time. So can you tell us about that year? Sure so you know. I had two friends and We hid degreed in High school that when we graduated we would all take a year off. And you know is this is the beginning of the seventies and that we would all travel together and of course by the time we graduated. They went on to college and I kind of stuck with it and I really wasn't ready to go on to university and I didn't know really what was ahead of me and and so I took a year and I traveled around Europe and My parents who originally came from Poland and were Holocaust survivors and finally came to Montreal. Where I was born they knew people from all over Europe and they gave me this whole long list of names and I sort of nodded at them. I took the list but I know intention of seeing anybody but you know I was in Europe for bed. Six seven eight months and in the end. I saw every single person on their list tonight. Orienteer- up and I got some nice home cooked meals and occasionally slept in a nice bed so that was good and then When my money ran I really? Didn't you know it's funny to think? Now you know I've got two daughters in their twenties and You know this was. There was no cell phones there was no Internet. I don't even remember how I stayed in touch with my family but it wasn't very often and when my money ran out it was kind of appointed prior to didn't want to go back home yet and so. I figured where can I go without money? That will take me where I can work and I went to Israel and I said I'm sure somebody'll I can go work on kibbutz but I really had no plan. I didn't know how would happen and I arrived. And there's the baggage carousel and I had this Big Rucksack with the Canadian flag on it and I just took it off of the carousel and somebody came up to me and said Hey WanNa work on a kibbutz I said sure and it was a fascinating experience. They actually put me up in a different kind of Farm environment was called Moshav. It was in the Negev desert between Beersheva any latte and the moshav differs from kibbutz. In that it's really more of a each family works itself but there's a community some community services and community equipment. They used together and I was there for a couple of months picking Tomatoes and eggplants and Growing or raising gotTa Turkeys and that was You know an incredible experience for me just working on the farm using my body in the middle of the day everybody takes Esta and The person the farmer I worked with head little. I don't know you call Noah scooter like a VESPA kind of thing. And this was a in the middle of the desert and they had a paved roads that went out to where they thought. They would expand for more fields. They didn't have desert but they had irrigation water so that's how they could grow the crops but the places that weren't yet being built were just desert and I would take that thing out in the middle of the day and wearing these tiny little shorts and no shirt and just go zooming out on these paved roads with nobody around and it was pretty incredible. Fantastic I understand that When you were Born your mother had two special wishes for your future. What were they so the the story is? I don't remember it from being a newborn but The story is that when I was born in my mother discovered. I was a boy her to wishes for me. Were one that I learned how to play the violin and the other was that I go to Harvard so I never learned how to play the violin. I guess the second one was my way of making it. The the that works so you were sophomore in college and you weren't sure what to do next but then one day you ran into professor over on Harvard Square. Who asked you how are you doing? So can you tell us what you said? And then how that chance encounter led you to start studying the sex hormones of lizards. Yeah to mazing how life works really Lena thinking back like I told you my freshman year was kind of like being a freshman and my identity was as a as an athlete is a hockey player when that came to an end. You know I really wasn't sure what to do and didn't have any you know. I took some biology science classes. I like that but I really didn't have a path forward for myself. I didn't have an identity and I ran into a professor of biology class that I take in the previous semester the year before and I'd done well in the class. And you know he just chatted with me and said how you doing and I was honest with them. I said you know I was really thinking about leaving school or taking time off and I told them that and I wasn't that happy and he said why don't you come work in my lap Maybe like it and so I- dropped by and I worked a little bit on this project and a little bit on that and eventually it really grabbed me and and the work was being done. His name was David Cruise in a after Harvard. He went down to the University of Texas in Austin. He did really amazing work. Brilliant man and He had a reptile lap and P and had lizards and snakes and The first project I did was really boring but in the end very important which was that he had done a project where they had taken a radioactive testosterone and injected it into the lizards and then when the animals were sacrificed. The take the brain and you could slice it up very thin and put it on a slide with an emulsion of photographic paper or photographic emotionally. What would happen? Is that the radio-activity these tritiated Molecules would basically develop little spots on the photographic paper. And so you could see the cells and you could see where there were as a high concentration of these basically black dots and those black dots represented the presence of the radioactivity which had been injected for testosterone. And so that. First Project was actually mapping out on pieces of sketch paper the thing projected onto the paper and you sort of draw the outline of it and then put in where the areas were that were lit up by the radio activity and that became a map of the Lizard. Brain that showed where to stop Stran- was taken up and it was taken up in a few areas and one that became the focus for my research over the next three years was the sexual center of the reptile brain. Or at least that Lizard Brain and that was the media pre-empted area which overlaps with the anterior hypothalamus. In you know people say why do you work with with lizards like why reptiles everybody's used to research in mice and rats an from an evolutionary point of view to actually a really critical? So when we think about the vertebrates animals that have backbones we start with the fish and amphibians and reptiles and then the reptiles become a branch point in evolution where one branch leads to the birds and the other branch leads to mammals. Both of which the mammals and birds we think of as the higher vertebrates or the most evolved if you will but much of the biology of that brain if we're just focusing on the brain for a second is conserved meaning you Mo- most of it actually functions in Almost an identical way in the higher vertebrates. So we still talk today about the Mammalian brain is having a resilient part of our brain. We talk with human brain is having a reptilian part and the reason we do it is because the the physiology of that area is really almost identical in humans and in lizards or reptiles in general and so whatever it was that we would find there would actually have potentially implications that would ultimately we sort of think of. I think the much of the biology we're interested in is like what does this have to do with us? Not all of a lot of it and And so that was and so once. We had the area that we knew that we wanted to get to and we had a map of the Lizard. Brain the next set of experiments that really took up most of my next several years and then really led to my work over. The next forty years was to look at what happens when we manipulate to stone in the mail lizards and this is really pretty cool. So the list we were dealing with a call to knowle's caroline and sece's the American Chameleon these lizards that you see in Florida and the Carolinas in the Bahamas there about three to four inches long. They sometimes get in your hotel room or you see them on the palm trees and we see them here all the time it agency by the way we see a running all over so if you ever come visit us you'll get a chance to see them exactly. So they're they're easy to find in what happens if you put a male in a cage with the female or they have this bright colored flap of skin under their neck. It's called Delap and the sexual behavior of the male knowle's but a lot of the lizards is to extend that do lap in their head bobs up and down very rapidly almost like a the mail saying. Yay and the female. If her ovaries are intact will do a little very elegant stately. Push back that basically says okay. Maybe I'm interested. Let's see what you got in. The mail comes closer extensive do lap and in the bobs up and down again and they repeated a few times and then finally they mate well turns out that when you castrate the mail which means to remove its testicles which is the source of its. Testosterone. You put that male in a cage with the female again and it does nothing. It doesn't care The female will sometimes to push up as if to say. Hey Buddy. I'm over here in. The mail does nothing. And then we knew that you could put testosterone these little implanted under the skin of the Lizard and recreate. It's sexual behavior. But my project was then having identified the part of the brain that we are interested in was to develop a way to deliver minute amounts of testosterone right into the sexual centers of the brain and then to see what would happen and when I was successful in doing that putting it in the right part of the brain which was a whole you know stick by itself just had had to actually deliver it but when I was able to do that successfully this mail without testicles and without detectable circulating testosterone and its bloodstream would see the female delap would come out head. Would Bob up and down. Yeah Yeah Yeah Yeah. Yeah and they would make an amazing amazing thing. That's fascinating Abe. Just really quick. I was sitting here making sure. I'm touching because I've heard this name David cruise you're talking about he worked with early on David. Cruise was actually the mentor. Advisor for my First Academic Mentor and Advisor John Godwin whose at NC State University and I did work with him looking at Arnie. visa toxin and The Blue Grass and I know David I worked with a bunch of David's students over the years On some behavioral endocrinology studies. So it's a small world. It amazing. I was just in Lisbon at a different conferencing ran into this guy. And who sort of an evolutionary biologist. And we're just chatting and HE TRAINED WITH DAVID CRUISES. Well so that's amazing. So he had a big impact in a Lotta ways and I'm not sure that you know he would know at one of the most amazing things I think. In sort of the world of teaching and academics is you never know what the ripple effect is going to be and how people are influenced by? Your work downstream. That is absolutely true. So for the past twenty five years the greatest fear related to the use of testosterone therapy in humans has been the fear that raising testosterone levels led to prostate cancer and this is largely due to a nineteen forty one paper by Charles Huggins from University of Chicago who demonstrated for for the first time that cancers can be sensitive to hormonal manipulation and he and his co author of the paper actually castrated men with metastatic prostate cancer because castration reduce oxyde phosphates which indicated improvement in the cancer and this was the first treatment for advanced prostate cancer that was shown to work so as a result castration became the standard treatment for advanced prostate cancer and Huggins won the Nobel Prize and also as a result medical students from around the world were taught that high testosterone levels cause prostate cancer. And we now know that that's not true of course but can you take us back to the early nineteen nineties when you began to question the so called scientific fact that high testosterone levels caused prostate cancer. Sure will you you say we know today? Of course that it's not true but I I would sort of challenge. That is that there's still a lot of people who really worry about. This is so in ten years of training for years of Medical School. Six years of residency. I didn't learn anything about giving testosterone all. We learned about testosterone for the most part learn. Just a couple of things. One was at least in medicine. Testosterone was necessary for male puberty. And that if a man lost his testosterone for lost his testicles to cancer or Trauma that he wouldn't be as if it happened early. He wouldn't realize he wouldn't. You know develop beard or muscular definition or things like that and that was pretty much it. And the other thing we learned. Is that when men had Bad prostate cancer is that we lower testosterone so in six years of residency in urology. Which is the specialty that deals closely with prostate cancer? You know many times. We would lower testosterone either by early in my in my training. Either by removing the testicles. Just like I told you. We did with lizards or right around that time came the introduction of these medicines called L. HR h agonists lower testosterone just by injection and so that soon became preferable to doing surgery removing a man's testicles but when I came out of my training in one thousand nine hundred eighty eight. There was no doubt in my mind as there wasn't with anybody I knew the testosterone was terrible for the prostate and terrible for prostate cancer. And we believe that we are taught and we believe that Prostate cancer was caused by testosterone that high levels of testosterone wouldn't would cause it in and create an environment where aggressive cancers would appear and it men who were lucky enough to walk around with low testosterone would never get cancer and so we learn things like men who lost their? Tesco's early in life never got cancer and Unix never got cancer and that was it and there were everywhere in every city there was often one specialist. Sometimes to who dealt with the very very rare cases of men who'd had Patou itary tumors removed and as a result they had you know vanishingly low testosterone. Where like I say. They had lost their testicles. For one reason or another and those cases were rare. There was somebody who usually endocrinologist that would treat some of these guys and it's amazing how this is all changed and so when I started in practice. One thousand nine hundred ninety eight. I was at Beth Israel. Now it's Beth. Israel deaconess medical centers part of the Harvard Teaching System Hospital System. I started specializing in Male infertility and male sexual and back. Then we didn't have much to offer these men in terms of sexual problems. There was no Viagra. There was no Seattle and these guys would come and I was just curious because of my experience with the with lizards and And I just started checking testosterone levels. There was nothing I was trained to do. I was really just curious. And the first thing that struck me was how often the testosterone levels came back low in these men who had you know diminished libido or sex drive or reaction. Proms and it was like wow like I. I never knew that and almost as a Lark I just wanted to see what would happen if men were really liked lizards and I gave some of these men testosterone. I didn't know how to do it because we had no training around that I went to one of these senior endocrinologists I said had he give testosterone and she said. Oh It's easy you give two hundred milligrams Testosterone once every four weeks. That's all in so I had my nurse. Give a few of these guys Injections every four weeks of of this testosterone. And then I saw him back after I said how you doing and the Governor Guy said Oh my God it's Great. I feel better. My sex drive is better my erections. You're better as a and they would say I'm better in ways. You never even told me could even be possible. My wife says I'm nicer to be around. I wake up in the morning with the sense of optimism. It's like wow like what is this. And my first thought was that this was a placebo effect because it was such a powerful response. These guys had and nobody told me about it. It probably wasn't real but the thing that convinced me that it was real and not a placebo. Is that almost all of these early guys? Who had a good response would say so? That's how I feel for the first couple of weeks after the injection but remember. They were getting injections. Every four weeks says Dr for the next two for a week or two before my next Gentian all my symptoms come back like what's up with that and I had no idea and I joke that is kind of like a bad version of a double blind experiment where where the patient didn't expect noted the doctor in that case and just started checking blood levels and it turned out in every one of these men. The testosterone levels were up early in that injection cycle but by day twelve to fourteen. All of them were back to their low baseline levels. And what I got. And there was no way that any of these patients could know that that wasn't easy in from it. Turns out that there was information on it but not much and not easy to find. This is especially before the Internet and before you head product information available everywhere and articles that you can today you can access this but there was no way they knew then and when I got out of that which was true was that man could tell when their testosterone levels were low and they could tell when their stock levels were higher or normal it was real and as I started doing more of this and thinking what like. This is really cool. You know it came back to the prostate cancer issue because now that I was raising testosterone. I was absolutely terrified. That might be doing something bad for these men the same time. So Abe an incredible story and it's really disappointing that for nearly fifty years. No one bothered to look at what was happening in men. When you raise your testosterone and it just reinforces that we as scientists need to always question things especially the status quo and received wisdom. That is in front of us. But that's not easy as it sounds like you. I'm going to get you probably had some pushback as you delve into some of the work that you're doing yell I couldn't agree with you more. You know it seems to me. Having dealt with this over many now. Several decades is that it seems to me that the longer a truth there some foundational concept has been around the less it becomes questioned and challenged. Indeed Science does not best proceed Through consensus know exactly right and once it's been around for a while everybody just says oh we we all know this is true like otherwise. Why would this have been around my? I learned this from my teacher. And he was the most brilliant guy ever knew like everybody just agrees with and then it becomes really hard to challenge it or question it so you know the the work that I did following. That is that I was so worried about. Tell you this story so I am now treating you know. A moderate number men and We have a residency program where the residents Go from one of the Harvard hospitals to another and they basically are like bees cross pollinating different institutions. So there ended up not being any real secrets you know and I was starting to talk about this to the residents in my faculty and you know that these guys are doing well and it was a shock. And there's something really marvelous. How really focus helping these men and it was about four years three to four years after I was Out in practice and at our national urology meeting the America you a American Urological Association meeting. I ran into my former teachers who had been at. Who's faculty at Brigham and Women's Hospital? This sort of assist Organ Sister Hospital and he said anybody here that you're giving testosterone to men. I said Oh my God yet so good. It's like we didn't know. And He puts up his hand like a like directing traffic and he says very dramatically says. Stop he says. I don't think you should do this anymore. I heard you doing it from the residence. I decided to give testosterone to a man his. Psa went up. I did a biopsy. He's got cancer so I don't think you should do it anymore. You're GonNa give these guys cancer and of course that was always the fear and I was already talking to these men. They say what's the risk and there wasn't a whole lot of written experience about this and I would talk to them and say you know what you know theoretically there's concern about prostate cancer. We're going to monitor you as closely as we can. They would say how you're going to do that. And you know the two ways. We Monitor people are. Psa and and we feel their prostate digital rectal exam. We can't and they say well you know. Could you miss it and I would say it's possible. And that's one of the risks and we have these long conversations with these guys before they go on to star in when this former teacher of mindset stop by the sky with cancer. I don't really WANNA stop. I think this is really good. I don't know about that one case that you have. Maybe it was anecdotal. And he says to me says Listen if you're going to do it and I strongly recommend you. Don't I think you should biopsy prostate? I make sure they don't have any existing cancer and that seems kind of radical and invasive prostate you know we do a lot of prostate biopsies but back then it was no fun. We frankly we didn't know how to anesthetize man. It was an unpleasant experience. You know now we do it in the office. It literally takes five to seven minutes. It's not it's not pleasant but it's not terrible and But back then it was a big deal and I to my chief of And I said to him. Listen I ran into Dr so and so and he suggested I do these biographies before I give to stone and I'm kind of thinking. Maybe that's the right thing to do. I don't WanNa you know. WanNa make sure that. We exclude as well as possible. The presence of cancer so it doesn't like grow on them spread and he said fine. Do it and so that became a requirement. Did I made on men before? Giving Him Testosterone Even if their PSA was normal and their prostate exam was norm on other ways they had no known indications. Get a biopsy. The only reason I was doing a biopsy was to make sure that they didn't have an existing cancer. As far as I could tell the prostate that might grow like wildfire if we gave them testosterone. Not every man agreed but a lot did and shockingly. We found cancer right away in these guys and remember that the belief at the time there was based on what was called the androgen hypothesis everything bad about prostate cancer seemed to be testosterone related so high testosterone lead to cancer and the converse was that low testosterone was supposed to be protective. The belief was that men with low testosterone would not get cancer and so right away. I was finding cancers in these guys who had no indication of anything and at the national. Ua meeting a few years later we presented on. I forget it was thirty or thirty. Three men who had these biopsies and we had. I think six cancers and I fellow gave the presentation and this net internationally known figure famous famous Guy. Bob Crane came to the microphone at the end and in addition to being famous he also had one of the biggest booming voices. You've ever heard. And he came to the microphone. And he said this is garbage. Everybody knows high testosterone causes prostate cancer. Low Testosterone is protective and the room is packed and He Says I. I bet you dollars to donuts. You can do another hundred biopsies and you won't find another prostate cancer. So we thanked him for his comments and continued to do it and when we had fifty patients in the cancer rate was there is still high submitted the Journal of the American Medical Association. Jama and something happened. That had never happened to me before never happened to me since I've published two hundred papers. Which is that. The editor called me called me and He said you know our editorial board was just looking at your submission. We were very interested. This is the opposite of what we've always been taught and told and you've got a high rate of prostate cancer in these men. We thought it should be low. But you know you've only got fifty guys and I'm sure these don't come by every day and you know we're a little concerned just that the numbers low but I tell you what if you if you can collect Some more numbers and maybe already have you know. We'll consider it. And so when seventy seven men. Eleven of whom had cancer one seven with a normal. Psa We resubmitted it and they accept it and that was published in Jama Nineteen ninety-six more than twenty years ago. And at the time nobody knew what to do with that information frankly including me and we followed it up some years later with a much larger series that showed exactly the same thing which was that there was a fourteen to fifteen percent risk of cancer detectable just bye-bye ups in these men with normal. Psa But low testosterone and that rate of cancer that for one out of seven or fourteen to fifteen percent when we published it in nineteen ninety six was as high as for men who had known increased risk cancer due to an elevated PSA or prostate Najah. And so. We didn't say at the time. My chief who was on the paper wouldn't let me say that we thought low testosterone was a risk factor. We basically just hemmed hedged a little bit and said that in the presence of low testosterone that may be. Psa in other tools look for prostate. Cancer are less accurate but it was the beginning. It was the first piece of evidence that the story that had been told since the nineteen forties. Was that there was something wrong with it. Because men with low testosterone did not have a reduced risk of cancer. It appeared if anything they had as greater risk and maybe even an increased risk seven and two thousand six flashing forward. Just a little bit. You pulled together all the literature that you could find and wrote a paper that was titled Testosterone and Prostate Cancer a historical myth which show that the data contradicted the Oh believe them more testosterone will lead Tamara prostate growth of all. The papers have written. I understand that this one is your favorite. Is that correct? It is it is so you know what led me to. This was so nineteen ninety-six. We're doing these biopsies clearly. Low Testosterone was not protective. That part of the story was BS and I was treating a lot of men and in two thousand and four together with my fellow. We ended up writing review article on the risks of Testosterone for the New England Journal of Medicine. And just to give you some historical context. The modern era of testosterone could be argued started around two thousand and one with introduction of the first testosterone jail that was approved by the FDA called Andrew Joe. And that was the first time really. The doctors around the country were getting detailed on a testosterone. Product was branded. They were not TV commercials. But they were you know. Ads In magazines and Medical medical journals and stuff and the women's Health Initiative study had come out about women and hormones in two thousand and two that had raised concerns about risks. And so when we wrote this paper testosterone was kind of this new Had Been Around since the thirties but it was kind of a reborn new Item in medicine and there were concerns about hormones and women in one of the things we wrote about in is that we couldn't find it until we until we did that review article. I still believe that high testosterone must be a prom prostate cancer. Like I still believed old. What you're taught doesn't disappear didn't have complete vision right away. It was always like pulling back one extra layer of the onion. I knew that low testosterone wasn't protective but high testosterone must be bad. Otherwise why would we lower testosterone in men with advanced prostate cancer and after we went through about two hundred articles reviewing him we could not find a single article they provide support for the idea that high testosterone was bad for prostate cancer or the testosterone? Therapy was bad. We'd simply couldn't find it. We didn't say it wasn't true but there was a fair amount of contradictory evidence. And so you know I'm on the lecture circuit kind of in Urology talking about testosterone. Now and about you know the the date and the workweek done that showed that may be testosterone wasn't so bad for prostate cancer in this older prostate. Cancer Oncology Guy says to me you know what a your stuff's very interesting but you have to be careful because maybe metastatic disease is different and hugging. Huggins said so so I decided to actually find out what hug and said and in that time when you wanted to get to articles you had to go to a strange building. The House Law of articles. They had a name. You may be heard of it. It's called the library We don't we don't deal with those much anymore. Now everything's on. You can get almost anything online but back then. I walked myself to the Harvard. Medical rb can't way and in the basement. They have these archives of all these articles. They're all bound. The you know volumes of nature going back to the eighteen hundreds you can just pull off the shelf and there was the original article from nineteen forty one cancer research by Huggins and his CO author. Hodges and that was the article that we're he established that he took these guys with prostate cancer metastatic to bone and he removed their testicles or gave them estrogen to lower their testosterone. And he showed that this blood marker called acid fossey's which is sort of the precursor to PSA if you will for prostate. He showed the all in all cases when he castrated these men. The ACID FOS potato would go down and also wrote that. In every case where he gave injections of testosterone the acid foster as would go up and I remember the feeling of reading that and getting so nervous that my brain didn't work right because my palms were sweaty. My heart was racing because by now I've treated a lot of men I've allotted men under my care with testosterone. And I kind of told myself that maybe wasn't true that testosterone was bad but I was worried about him. And here's the patron saint of Urology Charles Huggins saying YEP IT CAUSES. Prostate cancer and the final sentence of that paper was injections of testosterone activate. Prostate cancer. I thought. Oh my God you know I had small children. I had this image of the police coming to my office and taking me away for doing this. Terrible terrible work in in in a moment of very proud of it of self discipline while my heart's racing I kind of forced myself to reread the paper. Answer a few questions that I wrote down for myself and one of them was how many men did he treat with testosterone and the papers are done differently back then they're more a lot more storytelling and sort of anecdotal cases in case histories and as I went through it and read it again and again it turned out that he only gave injections to three men of those three men who got testosterone only gave results for two men of those two men one had already been castrated which today we understand represents a special case where the prostate is you know essentially starving for any kind of testosterone or androgen and in the end the whole ball of wax about how testosterone is dangerous for for prostate. Cancer comes down to this one original paper which itself was based on a single patient. Who is still hormonally intact? Who received stone for only fourteen days? And that Kerr for the acid phosphates in that man goes up and down. So erratically did it is unintelligible. And that was the story of testosterone prostate cancer in seventy years later were stuck with a premature conclusion based on basically one anecdotal story that I think could not only could be interpreted differently should be interpreted different amazing thing and when I did that I then went through every like he was I opening like. Oh my God this is what it's based on this huggins work around testosterone causing prostate cancer. And what I did in that. Two thousand six article wrote where I wrote about. The historical miss was split wrote about that. But also I pulled up all the older literature and all the stories that created what I call the lore of testosterone in prostate cancer. So for example I was taught in training that men who were Unix never got prostate cancer low testosterone prevents prostate cancer. And so I went to find the source of the and the source from you know asking around and residency was. Oh Yeah. They did the study where they went. And they found these surviving UNIX in China and they look for prostate cancer. None of them had well. I found that paper to from the nineteen sixties. And what they had was. I don't remember how many guys they had something. Like twelve or fifteen of these older men and back in China. They used to have something. On the Order of ten to twenty thousand of these UNIX living at a time and they just had from whatever Pruitt ever period it was and You know they took care of the noblemen and the the royal families and and nobody checked them out for prostate cancer. It turned out they did have prostate exams. And some of them they felt the prostate in other words. The prostates were small but they didn't have. Psa's they didn't undergo any kind of imaging. Nobody had a biopsy that paper had nothing to do with finding prostate cancer. And yet the information kind of fit this narrative that we just worked for everybody and in India and just one more piece of a story that turned out to be. I don't want to say not true. But it didn't say what it was purported to say it it just looked circumstantially like it added to the story and the story was wrong. You followed up this paper with one that appeared in the European Association of Urology. It was titled the Saturation Model in the limits of androgen dependent growth. Can you explain how this situation model fundamentally changed the way you think about the relationship between testosterone and the prostate? Sure so you know gone out of everything I've I've told you and and Thank you kindly for your your your patients in hearing these stories it's funny. How Science Advances Right? It's often not from these randomized control trials. They have their place. But sometimes it's just somebody just trying to follow through where things started from so what was clear to me. Was that the data and we had a lot of it. The data that higher to stops Joan is related to prostate cancer. Appear to not be true. Giving two men who have big prostates have higher testosterone than men with smaller prostates. There was all this stuff. And they were animal experiments the same way that it it appeared that for a large range of testosterone concentration scale. If you will that prostate didn't really seem to care at all and yet there's another observation which has really been propelling the whole thing. Which is that. We know that if we can straight men or reduce their testosterone dramatically. Psa's will come down and the PSA's can go from very high numbers down to undetectable. That part's real. So there's a paradox. There lowering testosterone shrinks the prostate and lower. Psa there's no doubt every doctor who seen a man with prostate cancer knows that has seen it over and over again. If you're a urologist and yet raising testosterone didn't seem to do anything and so would occur to me just from some little Pieces of evidence. Some of it from the nineteen fifties and sixties was. It appeared that if you gave tiptoes down to a man who hadn't yet had his testosterone lowered. The cancer didn't seem to change in what had said to me was that there was a maximum amount of stimulation that could That androgen testosterone like substances could provide to the prostate or prostate cancer. And once you reach that maximum. It didn't seem to matter if you added in more and if you withdrew it and you deprived it absolutely you know something happens. You're depriving it of it and so the term saturation comes really from its biological term. But there's a practical version of two if you just had a little scale and you put a sponge on it. That's sponge has a certain weight. If you add some water the sponge will hold onto. The weight will go up yet. A little bit more water way to go up at a little bit. More weight will go up at some point. The sponge can't hold any more water. At which point we say it is saturated and you can pour water onto it but you've reached the maximum weight it's done and it turned out you know. Huggins worked in a time. When we didn't understand how many hormones worked most of them work primarily through binding to receptors so for tips dostram binds to what's called the androgen receptor and it turns out there's a limited number of copies of the androgen receptor per prostate cell. And once you reach the maximum for that you can add in all the testosterone. You want that mechanism can't do anything anymore. It's maxed out. And that's what the saturation model is. And so we propose that in. I did it early in two thousand six with my myth paper but then again together with a brilliant biochemists a colleague Abdul Trish we really provided in two thousand nine article data from animal models from in vitro systems and also from human studies all the data that really supported it and to this day. Ten years later I don't know of a single example in in biology or medicine between regarding staw strong and prostate whatever prostate PSA prostate volume. It doesn't fit into that. It's it's clear that's what happens. There's a maximum amount the you can stimulate it and when you deprive it by all means things get smaller and you don't get the angiogenesis stimulation and that's the saturation. On the importance of the saturation model is is that. It provides a new theoretical framework for understanding the relationship between testosterone and the prostate malignant or benign and then became the basis for which men now or doctors now can provide testosterone safely to men who have previously been treated with prostate cancer. Because if these guys are walking around with a low wish but still some level of testosterone the amount of testosterone stimulation of those cancer cells if there are any is going to be extremely limited and that's allowed an and now many urologists around the country around the world will now offer testosterone to some men with prostate cancer. Especially those who appear to be cured. A The work that you're doing today that really excites you has to do with men who are coming to see you about metastatic prostate cancer and standard treatment for these guys who spent a lower their testosterone as much as possible which actually becomes a form of chemical castration. And I hear that it was a phone call from a ninety four year old gentleman. That guy you interested into looking into men with metastatic prostate cancer. Is that right amazing? An amazing story so this is a several years ago. Now this guy calls me from out of state. He's a scientist. He's got like a hundred patents and despite his age he seemed very sharp on the phone and he got on the phone with his daughter who's a nurse practitioner and they had read a lot of my research and he soon come see you. I want you to put me onto Austrian and he had metastatic prostate cancer. I didn't have a lot of the details yet and he said if I come see you will you treat me no guarantee but I'm happy to talk. I'm happy to talk to you about it and we'll see but you know I can't do much over the phone so he was supposed to seem. You made an appointment seeming like a week or two later and then that got canceled and he came several weeks after that and it turned out that the reason it got. Can't the appointment got cancelled was because his cancer had grown to obstruct the yours carry the urine from the kidney down to the bladder and he needed tubes to divert the urine. There called the frosty tubes. And so when he came to see me and so he was hospitalized for that and he got out. He still made his trip to Boston to see me and when I came to see him he was ninety four. He was pretty looked pretty good. He walked to the cane but he got on and off the exam. Table by himself and brain sharp is daughter. The nearest practitioner was with them and he had this tweety kind of Jack and he had one of the urine bags from his right side in the right pocket of his jacket and he had the banker. The left side in the pocket under left jacket left side of his jacket and We sat down in the in the in my consultation room. I said so. Tell me what. What are you interested into Austrian for and he said well. I used to exercise every day and it made me feel good and now I'm too tired. I don't do it at all and I used to send emails and correspond with my colleagues all around the world and I'm don't do anymore. I'm just too tired. This guy had cancer that had spread to his bones. He had the highest. Psa of anyone. I've ever met at that time. Which was over five hundred? He had blocked kidneys on both sides from obstruction from his cancer. He was in bad shape. He'd lost lottery and He was really what we call. Sort of pre terminal. You know like he wasn't about to die today or tomorrow but you know it wasn't going to be long for him and I said to me I'm not so sure about treating. You have never treated anybody like you. I've treated men with low grade cancers that were just watching. We call that active surveillance. I've treated men. After they've had surgery for their prostate cancer and they seem OK. I've treated men after radiation for their cancer. But they seem okay you have prostate cancer that spread throughout your body and my fear of giving you testosterone is that your cancer will grow rapidly and you could die tomorrow or next week and could cause you pain. One of the things we worry about in urology with advanced prostate cancers it goes to the bones and the spine vertebrae could collapse from a fracture from weak bones and cause paralysis. And I told him all these things and He said I've never lived in fear doctor and I don't want to. I don't intend to now says I know that I'm going to die of prostate cancer. And even if it's not cancer ninety four years old but while I'm here on this planet I'd like to live as well as as well as I can so with Some hesitation intrepid days and and writing a very long when we call informed consent that he signed where he knew. All these awful awful things could happen to him off. He went with the prescription and And his daughter started giving him injections of testosterone at home and within four to six weeks we spoke in. He was feeling better and he started exercising regularly. His appetite improved he gained weight and he started corresponding with his colleagues and he started working on a new patent wrong and he survived almost eleven months and when he died one can say was from prostate cancer which was ultimately but really would cost him to die with his one of those tubes and the kidney had fallen out at home and people can get infections when that happens and he got septic and his daughter didn't want him admitted to the hospital so we got some antibiotics. He wasn't hospitalized and he died about two weeks after that But you know what? I don't know that we shortened. His life expectancy by even one day and during that nearly year he was on testosterone. He had great quality of life and he wrote to me and sent me pictures about his story and his daughter did as well and they not only gave me permission to use his name and his photograph and I've used his photograph in a couple of lectures But they he encouraged me to do it. He knew he was doing something that was sort of new and and the the fact he was doing so well with so different from everything that we had been taught and after he had that experience he gave me the courage to start doing this in a limited number of men with a similar situation and so we continue to to do it and so far. I tell them in this. We don't have the kinds of data that we like and medicine where we have these large control trials and where we can say what the safety risks are and how great the are we. Don't have that but anecdotally. Here's what I can tell you. That's amazing is that not one of the men that we've treated has had any of these terrible rapid of prostate cancer that causes all kinds of morbidity and. Proms just haven't seen it. No It's good. Ask like a great story to and so you use the term. Lo T to describe a condition that is otherwise known as Hypo at them or test around Deficiency Syndrome although people think of testosterone as the primary male sex hormone. It actually is much more significant than that. So can you give our listeners? An overview of the different biological functions of testosterone sure so testosterone is everywhere and works on an incredible array of of Tissues so you know we think about it often around sexuality and male desire and in the brain but also affect mood. It affects the function of the of the Penis in terms of erections. It affects muscle. Which is why the athletes in the bodybuilders. All want something testosterone. Like to help them when they were to cheat with it affects fat to the testosterone keeps our our fat mass down. It affect red blood cell production in the bone marrow It affects nerves in effect liver function and it effects skin and scalp and body hair and scalp hair and skin oiliness and something else. Which amazing we we have this A new a new medical society as of a few years ago. Three years ago called the androgen society where we bring in. All the different specialties into chronology urology primary care and We have a meeting coming up in April in Orlando and one of our speakers in ophthalmologist whose published work. That shows that men with low testosterone actually have decreased production of tears tears so one of the treatments they have for people with dry is is they actually have a testosterone like boy I O ain't that amazing. Yeah Yeah and affects bone so you know we. Everybody knows but women are at risk for osteoporosis. After menopause estrogen levels go down it turns out that men are at risk cross. You prosise to if they're stronach's down and on that note there huge numbers of men who have symptoms of low T. and we know that testosterone levels decline with age and since this decline is a natural part of aging. Many physicians argue. That we really shouldn't be treating people with low T. So what's your response when you hear people say that yeah So that one makes me crazy? So here's the thing so the argument has been because it's a quote unquote natural or normal for testosterone levels to decline as we get older. The argument is it's normal therefore we shouldn't treat it. It's just natural part of aging people should just get used to it. And that's who we are and here's what I would say. Is that almost everything we treat in? Medicine is age related. So what happens as we get older is that we get bad eyesight? We get bad teeth. We get bad joints. We get bad blood vessels. We could bat hearts. We get bad blood pressure control. We get bad sugar control control and we get cancer. Every one of those things is age related which means they become more common as we get older. That's what aging is sucks and we treat. We treat every one of those things either to improve health quality of life derision of life. That's what we do and the idea that we should avoid treating men with float who are symptomatic from low testosterone often miserable. Just because it's more common as we get older makes no sense no sense in my world and we agree with you on that one. Here stem talk is an educational service of the Florida Institute. For Human and machine cognition a not for profit research lab pioneering groundbreaking technologies aimed at leveraging and extending human cognition perception locomotion and resilience another interesting development. There's been a controversy around the role of testosterone and cardiovascular health and one of the most common assertions about testosterone replacement therapy is that it can increase a patient's risk of cardiovascular disease. There's actually paper that came out in two thousand thirteen in Jama. The reported increase cardiovascular risk and men given testosterone replacement and the study compared the incidence of heart disease and eight thousand seven hundred nine low testosterone men in the VA health system who underwent coronary angiography. And it made headlines around the world and you looked into the study and found. The study statistical analysis was seriously flawed and today twenty nine medical societies have called for the retraction of the original. Jama article arguing that the data are not credible. Can you tell us about this episode and the study itself? Yeah this is an amazing story but how science works and how it fails forbid twenty years before the publication of that article. I author is is Vegan V. I. G. E. N. published in Jama Two thousand thirteen for twenty years. There had been a growing body of evidence that having a normal testosterone or maybe even testosterone therapy was beneficial for the heart and for cardiovascular disease and it was based a fair number of studies showed some of which were observational. Where if you just looked at populations did men with the Lowest Twenty to twenty? Five percent of testosterone levels? Were at higher. Risk of having heart disease was associated with severity of Heart Disease. Low Testosterone was associated with increased mortality. And then by the time that paper came out there were two papers not randomized control trials but observational studies where they looked at men with low testosterone who either receive testosterone or. Didn't you know not everybody? Who's on treatment? And those studies have shown that the mortality rate for men who received historic drone was half as high as the men who are untreated half his high. And then this paper came out and it's an observational study and in your listeners will understand that you know when you have a randomized. We call prospective forward looking. Study tryin control everything that you can and you collect data as you go and you've tried to equalize if you will the confounding factors that you may or may not know about on both sides and with an observational study. You're looking to groups who for example you look at one group that got to stop the one that didn't but they all have low testosterone and frankly we don't know why One group did in or one individual may have gotten in one didn't and there may be something that we can't even put our finger on that accounted for that difference in that thing we can't identify might be responsible for differences in outcome right like we don't know and so those kinds of studies are valuable. But you can't hang your hat on too much unless every studies showing the same thing they repeated so this study came out and it was contradictory to this twenty year history. And it was amazing thing. So this this group wrote as you described over eight thousand men in the. Va System All of whom had coronary angiography. That was the group that was identified. Some of them went on to get tossed around prescriptions in some did and what they reported was that there was a small but significant increase in the number of heart attacks strokes and deaths in the men who got to stockton compared to the men who didn't and so the conclusion was. There was an increased risk cardiovascular risk. So when this paper came out I looked at the data as did several my colleagues and the key headline in there that was carried in every news article. And for whatever reason some some of these stories become big news right and they're carried everywhere not just for the the nerds amongst us the health conscious guys but like to the public right. They just become big big headlines. This was one of them here. Was this common. You know. Very increasingly frequently used treatment testosterone. Some people are anti-test Austrian because of the ant. They think we should age naturally like we spoke about some people think it'll cause cancer some people. I'm certain are against testosterone because it sort of promotes sexual function in their anti sacks. But for whatever reason here we are and Oh my God with this common treatment and now we find out that it's killing people that's sort of the essence of the argument and the term that they used in their in their Abstract in the paper was the absolute rate of events and that they said was higher in the men who got testosterone so absolute rate of events is one of the simplest statistics in medicine and science. And it's literally. How many events were there per group? Or how many events were there divided by the number of people in a group so if you had ten events one hundred people? Your absolute rate of events is ten. It doesn't get adjusted for anything like by age. Whatever the numbers are the numbers are and it reflects reality and so it's very comforting to see a study where they give an absolute rate of events. 'cause you understand what actually truly truly happened. You know when when the statisticians get in there. He started Justin for this and adjusting for that. You hope they're doing a good job but the truth is we. We have to sort of just depend on their good practices honor but absolute rate events Israel. When you look at it you can calculate this yourself. And so they actually had the number of men who died the number men who had a heart attack number men who had a stroke and they give you the number of people in each group and you can just do that that calculation yourself in two seconds. You don't even need a calculator for so easy. And when I did that based on their numbers I got something that was completely opposite from what they reported so what they reported was that if I remember precisely is that they reported that at three years. The number of events in the Austrian group was twenty five point seven percent and in the non testosterone group was nineteen point something and when? I looked at the numbers. The actual rate of events in the testosterone group was ten point one percent in the other group that didn't get testosterone. It was twenty one point two percent in other words. The absolute rate of events for the guy who got testosterone was half as high as the men who didn't get it so what they reported was completely wrong. It didn't just have the numbers wrong. They had it reversed so a couple of my colleagues are going. The numbers don't make sense numbers on somebody should talk to jam. We should write a paper. And so I said I'll call and so I actually put in a call and managed to get to the editor of Jama within. I think three days after it was published and we had a very nice conversation. Howard blocked and My congratulated him on his success with this paper and he was very proud of you. Thank me and I said you know. I'm calling on behalf of a number of colleagues in the testosterone field and we'd love to write you know your results are opposite twenty years of data and we'd love to write a perspective on this and he said Well thank you very much but really don't have room and and but we encourage you to write a letter and I sort of got the feeling he was getting ready to push me off the phone and I can. I just show you something in your Abstract he said sure. I've got it open here on my laptop and I went to the numbers with them and I said you numbers are wrong. I said you're authors made a mistake you reviewers missed it. You had somebody right in editorial on this who missed it and I say jam has responsibility. Here you've misreported the data in this paper that's been where the results have been transmitted around the world and there's dead silence on the phone and after a moment he says and clearly. It was obvious to me. He was like looking at those numbers because they're not complicated and he realized there was an area. So I can't disagree with anything you said and we're GONNA get in touch with the authors and I'll let you know what happens and within a few days. I got an email from him where he said. The article has been revised very briefly. And when I went online there was now a revised version of the article and by the way without any indication it was no longer the original article that didn't happen for another two months which is unbelievable to me and they use the same numbers that twenty five point seven percent in the nineteen point whatever it was but now instead of saying absolute rate of events they called it something like estimated probability of events. Using Kaplan Meier curves something very statistical sounding. Because that's what it was. You know we can argue whether or not. That's believable or not. It seems to me. It's not like on authors. There were so many authors on there who are in public health for statisticians and everybody has to sign off on these papers. It's not believable to me that everybody would have missed that basic error if it was really just the wrong term and it wasn't just in the abstract it was in the text as well results and so that was bad enough but we ended up actually writing a letter and we picked up on another area. That was bothersome and in response to a query that we had the authors responded that they had looked at One of the groups and they had made errors in over a thousand individuals Turned out the Nine percent of their all male population turned out to be female. Yeah Good luck with that so just imagine for a second breast cancer studying women. Were you find out that almost ten percent of the population is contaminated by men? Like it's just it's just basically bad and so We wrote a letter and we believe that the data were not credible and it turned out the twenty nine medical societies signed on and Jama declined to retract the article. We thought it was just bad information and so that paper. Still persists in the impact of it is incredible to me because listen I. I don't attribute any bad intentions to the authors. I think they just made mistakes. I think he was just a sloppy piece of work. It happens. I think it was. The first author was a fellow and I think there was inadequate oversight and people get excited when they have a chance of getting into big journal. You can sort of make your career if you will and I think people just sort of slipped past but the impact of that bad article what I would call not just bad information but essentially non information. We don't know what's true or not true in that paper anymore. The impact of it is that in the field. There's now this cardiovascular controversy and there's many doctors and patients who read about those cardiovascular risks being increased and it's very hard to turn that put that genie back in the bottle and so at every meeting that I go to. We have some debate on the cardiovascular risks and we update it and whatever and I can tell you that about a year ago. We published a review paper on cardiovascular risks since that paper and I think they were twenty two controlled. Trials and not one showed increase increased cardiovascular risks. Not One. It's an amazing story. Both in terms of the failure of pure review which we see more and more now and Often the reviewers hardly go through the data even coupled with Remarkably sloppy work on the part of the original authors. More recently in twenty seventeen a trial by bud off a tall was published in Jama and suggested that testosterone replacement therapy and men with low testosterone lead to more rapid progression of plaques compared to Placebo. Can you discuss this paper sure? So that paper was done because of the other paper no doubt right so once you have something that's his. Oh we've got to watch out for for heart disease. All of a sudden there was a slew of papers looking at heart disease and testosterone. As I just mentioned none of them were able to show that they were increase bad outcomes not and several of them showed benefits of testosterone versus the no treatment so the the article by Buddha off now is part of what was called the testosterone trials. This was the largest prospective trial of testosterone ever multiple sites around the country supported by the National Institutes of Health National Institute of Aging Seven Hundred. Ninety men sixty five years of age or older average age. I think was seventy three underwent one year of treatment with Testosterone Gel. Or when you're of treatment with a Placebo Gel and then There was a second year where nobody got treated. But they monitored the men for safety issues. Did anything happen to them? Heart attacks strokes etc overall the number of what's called the major adverse cardiovascular events. We call it. Mace which consist of heart attack stroke and death in year. One for that study. There were seven events in the testosterone arm and seven events the same number in the placebo arm in the second year again. Nobody's being treated but they're now being watched. After that first year of treatment they were nine events in the placebo arm and only two in the testosterone are. If you add up those two years they were sixteen. Events in the placebo arm and nine and the testosterone are clearly no indication from those data. Seven hundred ninety men large study multi-institutional carefully monitored the testosterone increase cardiovascular risk. Right in the magic. If the if the numbers were reversed and there was sixteen events in the testosterone. I'm everybody will say Oh. It may not reach the TISCO significance or they say well. The number of the number of events is still relatively low. But they would say oh. We think there's a strong signal here. There's nobody saying from these data. The testosterone is protective. Although maybe it is one of the parts of that study was they selected a subgroup. And I don't recall how they picked the man who did this. But they picked a subgroup who underwent evaluation of their coronaries with C. T. Skin Coronary C. T. Now What's interesting? Is that as coronary? Ct is used to evaluate heart disease. Now in men and has been for. I don't know ten fifteen years or so and normally the talk but coronary calcium scores and it turns out that the more calcium the higher calcium score the greater the risk of heart attacks like that's clearly established and the difference in the group of men who did get testosterone and into the end of the year. The calcium scores were the same. They're identical they were basically unchanged both groups there was another factor that they looked at though which was called. Non Calcified Plaque. Non Calcified Plaque. So the part that is not calcified and If you speak to cardiologists they don't know what to do with Conan calcified plaque like. Maybe it's important. Maybe it's not has not been shown to be associated with bad outcomes. What the outcome of that study was was they said. Well there's more of this added a non calcified plaque in the men who got stoned than the men who didn't and so people say well we don't know exactly what it is but that can't be good right. Plaque is in good in general we don't know and what's interesting. I think the group was over one hundred hundred thirty five guys or something. There wasn't one single cardiac event in that group not one. And here's the thing is that this was a it's funny. It's it's often called a randomized control trial. It actually wasn't too is something else which is called an assigned people were assigned to groups. It's sort of one step up in a way from a randomized trial because they're trying to make sure that by chance alone that the groups don't get overloaded on one side versus another. So you could you could. In randomized trial ended up with two very different groups who has a lot more high blood pressure than the other for example just by chance and so they made sure on a number of important items. The two groups were equal. We can call it. Randomized has the same effect as randomize. But here's the thing has just because you do that. For a couple of items doesn't mean that everything ends up being equal and so when you look at the baseline level of the non calcified plaque in the two groups one of which got testosterone. One got placebo. They were completely different. So the Placebo Group had almost fifty percent more of this non calcified plaque at baseline at the end of the study. That something like only forty percent more plaque but they had more plaque whatever that plaque is that's non calcified whether it's a risk or not you'd rather not be in that placebo group and because they're not bounced at the beginning to change the delta. That happens over year is I. Think impossible to Interpret because maybe there's just a certain amount of catch up that has to happen or let's call it regression to the mean. Maybe there's certain amount of variability in how it's measured don't know but that's the basis for it and so the booed off is articles often cited as. Oh you see. There's really something happening here. And it's important to recognize that knowing that it had the limitations. I just mentioned to you but in the end the much larger group of seven hundred and ninety men overall showed no difference or no no worrisome trend in terms of heart disease heart attacks stroke her death guys who got testosterone versus guys. Who didn't that's interesting. So you mentioned that There's evidence and more and more over time that testosterone replacement therapy may actually be to some extent protective with respect to cardiovascular disease. Is there strong evidence for a mechanism of action? There is the elevated esther. Dial you might see what what. What do you think accounts for this if it is in fact protective well? I don't think it's terribly complicated. So one of the things that is shown in in essentially every stroke trial is that raising. Testosterone lowers fat mass. We know that fat mass is obesity. If you will fat mass associated with cardiovascular risk it may be as simple as that it decreases fat mass and increases lean mass which is basically muscle and we know that each of those is an independent predictive factor for development of heart disease. It may just be as simple as that as you pointed out earlier. Testosterone not only affects men sexual desire and performance but also their mood their thinking muscle and fat as you just mentioned in short their overall wellbeing there are a number of studies showing that as many as something like forty percent of men over the age of forty five have low levels of testosterone and the average male testosterone levels have declined significantly over the past fifty to one hundred years. I was looking at the Massachusetts male aging study which gathered data on fifteen hundred randomly selected men. In three time periods. The first was in late eighties. The second in the late nineties and then the third two thousand and two thousand four and in this study they Measured their total testosterone levels as well as the bioavailable or free testosterone levels and what they found was that both total and bio available tee levels had decreased more than twenty percent over this remarkably brief period lest one think that this is only a Boston phenomena and I would understand why people might think that having been there a large finish study reported similar findings a man born in nineteen seventy had twenty percent less testosterone than his father at the same age and then finally a two thousand seventeen. Meta analysis not on testosterone but interestingly reflecting the state of the modern mail suggested that the sperm count of the average western male had been halved in the last thirty eight years. I wonder if you had any comments on this current state of affairs and specifically. What do you think is driving what appears to be a rapid change in the level of this critical hormone and the broader societal consequences? Poor men demonize hormone. We're up against it no seriously so you know you know. They've been some really good movies about loss of fertility. What happens in the future and like those few people that can still reproduce your so valuable? There's you know obviously in with there's one thing and women is the handmaid's tale stuff and and then there was this great one about about men in anyway You know listen I think that some of that stuff is probably real One has to be careful for methodological reasons about comparing older and and recent stuff but I suspect it's true. I mean some of these results are we're getting consistent reports and so that makes you think that maybe there's really something there. There's one there's again and not to be over over simplified but I think that obesity is is one of the likely contributors to this so obesity leads to lower testosterone levels testosterone is critical for sperm production spermatogenesis. And I think it it. It may be enough to account for both the decline in in measured testosterone and also the sperm stuff. You know the other argument. That's out there. That people are worried about is environmental estrogens. That certainly may be contributing as well. It's hard to now it's interesting you also see drastic reductions in grip strength among the millennial men compared to their father's. Isn't that interesting it is. Most people are aware of the term menopause. But not a lot of people are familiar with the term Andrew paws which is the male version of menopause. And I understand that you hated this term when you first heard it so why is that? I hated it when I first heard it. But I'm a much more sympathetic to it now. The reason I didn't like it so I in the term. We don't use it as much anymore. But you know it's obviously a term that came up to draw in obvious parallel to menopause right. So you know there's something hormonal that's happening to men in when I first heard it. It sort of became popular in the early two. Thousands was that I thought it was too simple and it was too easy to poke darts at like. I think this business of men having low testosterone about society just individuals that I see where people dismiss this important a medical condition. They don't think it's important. They think it's all made up. They think this is a pharmaceutically-driven false epidemic. Every day in my office I see people who have been evaluated and seen by other doctors. And they're told this is on their head to Saas. Joan levels are fine and just get on with life. This is what it is to get older. And we treat many of those men if their levels of testosterone are low and we only treat them if they levels are low and for some of these people. It is life changing. You know whether I'd one man say to me you know I did okay before but now that I'm treated with Testosterone I. I realized that before I was seeing life in black and white and now I feel like I see it in color like it's it's a different character of what life is like for people in the Andropov thing I thought was too easy to dismiss. Because obviously menopause happens to basically a hundred percent of women at a certain age. It is in the low testosterone doesn't apply to every man it may be a large large number but it's not every man. Menopause happens you know usually sort of Mid Forties to maybe early fifties sometimes younger Limited time in life right like maybe a ten year period where pretty much every woman goes through it and you know testosterone for men. We see guys in their twenty. Sometimes thirties forties fifties. Sometimes they show up in their eighties like there were too many differences there. The reason I ended up liking it better is that it actually provides a brain construct. A way to conceptualize what's happening to men. That is not that different for women so nobody disputes that menopause exist. You can't dispute it it's there. It's hormonally based in the part that is similar is that there are hormonal. Changes that happen. relating to age and men many men that have widespread effects on their biology and their sexuality and the by giving back some of those hormones we can absolutely reverse or resolve many of those symptoms. Those parts are the same in men and women and for that reason I no longer think. Andrew Pause is such a terrible term but we tend to not use it that much anymore so when a man starts experienced symptoms such as low desire and chronic fatigue. He may go to his physician and ask for his blood to BE TESTED FOR LOW TESTOSTERONE LEVELS. But these lab tests can be deceiving. Can you elaborate a little bit on this? Yeah I'll tell you one quick story. He probably tired of my story that I'm going to take this great story. Got Great Guy. The Guy Comes to see me. I think he's forty two. He's married he has no sex drive he's otherwise in pretty good shape any says you know. My wife is really upset that we're not. We love each other. I love her. I'm attracted to her but I just don't have the feeling for sex anymore and she's she thinks it's her she thinks. Maybe I'm having a fair I don't find you attractive. She stays in shape. Like it's really stressful. So my doctor. Primary Care Doctor. Got My blood tests and it was low for a total testosterone. I think somewhere in the range to fifty or so well and almost everybody would agree to fifty as low people debate. What is a low level? But there wouldn't be much debate about his. And he says he got referred to this into chronology Somebody who I know who's prominent in the in the medical community and the endocrinologist says to him. Yup You levels are low but Listen in the old days the Queen's had these men who are wise counsellors and they were UNIX. They had their testicles removed and they trusted them and they were thought to be wise and they had a good life. Your testosterone is so much higher than those UNIX. You're you're fine. You can go now and it would he said to me it was very funny guy says to me. I don't give give I don't even know the right nice expression for radio says I don't care about these ancient queens. What I care about is the princess who sleeps in my bed every night. Yeah Fair enough. So there's two we traditionally we. We did everything based on total Austrian and important for your listeners. To know that testosterone is it circulates in the bloodstream but ninety eight percent of it is bound to carrier molecules and only about one or two percent is free or what we call the part that gets into your cells as the part that is unbounded. We call free. One of the big carrier molecules is called sex hormone binding Globulin. We usually abbreviated as S. H G and the main characteristic to be aware of the testosterone bound to SHP is bound so tightly that when the testosterone bound to that molecule goes past the cell that needs testosterone. It can't be released. It's bound to tightly and essentially that fraction. That's bound test. Each is not biologically available as we get older and in some men for unknown reasons S. H. BG levels can be high and which means that it sops up along the testosterone that still can be measured in the blood and the higher your S. h. e. g. the more your total testosterone is going to look normal and so some of these men are truly deficient in Their free testosterone is low but their total testosterone which is what most doctors measure and trained on looks normal and so they told no you don't have to Saas Jones fine and the sort of the more evolved sophisticated Clinician than will understand the importance of free testosterone and we treat a lot of men just based on their free testosterone being low the other issue that confounded for your listeners. Who think that they may be candidates for this. Want to know is that the laboratories all put out there called reference values. You know sort of what they think is a with the proposes normal values and the reference values for testosterone and free testosterone often. They're put out by various labs. Have no clinical relevance they weren't determined by whether or not people have symptoms at that level or not and many of those reference values go very low which means you have to be crazy low for it to show up on the lab report as being below the reference value right. And so that's a major problem so we don't use lab reference values. We published a paper some years ago. We just query twenty-five labs. We just call them up. What are your reference values for? Total and free testosterone have twenty-five five labs. They were seventeen different reference ranges and the level that was considered low varied by four hundred and fifty percent. So what it means is that you can have a laptop you can have the same value. That one lab will say as normal in the under another liable stays low so for total testosterone. I you know I think everybody United States would pretty much agree. That less than three hundred is low. I actually think in Europe with us. The number three fifty. I think that's a more reasonable of value but free testosterone has gets messy. 'cause they're different assays with different units? I think it's the most common is calculated free testosterone in my opinion and the clinical experience. If somebody has a free testosterone less than a hundred picograms per mille and they're symptomatic than they probably deserved trial. If treatment. I makes a lot of sense in what often gets missed in. These discussions is normal is not necessarily desirable in a population that is overweight. Metabolic sick many cases and so Homer Simpson's normal but homer simpson is not optimal and it's a very good point so in nineteen ninety nine. You founded men's Health Boston which became the first comprehensive men's health center in the United States. And you and your colleagues. Mhp have been among the first to offer a number of new therapies. Can you give our listeners of the background on 'EM HP and also an overview of the center and what you guys are doing there? Oh my God. I'm so glad you asked so one of the things you know. I've done all this work around science and stuff but I was a fulltime faculty person at Beth. Israel deaconess medical center. I was sort of on the academic track. If you will and in one thousand nine hundred ninety nine I realized that I. I was specializing in Male. Sexual issues and male infertility issues. I did vasectomies I dealt with some prostate stuff and I went to the head of the hospital. I said listen I practice. What I think could be considered men's health that term did not exist back then like we had no sort of didn't have any meaning but every center in Boston and in many places around the country. Every hospital had a women's health center and there were no men's health centers and I said I think we should open up a men's health center. I want to run it and I think we can really help guys you know. Sort of. Give them one center of excellence around the stuff and the head of the hospital loved it. We talked for about an hour at the end of the hour. He said this is great. Let's do this. I said how long do you think it'll take? He said well. Listen we're big bureaucracy? I've talked to facilities in nursing. And whatever he says any. I'll take three years could be longer than three years. I was young ambitious and ended up leaving. I still have a good collaborative relationship with Beth. Israel that's still my institutional home and Harvard Medical School but I went out and I did it on my own and it was the first comprehensive kind of men's health center in the country offered testosterone. When nobody else did. We looked at bone density testing. Because of the stonework that nobody else was doing. We looked at muscle and fat composition. Which nobody else was doing? And then I did some of the standard urology type things you know. Like treating people with erectile dysfunction with pills and injections and I did surgery Ford for implants and we dealt with male infertility and then over the years. So we're now said. We just celebrated. We just had a party for twentieth anniversary of Men's health. And and you know where we are now is in in the concept has been did. It's helpful for men to have a place where they can go to talk about the issues that the often are too embarrassed to talk about to anyone else including their primary care doctors and where they're able to get state of the art care for those things sometimes tradition on sometimes some of the newer treatments that are out there. We do clinical trials and now we do cardiology services for the last several years. With Board Certified Cardiologists. We do echoes and stress tests. And you know. There's this huge overlap. We've been talk the cardiovascular risks with testosterone so it turns out that if you have low testosterone or you have a rectal dysfunction which often overlap but both of those items are risk factors for later development of my cardio infarction both of them and if you look at the cardiology population. Some huge percentage like eighty percent of people with coronary artery disease. The cardiologists have either erectile dysfunction and low testosterone. So you know. We're not and so the cardiologists that we have a Evan Appelbaum. Who Superb you know? He sees himself as a preventive cardiologists. And that's part of what it is that we offer sounds like a very valuable service. Indeed absolutely we touched on a little bit but could you talk about the different modes and types of administration of testosterone. This has also led to a good bit of confusion in the community. Yep so they're many ways to give testosterone the ultimate concept though. Is that as long as we can get testosterone up to a good level and have it be up for most of the period of time with treatment? The results are GonNa be the same and so some of this has to do with just consistency of results and convenience. The oldest form testosterone worthy injections I mentioned huggins and The prostate cancer guys. They used to be injections that lasted only a day. So they'd get daily injections. The most common injections now are are. What's called Testosterone scipion eight or testosterone in an and usually we can give those on a weekly or every two week basis They're inexpensive. They've been around forever they get good good. Absorption it's a shot usually in the bum or in the thigh The downside is the levels will go up and they'll go down and so some people feel that and they feel like they're on a roller coaster but it's effective and we can work around one of our favorite treatments that we use than the Are these pellets? So it's like compressed testosterone. It looks like a grain of rice. We take a few of them and we put them under the skin. We numb up the skin of the buttock. And we make a little Nicorette we place these pellets into the subcutaneous fat. And you don't need a stitch or anything you just get a little fancy band-aid slow release Form of testosterone. It'll Released usually over three months sometimes a little bit longer for months. There is a long acting injection. That's been approved by the FDA. It's called Historian on-deck no eight. The trade name is feed and then injection happens every ten weeks so that's not too bad levels. Tend to drop a round day week. Eight to ten of some people needle extra support around that time. There's a nasal testosterone which is a Jimmy. Squeeze it into your nose. You Rub it around for a bit. Very actually convenient levels. Go really quickly go up to very good levels. The interesting thing though is that they dropped quickly so you have to do a two to three times a day. The results are pretty good. And what's interesting is because a lot of the day the testosterone is back down to normal which we would we would think of as not being helpful but it turns out that some of the risks that we monitor in some of the effects of stone like lowering sperm counts and stuff while you're on treatment don't seem to happen as much with that. Nasal Gel so that's interesting and then we have the creams and the jails and that have been around. Andrew Jelly mentioned was the first jail was approved in two thousand and one. I think it was has been the most popular but now insurance companies have made it so expensive that too. That's gone down in the injections have Have become the most popular a lot of compounding. Pharmacies can make historian creams and have done that for many years. That's usually inexpensive. The big issue with the top would call topical says that the absorption is variable. So some people just don't absorb it at all and some people only absorb it a little bit so we don't always get great levels with at the same time for a lot of people's completely noninvasive and that's really when they wanna do and as long as we get good levels. There's nothing wrong with it. Recently was approved in oral testosterone. It's not yet available on the market but expected to show up in the next couple of months and we'll see how effective that is That's interesting I'm also hearing a good bit. Lately of a transdermal Testosterone Applied Typically Allocate Twenty Percent Gel Scrotum early and they're supposedly get very good absorption. Have you heard anything about that? Yes so you know the the very first topical we're actually patches. Before the ANDRO was approved there was a patch and it was applied to the scrotum and and people thought. Oh it's the scrotum because that's where the testicles are no it's because the skin of the scrotum so thin it's so thin so it's absorbed more readily there and so the scrotum can be a useful place to apply some of these compounds one. Here's all kinds of different opinions regarding the issue of a remedies ation of testosterone to estrogen associated with replacement therapy and some folks are very concerned about this and watch it super carefully and prescribe medications to suppress this and other see it as a feature not a bug and. I hear a lot of argument about this. How do you think about this? And are there any risks associated with over suppression of around? Yeah that's an important question so you know. A lot of testosterone work has come really out of the anti-ageing community and there's been a belief that testosterone estrogen dial are kind of like battle. Duke it out for for surpremacy in the body and and the testosterone is good for men and estrogen is bad for men that that's over simplified so it turns out from some very sophisticated studies that men need estrogen to and some of the activity that we attribute to testosterone happens by its conversion to estrogen. Examples are including bone density and also inside the brain and in one study. That looked like We I've I've mentioned several times. The testosterone reduces our fat and it turns out that estrogen appears to play an important role with that too so because of the fear of estrogen and also important to understand especially for your audience. That's a little bit scientifically savvy. Is that estrogen. In men and in women comes directly from testosterone. It's converted by an enzyme called Romo taste. It's one chemical change and so in women that testosterone doesn't stick around that long. There's lots of Aroma. Tasting GETS CONVERTED TO ASTRO DIAL or estrogen in general and in men too so when we raise testosterone in men. We necessarily increase estrogen to you know. We wrote a review of this some years ago and we just couldn't find any important negative aspect of higher estrogen. The one thing that I've seen occasionally is that there are some men who get very high testosterone levels Estra. You dial is very high and for some reason. They're just not getting the benefits we expect and in some of those men if we lower estrogen moderately modestly demand. Make it better Better results with that. So we don't I don't use the aromatase inhibitors. Those the ones that prevent the production of estrogen. I don't use them all men. I use them relatively sparingly but I do use them in some men when it's indicated in or if they're symptomatic some breast tenderness or something and some of those men it can be important. It's important to not drop the estrogen too much. And I see this all the time from people who come in from other centers because it's bad for bone density. We need our estrogen for bounce. Yes so earlier you very nicely explained the plea tropic effects of testosterone in the widespread problems associated with deficiency and I think people in our audience appreciate that and the benefit of normal or high normal testosterone. Has Anybody what he looked at say. Supra physiologic levels instead of twelve hundred or a thousand two thousand. Do we have serious quality studies looking at that? There are a few not many but there are a few where they looked at it especially in older men and the part that interested me and was part of my developing the saturation model is that turned out that the men who got these super high levels or super high doses of testosterone had no change in their PSA compared to the man who got just normal amounts. Your model would suggest that. Yeah but but that helped me actually get to that. Oh I see cancer. It's like it because it was shocking to me so there are two studies that That come to mind around the super physiologic doses of testosterone and one was for I think twenty weeks in the other one for for nine months and nothing terrible happened to any of these guys. You know their levels of testosterone were sometimes three times the upper limit of normal. You know the one thing you have to watch for. One of the risks of testosterone treatment is that the red blood cell count the Madden created. The hemoglobin can go up too high so we don't know exactly how risky it is but it doesn't sound good and the fear is the fear. Is that if it goes up too high. The blood gets more viscous maybe leads the klotz. A lot of it's theoretical. But we sort of stop it at fifty normal is usually up to fifty percent and we stopped difficult to fifty four or we or take blood off the people we sent him to the. Red Cross to donate and so that does appear to be dose related or at least concentration dependent with testosterone. So if you're on injections for example have a higher risk of that elevated red blood cell. Count if you're on gels limit sense so the guy in the supra physiologic part you know we just worry about that but the big thing that people have worried about with the super with the excessively high doses you know. Is there something bad that happens? What about this road rage that we hear about mood stuff and it just didn't happen it just didn't happen now? They weren't huge studies. A lot of the stuff is kind of bogus our defer your listeners. To one of the most entertaining books I ever read but I learned a lot too. And IT'S BY JOSE CANSECO. Who was the Homerun King? Who openly took you know? Anabolic steroids. And it's just fascinating and fun. And he makes the claim in their books. Got Fifteen years old or more. You know he's. He writes in the book that he knows more about all this stuff than any doctor in the United States and I'm sure it was true because doctors tend to not give super high doses of this stuff and of course if here in athlete and you're trying to maintain some crazy high level of performance. You know they may be something to that. I'm sure there is Anyways just an interesting read indeed in your book the truth about men and sex. I think it was a twenty thirteen. Twenty fifteen book. You explain that you were trying to pull back the curtain to reveal men as they really are. The last chapter of the book is titled Men. Are People too now that you would need a chapter like today's world? It's definitely needed to talk about that. Chapter little and what you mean by you know the When I was in medical school I had Two things I was trying to figure out how to decide between two areas and one of them was Surgery which then led to urology which is a surgical sub specialty. But the other was psychiatry. And I've always been fascinated about the mind and relationships and emotions and I kind of fell into this area of the sexual medicine part. Were guys start talking to you about stuff and when I started doing that work and you know I was young when when I came out what I was maybe thirty two and you know is married and I didn't have that much experience around these things and yet guys talking to you and you're supposed to be wise and give them advice and I learned from my patients. One of the things that I learned just by listening is that men were so different from how they're portrayed in the media and in movies and I don't mean to excuse for a single second all the men who bad stuff around sexual violence and stuff that's criminal but you know we're talking about half the population or mail and I'll never forget one very early on. I had this guy walk in my office. Who was like way too cool for school and I had an immediate negative reaction to this guy and like I didn't I didn't I even before he opened his mouth. I didn't like him. And all this stuff and and it within a few minutes this guy's telling me about how he has premature ejaculation and he has a girlfriend and he doesn't feel manly enough because he feels like he can't provide enough sexual pleasure and satisfaction to his girlfriend and he's crying in. I was dumbstruck. And I realized that I'd made this quick judgment and I was completely wrong. And there are a million guys out there like this guy who are really struggling and they're struggling with their masculinity and they're struggling with whether they feel clear worthwhile and the other thing that came out and really is supported by thirty years of sort of you know behind the closed door. Having guys talked you bet stuff is important. It was for men in relationships to actually be good to their partners. You know we're talking largely about straight couples but not exclusively sex for the guys has which is completely opposite of what everything that I thought I knew and you know I see. Sometimes these men who had erectile dysfunction. They've been married for quite a number of years and you know and I've heard this on a few occasions and this one guy says to me I feel like I'm letting down my wife. The sex was always a nice part of our relationship. And now I feel like I can't hold up my end of the bargain. That was shame associated with not for him but with regards to what he was able to provide to his partner so I wrote that book filled with stories from my patients but the theme is really what our guys really like when they opened up around the stuff. And what's it like for men when they lose something important like their sexual functioning and what's it like when we can treat them and they can regain. It was incredibly important. Work that you're doing and you have people flying in from around the world to visit men's Health Boston and meet with you which I know keeps you extremely busy. But when you're not working we'd like to know what you do in your spare time and also. I've heard that you like to play golf. Even though you're not very good at it and is that right I. I'm not sure you're supposed to tell everybody I'm not that good at it but the ULTA I like to think I can have as good a time as anybody but I do. Spend a lot of time on my work. In years ago I was inspired by an ice to struggle with it because I would see my patients during the day. My kids are grown now. But you know I'd come home once they were asleep. I'd work on paper and science and it was just so fascinating to me and and especially with the work that we've been talking about here like you know. I really felt like there was something that I was seeing. In a number of my. I wasn't alone. Of course I've got any number of colleagues that are dear to me and sort of on the same team or wavelength. If you will but that we were actually moving the ball forward you know in an important way that matter and there's a gentleman named Bruno Lunen felt brilliant guy. Who's now I think? Ninety and he started a society called the International Society for the study of the aging male. And it's probably fifteen years ago. He was in his. I don't know late Seventies. Who would ever and I saw him. It's a meeting and some other things some other country and there was going to be a dinner that night and I said you're going to be Bruin. You're going to be at the dinner. He says no no. I got another meeting. I'm leaving. He was going to other countries Brunei. How do you do it? L. D. R. U. He says my life got better. He says when I realized that my work was my hobby and my hobby is my work and that applies to me a lot too and you know some of us are really blessed to find something for me. It's been kissed Australian ever since I was you know with twenty year old undergraduate at Harvard. Tiff find work that we find interesting. That keeps US thinking that feels like it matters and where we actually can with the work we do make a difference and It's been An incredible journey for me and and I've had the best time fantastic anything. We can all say the same in this room for sure and you showed up at Harvard when you were eighteen. And now you're sixty three and you've been at Harvard this entire time for someone who wasn't sure they even want to go to Harvard. In the first place you certainly planet some deep roots on that campus. So I'm curious. Was that your plan all along and it's just one thing leads to another. You know but you know I told you that. My mother wanted me to to both learn how to play the violin or go to Harvard so I think if I were to leave Harvard I would need to pick up the violin. That'd be another hobby down the line but it sounds like you're going to be at Harvard for for quite some time so Eight this has been a lot of fun and this This podcast is very important to a lot of the listeners that we have so. Thank you so much for spending time with us today. It's been fantastic. Really interesting thank you. Oh It's been a pleasure to be with you so much. Skin pep talk stem talk so that was a really important interview when it comes to sex whether it's from the male or female perspective. There are a lot of taboo topics every like that age is trying to help people become more comfortable talking about these topics. There's so much that all of us can learn from as work men's health in particular absolutely and it's really disappointing that a hugely flood paper written in nineteen forty one could become standard medical practice in terms of the diagnosis and treatment of prostate cancer. Net and in discussion with A. We've heard of several such poorly done papers with inadequate period view because of this paper for decades men with low testosterone levels. Were denied treatment that would have significantly improve their health. Workers another reminder that scientists and researchers we all have an obligation to constantly question things particularly received wisdom. It's incredibly important. So if you enjoyed the interview as much as I. Did we invite you to visit the stem? Talk Web page where you can find the show notes for this and other episodes stem talk dot. Us This is. Doc reneged signing off for now. Ken Ford saying goodbye to we. Need again on stem talk. Thank you for listening to stem talk. We want this podcast to be discovered by others. So please take a minute to go to itunes to rate the podcast and perhaps even writer review more information about this and other episodes can be found at our website. Stem Talk Dot. Us there you can also find more information about the guests we interview.

testosterone prostate cancer cancer PSA Psa Charles Huggins prostate cancer metastatic Harvard hockey Harvard Montreal Boston abe Brigham and Women's Hospital Don Cornelius Google Little Pond Dr Abe Morganthaler NBC Bob Crane
Disrupting the Standard of Care for Earlier Diagnosis and Treatment of Prostate Cancer with John Bellano, Chief Commercial Officer at MDxHealth

Outcomes Rocket

20:38 min | 5 months ago

Disrupting the Standard of Care for Earlier Diagnosis and Treatment of Prostate Cancer with John Bellano, Chief Commercial Officer at MDxHealth

"Albums Rocket Nation saw Marquez here I. WanNa Talk to you about growing your practice postscript virtual dispensing platform to help practitioners dispense professional. Great supplements improve patient adherence and grow their practice from anywhere. When you write prescriptions, they're sent to your patients via text or email. And when they place an order, their supplements get shipped to their door. Eliminating your inventory costs, it's loaded with features like each our integration to save. Save Time patient wellness content to stay top of mind, an adjustable profit margins to control revenue. It integrates with your way of working with your patients day to day lives best part of it all. It's free so trifle script today. If you're considering adding supplements to your treatment plans visit full script dot com slash rockets, extensive guide on supplements and Drugs Nutrient. Pollution and interactions visit bowl script dot com slash rocket. Welcome back to the outcomes, rocket saw Marquez's here. Thanks so much for tuning in again today I have the privilege of hosting John Galliano. He has more than twenty five years of experience in the healthcare industry. He started his career in pharmaceuticals and transition to molecular diagnostics, or he has spent the past twenty years of his career. John is the chief commercial officer of MDX Health, a molecular diagnostics company focused in the field of urology with the growing need for solutions in oncology and also ways to take a look APP prostate cancer differently. The health is high, nearing a lot of ways for early detection and treatment so John such a privilege to have you here with us. I'm excited to. To dive into what you guys do. Absolutely, thank you for the opportunity to speak with. Absolutely. So what would you like to add to the intro? That may be I may have missed not much really. That was very on target with what we're trying to accomplish here today, and I'm Dick Sell. We do have a novel molecular technology and featured in A. And The company really has decided to focus in prostate cancer over the past twelve months, and like I say we. We have a lot of different opportunities and other types of apology, but we're relatively small organizations bill, so I think our focus is extremely important to what we're trying to accomplish to bring our technology to providers to payers to employers love it. Yeah, and it's. It's growing nate. I mean just you know last year alone I mean close proximity to me. Several people have detected it and also gone in for treatment. It's very real in my life and I know it's very real for a lot of people listening so before we dive into and the South I love to hear more about why you decided to get into the medical sector. Employees, you know out of college I wasn't exactly sure what I was going to be doing. A marketing degree from a small school in Pennsylvania, and actually a buddy of mine within the pharmaceutical industry working for Johnson and Johnson I'll be very happy with what he was doing. He was explaining to me a professional atmosphere now working West Divisions working with office staff, working with pharmacies, but ultimately you know bringing medication to the doctor's educating doctors positioned about either existing medication new medication, then ultimately help people get well whatever it is whether it's on college or infectious. Disease All being disorders. Whatever the case is that message of? Position about something new that they weren't aware of previously that can help them. Make better informed decision to help an individual suffering again from whatever they're suffering from that ultimately appealed to me and has stayed with me throughout my entire career, and it's really helped me. Make decisions on what companies what technologies I'd like to be a part of. That's great. Yeah, just that immediate impact he could have and you guys are doing such interesting things now with MDX health. So, what would you say? John is a hot topic that should be on the listeners minds and tell us a little bit more about how your organization is approaching it. Sure, not absolutely I. Think early detection is in an ecology. It's not necessarily a hot topic, although it's, it should be on our mind. Everybody's minds I in prostate cancer because it's not a hyperloop college you that people are unfortunately dying from at an alarming rate. We don't think about it as much, but certainly it is real. You know most men. If they live long enough, we'll have prostate. So that's something that absolutely everybody should be thinking about it again. It's early detection finding early really then helps the long term prognosis. And you guys are doing something really unique as it relates to how you tasked, and how you provide treatment plans, or at least recommendations based off of genetics and kind of that molecular level of information. Can you give the listeners an example of maybe how the organization has created results and improved outcomes or business models by doing it differently? Sure absolutely, I mean everybody in to help. Help prostate cancer very familiar with the PSA test PSA very very prostate specific antigen pets. It's been a gold standard for years as it relates the prostate cancer, the challenge is not as the civic the prostate cancer as you would like with our selecting the accident firm tests, they are very specific to prostate cancer so with the technologies. We can kind of help that informed decision. Decision go to the next level. Health officials help patients with a very simple selected a urine based outside the position, perform in their office, and give that patient and up position as well great comfort that, despite an elevated PSA, they might not have prostate cancer, and you know one most folks. It's somewhat of an as symptomatic thing when you have an elevated PSA you're not gonNA. GonNa realize you're potentially risk. And then we come along with the life and really help again that decision and help put the patient at these that they not have prostate cancer. Yeah, you know it's a challenge. Those false positives, and what would you say is the reason you're able to get a higher degree of confidence that there's prostate cancer or not compared to the PSA test. Sure, no, it's the core technology that are custer based on. You know it is an extremely sound molecular technology that we use to create all of our past at least the two tests of the mark all protests that we're bringing the market moving forward, and then we make sure then you know we take a broad approach and all the clinical studies that we do well before we launched. These is as commercially to make sure. Sure that we believe the fundamental technology is sound. Put On, you know variables to it now. We study that intensively again extensively before we launch a product and events well-polished documentaries as well now that's super key, and just thinking about the stakeholders in healthcare I mean we have physicians. We have hospital executives employers footing the bill payers footing the bill I mean I. don't even know how much waste happens because of misdiagnosis, Dino. not so much ways, but but our approach though it anytime, economics is obviously extremely important how we think about commercializing our tests, you know long are the days where you could just bring a test in the market. Expect Reimbursement. Boring payers are now wanting not just the clinical data, but of course the economic data that shows that we're GonNa, pay you X.. X. Amount of dollars for your novel molecular. Technology that's GONNA create a savings or so, and we certainly showed that over time, which is why we've done and have over eighty five in network commercial contracts for our confirm say we have Medicare coverage raw, confirm essay, and very shortly we'll have so coverage as well for Medicare. Expect same deduct to happen with the. The commercial payers as well again. It's not just the clinical data. It's the economic data and the savings that we can show to the payers over the course of time I think that's really great John, and if you had to pinpoint where the savings comes from, what would you say? It is mainly maybe one or two things. Well, it's it's you know finding. Finding cancer early, okay, and then treating it early you know the long-term savings come from just the basic, so you know I diagnosis prostate cancer. All the things involved in that hospital stays medications frequent trips to doctors off. It's all those things that over time versus catching early treating early, so you don't have those enhanced complications due to something like prostate. Yeah makes a lot of sense and you know thinking about it from an employer perspective I mean. Do you really want your employees to show up to work stress thinking that they have prostate, cancer, or letting it lay without having treated the impact on morale workplace productivity. You know if you're footing the bill for your insurance. This may be something you want. Check out as far as what tests are your employees taking just something to think about Ben so John. Fascinating stuff and I Kudos to you and your team for raising the standard here because. Because it's it's needed from the discussion with you. It sounds like it's much needed. Something more accurate I. If you think about one of your proudest medical leaderships experiences. What would you say that is today? I? Don't necessarily would say there's one would I would say in general is I've been very fortunate to find novel technologies in the molecular fields in by gnostic understand you know that there's a a market to build from these technology putting a strategy together, and then building great kings of sales and marketing professionals, and then take those technologies to positions. Positions to medical staff educate them on these new and novel technologies, and then have been used it as part of their practice ultimately to improve patient care again. That's kind of how my career and medical started, and it continues today, so I can't say there's this early one, but when I look back those the things I'm most proud of identifying technologies that have just a great need and opportunity to serve markets that need you know a better better outcomes, better results, and then you know building, strategy and building right kings than to execute on those. Those strategies that's great. Yeah, and it's not easy to do right I. mean you need the vision neither leadership, the operations distribution all those things that you mentioned and you know thinking about the thing you mentioned is is the outcomes you know and we focused up front on the economics. It just ends up being a lot of where decisions are made, but at the end of the day. If I had prostate cancer, somebody that I loved had prostate cancer. Our something certain. You Know I. Look at my bank account. I know what it says. There's no. Maybe. Not like you need to know and so super cool that you're able to identify work with such a great company and the X. Health tells about an exciting project or focus that you guys are working on today. Yeah sure well. We're constantly evolving relation to understand our customers needs more and more every single ban. Our customers are really fold, essentially, even fourfold, certainly position payers, and then patients as well door, constantly evolving and constantly trying to understand the dynamics of what's happening in the. Office today and it's evolving constantly because there's a lot of consolidation right now I in urology practices across this country, so because of all those dynamics and in general you know people are not spending as much time as they used to with her physician, so the bottom line is we need to understand that and the tools and the information meaning the results, but it's really information that information that we're taking back to. The position has to be actionable, and they have to understand it, and that's a comment upon us to help them. Educate them and make that information accessible, so they can make informed decisions quickly. Quickly to then get that. Whatever next step is to that patient in a timely? Not so I would say that that's there are several things working on his organization, but I think if we succeed and we win, then we just constantly have processed improvement around how the we take the information that we're providing these positions and make it as simple and easy actionable for them to get their hands, and then make informed decisions than put a course of treatment together with their patients. That's what they want, and that's what the patient wants. And of course, that's with the pair as long as we're all. For sure yeah, no, that's a great call out and saw the work is important, and the method is is strong. I mean the support you guys getting both clinically economically is fantastic. You guys a veterans of what you do in. We're here close to the end of the podcast John. I always wished. These things are a little bit longer, but hey, we got the time that we have. You're doing A. A great job, so thank you for that right now. We're GONNA. Do a little lightning round, so we're going to build a little medical leadership course and what it takes to be successful in healthcare today, so I've got four questions for you. Lightning round style, and then we could conclude with the closing thought after that does that sound good songs Craig Gore Awesome. What's the best way to improve healthcare outcomes? Data without question it. Beta making sure that you have the clinical data to support you know whatever is you're doing? Again now it's changed in molecular diagnostics. Where before you used to launch an essay. Get reimbursed for it. That doesn't happen anymore. Especially, there's just so many more novel technologies outside so answered data data data, absolutely the best way to improve outcomes. That's acid done in house, listening to an audio book and There is a quote from Bezos that says if it's about opinions I'm always GonNa win, but. But if it's data than than, show it to me, we're we're talking here. I don't think that's great. What would you say is the biggest mistake or pitfall to avoid? Don't get so proud and enamored with your technology. because. It's only as good as it is in a doctor's man. I think there's a lot of companies that have amazing technologies, but they can't figure out how to take that amazing technology that's complicated behind the scenes that boil it down to something that simple, an actionable for a doctor to do something wet, and I brought a couple of those organizations. Myself just couldn't get over that. Hump of complicated information next generation sequencing is a prime example. There's a lot of information there a lot of data. How do you take that and boil it down to something that simple and an actionable for document understand and take action. I'll say I'll say. How do you stay relevance as an organization? Despite nonsense change, you know I think we have amazing relationships with our key opinion. Leaders around the globe Making sure were extremely mindful of what's happening in their. Listening constantly to all the stakeholders that we interact with position of course office staff payers, employers key opinion leaders. We attend conferences around the world national regional white conferences, saying relevant in the space so it it. It's a bunch of different things that we do to just understand where we are today is. where the market is a most importantly where it's going over the next three or five years, and also you know what the competitive landscape looks like for us as well as we think, we are some come along tomorrow and be a real strong competitor to us and we, we need to obviously stay relevant and understand what that means that this organization is well love it. Definitely committed, and you know the breadth of the coverage. Guys do serious. So what would you say is the one area of Focus that drives the majority if not all of the effort at the south. Market help and mentioned earlier. We are company that could do a lot of different things. We have marker biomarkers and Kidney Cancer Bladder Cancer, brain cancer, and not to say we can ignore those things, but we just have to find different avenues for those bio markers to get to the market you, but if we if we decided not focusing I'm so happy that we did as an organization of Focus in this important space of prostate cancer. Then we do it justice. Justice as well, we just be spread way too thin as a small organization, so we need to be the best that we possibly can be in prostate cancer, knowing that these other biomarkers that we have conservative the healthcare space as well, but look for look for partners to help us commercializes technologies, so we as a as as one hundred fifty, five hundred sixty people strong, be the best prostate cancer company in the world. That's amazing I could sign up for that. and there's and there's so much power to. Right John I mean when you know what you're after. It's hard to get distracted. Absolutely I mean. Think strategy is twofold right. It's about understanding what you're GonNa, do but also, but you're not gonNA, do so a lot of things. Come our way from time to time whether it's biomarkers or other companies with a with a sound strategy. You could pretty much decide in a timely manner. Yes, that's part of the strategy. We should explore that opportunity or no, that's not part of the strategy, and we just have to let that one go, so it takes discipline but focus. It really really helps in drive smart. US. That's awesome man, that's so powerful, great message John and the clarity is there and I'm excited that we're having this conversation today. Folks if You have questions, or if you WANNA, learn more, you could find MDX health at 'em. The X. Health, DOT com, or you could just go to outcomes, rocket, dot, health and type in and the X. Health in the search bar. You'll see a full transcript of my discussion here with John Allen all their CEO and along with show notes and links to any relevant things that we've discussed including the different tests like confirm MDX or select mdx for prostate cancer John. Before we conclude, I'd love as you could just share a closing thought and then the best place where the listeners to get in touch with you. Yashar absolutely and you mentioned earlier personal history prostate cancer similar. You know mindful, diagnose roughly two and a half years ago with prostate cancer, and you know I never even thought about you know what that means to me. As far as you know looking after myself, but it certainly raised awareness to me the rest of my uncles and everybody else that I come in contact. You know the at my age to absolutely take care of. Of yourself and do the right thing, get your PSA check as soon as you can. And often as you can, and then certainly if there's anything else they need, you know we can be here. Organizations that support you, but it starts early detection, certainly in so many other types of cancer, but of course with prostate cancer as well and folks could definitely reach me. I'd be happy to discuss what we're doing. Our initiatives opportunities index. The! John Delano at MD Excel, DOT com. Outstanding John Well Hey I really appreciate you sharing the insights and the great work that you guys are up to prove how we detect and diagnose prostate. Cancer can't wait to to share this with everybody. That's now listening so thanks so much for for jumping on. Absolutely, thanks for your time. Thanks for listeners time good afternoon. A.

prostate cancer John cancer MDX Health John Galliano X. Health Marquez Kidney Cancer John Delano molecular technology John Allen chief commercial officer Medicare Craig Gore US brain cancer Pennsylvania Dino.
Welcome to Man Advocate

Man Advocate

04:05 min | 2 years ago

Welcome to Man Advocate

"Welcome to man advocate podcasts. I wanna thank you all for tuning in. Thank you so much for taking the time out of your day to listen to me me talk. Thank you like it just gives me a warm feeling to know that hey, you can listen to anybody else right now. But to choose me, and I thank you for that Kamal tea Leoni inside Tinguely happiness. So the new man advocate family. Let me explain what man advocate means understand that the title says man advocate, but man, advocate is for men and women. It's for men because maybe the platform men need something where they can go, and they can express themselves were they can listen to someone is just like this xactly how feel but I can't say that in my relationship. Don't worry is. I will say for you. I could get in trouble. But it's so many things that the man wants to say in the mandible wants to do. But he can't because of how society has set up for us, and how we're perceived to the women we we can say certain things. Now, this show was also for women's because I want women to know the inner workings of a man and not through some book that you guys read based off those written by a woman. I don't I don't want you all to to have that. You know, I want you all to know the truth. I want you all to have a full understanding and not just read something that makes you feel better about yourself. And I'm not here to hurt anybody's feelings. That's the last thing I'm here. But I am here to give the the the best way to describe. It is I am the defense attorney on behalf of men. Whether the man is guilty. I'm here to lessen the sentence. Got to explain why he's guilty. If he's innocent. I'm here to explain why he can be assumed guilty. But he's really innocent. Like, I'm just I'm just here to defend men. And and help women understand it. Hey, a lot of things that we do we get it's our fault. But it's not everything. Everything is not always us sometimes issue. You'll be surprised. How often is actually you women the goal over show is equality in relationships. That's that's what I want because we have to understand that we are not in the school age of data anymore. This is not your parents and your grandparents relationships anymore. This is completely different. This is something that we all have never dealt with before. And I feel is best to everybody has an understanding. Everybody's on the same page in order to move for in your relationships. As men we have to express our feelings as women you guys have to pull back on sensitively. The best wagon. Explain that. Hey, guys, stop thinking, which dick Savitt women. Stop acting off your emotions does the best way. I can do this both sides. Nobody's fault there. But both sides have some type of blame there. And I just want each party to to to stand up and take and be accountable for their actions. But no one has been accountable for men men, we always accountable for actions majority of the time, but. No, one says that for us is just we go up on the old saying, you know, happy wife happy life, you know. But no one thinks about the man. I ask him majority of you. All right now. Hey, everybody knows when breast cancer mafias, right? Yeah. With prostate cancer. Those couple is apples. What we're going to get into it. We don't get into dating. We're gonna get into to love. We're gonna get into Phillies gonna get into all everything that's involved with men and relationships and women so with that being said, they'd again, I want to say thank you for tuning in. And let's get started. With the first episode.

Kamal tea Leoni prostate cancer dick Savitt Phillies attorney
5.16.19 Clark discusses his prostate cancer; Sneaky credit card surcharges; Soda taxes in Philly are lowering consumption

Clark Howard Show

35:19 min | 1 year ago

5.16.19 Clark discusses his prostate cancer; Sneaky credit card surcharges; Soda taxes in Philly are lowering consumption

"Hey, I'm aiming this, the host of men up a new sleep podcast and investigates. We get her ideas about manhood each week guest will tell the funny, embarrassing or sometimes disturbing personal stories that will help you figure out what we have to learn and unlearn about being men also want to hear from listeners like you, as we saw through all of our own personal messages to get subscribed to man up in podcasts or wherever you're listening right now. So glad you're with us here on the Clark Howard show, where it's about you, and that Walla yours, I want you to learn ideas can keep more of what you make today's Clark -rageous moment is an update on a New York law that allows merchants to charge you more to use plastic. Why is it a car crate? I'll fail Yan and coming up later, I have an update for you on my latest cancer tests, and I will tell you what's going on with my health and what my future looks like with cancer right now. I want to talk about something that has been very controversial around the country and also in other countries as well. It is. Sugar taxes where if you use. Sugared soft drink, you buy a sugar soft drink in some cities, some countries, you pay a much higher price for it? Then if you buy something that is not a sweetened soft drink. Well in Philadelphia. What people call the soda tax has actually caused sales of s- offerings to fall forty percent. Even when you include people like me that would go outside jurisdiction to buy drinks without the tax, even when you can't that sales are down forty percent. And according to the study that was published in the journal of the American Medical Association. The consumers in the Philadelphia metro area or consuming one billion fewer ounces of soda per year now because of the tax the tax is one and a half cents per ounce. So for a twenty ounce bottle that means it's now thirty cents more inside Philadelphia. It self sales fell by more than half. But then there are people like me that dropped about forty percent by going and buying outside. Now, I have no problem with trying to reduce what government has to spend for health coverage. By taxing some they have a big problem with bands. It's like the thing with cigarettes, do you know because of the massive increases in taxes around the country on cigarettes, and so many employers, treating smokers like pariahs, making you go outside in the cold, or the heat or the rain or the snow or whatever to smoke. Your cigarette that smoking consumption has collapsed in the United States and of late. The cigarette companies have been reporting continuing meaningful drops in cigarette sales today. The percent of trying to remember the percent of Americans that smoke is any now down to thirteen percent of adults. I think is the most recent number don't quote me on that. That's why I remember and it used to be forty percent for zero percent. So the awareness of. Health was one factor but the taxing. The daylights out of cigarettes was another at the same time. I'm not in favor of prohibition. And as you may or may not be aware. I'm one of those people who may be a lunatic, but I don't believe in making drugs illegal that. The we to say that some things are legal and others are not doesn't eliminate the illegality just creates crime. And takes people underground who might seek treatment otherwise but that's for another day. The idea of taxing soft drinks, I think is fine as public health thing because the problem with obesity, in the United States and the problem with diabetes. Those two things combined are an enormously expensive drain on resources in life, and no me at an annex. It came up in a car. Sinks Reese, I am not referring to diabetes. Somebody just inherently gets. I'm telling you about diabetes. It's based on usually weight gain and lifestyle is what I'm referring to. I probably said that in a way they'll still cause a carton stinks. Matt is with us on the Clark Howard show. Hi, Matt Clark. Great. Thank you, Matt. How can I serve you? So my wife and I are working on paying off and still, and we've got about sixty thousand dollars that we're working through. We just paid off my wife's car, and we're currently renting. But we want to know if we should just continue to rent while we pay off these loans, or are we missing out on the awesome interest rates that are out there right now? Yeah. That is a difficult puzzle. Can I ask approximately what's your combined family income? We make combined about a hundred twenty right now. Okay. So you're making double the student loan debt. Okay. Yes. And do you know what interest rates your student loans or caring? Yeah. There'd be tween three and seven percent. Okay. So if you've ever heard me talk about this the emphasis needs to be on the seven percenters the three percent loans. The absolute minimum you're allowed to pay you wanna pay, and you want to devote your efforts to the highest interest rate student loan. You've got. And then, once you wipe that went out the next one up, please, tell me the, the heaviest amount of your student loans or at lower rates. Not the higher ones. Can you tell me that or no? My wife is a big joke, and that is out about five percent and mine are the ones that are closer to the seven percent range, that are, you know, in the two three or four thousand dollar range. Okay. So those, that's gotta be a priority for you. Okay. Because that is a heavier burden than what we're talking about with what you might be experiencing with mortgage rates as you look forward. How much are you, as a couple able right now as a Renner to pay towards the student loans each month? Now what they ask for. But what you can really realistically, as a couple pay towards these, we are getting closer to three thousand dollar a month range. That's fantastic. That's absolutely fantastic. So you were going to be able to get these into a completely manageable standpoint. And if I was thinking about ratios right now it's fifty percent of annual income. I would say that, if you looked at buying a house next spring, you'd be at a point where you would have cut these loan, balances somewhere into the upper twenties. Mid to upper twenties, total own and you would have gotten rid of the higher interest rate ones. I'd say that would be completely a green light time for you to proceed with buying a home. Okay. There's Jerry likely anything that will happen. Although it's always hard to predict but it's very unlikely anything would happen in the intervening. Let's say eight to ten months till you start looking for a home that would drive rates up to a point that you're going to want to beat your head against a wall makes sense now where would that leave us of far? As a down payment. I'm in the school of thought that I want to get as close to twenty percent is possible now with paying off student loans. Obviously our savings account is not as large as it could be. Or what would you say should we just go ahead and rent, even another year? After that. Do you think? Don't want to keep putting it off. If you could set a target of ten percent that you could put down you could then get what soon as an eighty ten ten loan, which would sell help you avoid private mortgage insurance, which is the big benefit of twenty percent down. You take out a first mortgage for eighty percent of the purchase price. A second mortgage for ten percent, or home equity line, depending what's available or loan. And then the other ten percent is your down payment. Awesome. So I think you could completely set you're setting a clear goal. The goal is to be able to buy a home next spring. You know that what you need to do is cut the student loan debt by half and you're on your way. Thank you so much Clark. We just appreciate everything that you do for everybody. And every time I think about spending money, I just put on a podcast and you kinda set me straight. So do I do that with guilt or encouragement, which is that you get? I think a little bit of both. All right. Well, that means I'm doing my job, if I am able to sneak in some guilt, with a combination of encouragement, I've done things. Right. Chris is with us on the Clark Howard show. Hi, chris. Hi. Thanks for helping us out. Certainly chris. We're considering moving from Connecticut, the Florida to be near two of our grandchil-, or two of our children and our five grandchildren age coup months to thirteen years. And we've seen horror stories from family members who of us interstate movers. Oh, yeah. And including grossly misleading estimates delays of many weeks, receiving furniture items being lost or maybe stolen, how do I choose? And interstate neither what can I do to help make the process go? Well, yeah. So this is such a fantastic question. You're asking Forida has been the heart of the moving scams for people moving out of Florida, moving into Florida. There are a number of organizations that are alleged that they may well be run by the mafia read, they actually doing gauge in household goods hijacking, and we'll hold your goods ransom. For ransom. If you don't pay the ransom you never see your stuff again, stuff of yours, a stolen, they lie about what you're going to be charged and charge. You five ten times with the move quote was. I mean it is a hideous problem that happens in other places as well. But far too seems to be ground zero for it. So you're gonna help lead my body, I am because I'm going to tell you how to avoid the mafia. Okay. All right. So I want you to start at a website called moving dot org. And when you go to moving dot org. You'll see what they now call their pro mover program. And these are movers who've agreed till. Follow a code of ethics and a set of procedures their mainstream companies in the moving industry. It doesn't mean they're not going to break something a yours because that just happens as it mean that you're not gonna have some issues because moving is complicated, and it's hard to find people to do the work, but it's going to greatly reduce if not eliminate the odds that you'll be hit with a scam or criminals. The second thing. Go ahead. I'm sorry. I was gonna also ask about how about those places where you put it into a continue. Somebody moves it puts it into a container and then that's shift. You can do that. But you're doing a whole house move or you not. Yes, Connecticut the whole house move higher. A traditional mover over not gonna want to unload that thing. So, okay. When you hiring a certified pro movers, not enough and again, you'll find them at moving dot org. There's two other things you gotta do on an interstate move. You have a legal right to something. Nobody knows to ask for their is an estimate. And that's usually what you're offered. And that means nothing you only wanna get what snow is a binding estimate that means that you cannot be charged more than that price for the move. Unless you in some way, have misrepresented how much stuff you have? And so a binding estimate will eliminate that Bill shock at the end the next thing is that in a very anti consumer move. The US congress has left the reimbursement for damage goods or stolen goods or loss goods at what it was in nineteen thirty six. When obviously things cost a whole lot less. So you have to protect yourself by buying your own coverage. Usually from the mover, I want you to buy was soon as replacement value coverage, so that if anything is lost broken or stolen, you're covered for it for what it would cost to buy a new item. Take a couple of hundred dollar deductible to hold the premium down. But if you do those three things hire a pro mover. Get a binding estimate in ensure it odds are, it'll be a smooth move. Today's Clark -rageous moment is on me. I was so excited when New York implemented a new law based on a court ruling that retailers and restaurants are free to charge you a higher price if you use a credit card so essentially, there's a big charge for a merchant. Accepting credit cards. And if somebody's willing to pay cash, you pay a lower price than you, do if you use a credit card if the merchant chooses to charge a difference. This is why this is a car, courageous moment. And why this is my bat. I did not count on the fact that there would be businesses that would use this as a way to abuse their customers. The story in the New York Post about how knee particularly New York restaurants, are not disclosing to people till after they ring them up. They don't even say anything, then they just charge them more. They're charging in some cases, abusive massive surcharges for using a credit card is much as like on a five dollar charge. Charging you nine so it would have been five in cash nine with a card that kind of abuse, the reality, and what the court was doing was what I described was simply that if it costs a merchant two percent, extra take a card that they would charge you two percent more unfortunately, some unethical players are playing games. I still believe that we're better off if businesses are free to charge. A lower price for cash then for credit and then you make the choice about convenience and getting your points or whatever cashback you would make that call. But there's always people that spoil what's a good thing. It make it a bad thing by cheating people. So I guess it's really bad on them because I was too naive to see people would play at that way. It's great to have you here on the Clark Howard show was about you learning ways to save more and spend less and don't let anyone ever rip you off. You got a question for me. Go to Clark dot com slash ask. So I've been very public on the air for long time about having been diagnosed with prostate cancer last decade, and I have confused people all through the years that I have never had treatment for my prostate cancer, and there've been a number of people who've been very unhappy with me very upset colluding people in the medical field who feel that I'm being reckless careless and creating danger for others by encouraging what they feel is reckless or dangerous behavior. But I wanna share with you, some stuff and I have brand new information that I just got yesterday about what's going on my cancer. So prostate cancer. Certain skin cancers, and also breast cancer are different than many other cancers in there are different genetic makeup of the cancers with different risk levels in different consequences. Scientists now. No medical. Researchers now know that roughly forty percent of people with prostate cancer have extremely slow growing prostate cancer that they will die with not from the problem today is that we don't know who's in that forty percent. And so it requires. Process known as active surveillance, where you, if you fit what appears to be a profile of somebody who has an early stage cancer, that at least initially does not look, dangerous that can be validated over time by doing biopsies and in more recent years, MRI's, and so I- since two thousand six have had twelve biopsies and in that time, I've had one two, three, four MRI's. And so I am on a schedule that has been adjusted over time as my cancer shown, no meaningful growth over these years. And so, I am in this thing that Ridgely it's called watchful waiting now called active surveillance. A lot of people are in a community where the culture. Among doctors is that if any cancers detected it is to be treated immediately? Also many patients hearing the word cancer freak out, and get trait treatment, immediately, is the same thing, that's going on, believe it or not right now that gets no publicity at all. With medical researchers and scientists involving breast cancer where there are certain types of breast cancers, early stage, that are not considered to be in any way life threatening, but are heavily over treated. And there are doctors that are devoting their lives in the breast cancer field to trying to get the word out that, in many cases treatment is unnecessary and only the breast cancer quivalent of active surveillance is necessary is required. Other people have extremely dangerous breast cancer, just like others have extremely dangerous prostate cancer, and prostate cancer. There is a grading scale different than you're used to, like stage, one to four with most cancers prostate cancer. It's called Gleason, six seven and beyond and. The higher the number the worse it is for you. The lower the number the better people that are Gleason, sixes, and many Gleason, sevens, are good candidates for active surveillance. It is important with prostate cancer, the not freak out. And second to read in medical journals. And the prostate Cancer Foundation has a very good plain English guide to what you need to know. If you are, in fact, I know s- with prostate cancer, we have a link to it at Clark dot com slash cancer. And if you or a family member, or friend, or diagnosed with prostate cancer, and you're really upset, feeling a lot of anxiety go, read this free guide, and you'll have a better sense about what you should do as far as those. Either individuals who are not medical or people in the medical profession, who feel that I have been reckless. I just respectfully disagree. I've been very careful in how I've handled this, and I'm not going to do something foolish. I just got my latest results from my latest biopsy. I had an MRI last month at UCLA medical center in I had a biopsy last week. UCLA medical center and my MRI showed no evidence of any dangerous cancers. And the biopsy found what it's found all through the years, the minimal very low grade, the lowest cancer score Gleason, six of cancer. And so the protocol is gone from initially every six months having test to once a year to every eighteen months to now. I'm on been on a two year cycle now I'm on thirty months cycle, and so two and a half years from now I will less something happens in the intervening time. That's worrisome. I'll be checked again, I want you to know most of all and again, you want to know more about this. Go to Clark dot com slash cancer. I want you to know that as a patient. No. That you and I are way people, we don't have medical knowledge. I'm terrible at science terrible, but been very motivated. And I read medical journals, I don't read, you know, who knows who's blog. I read articles that are posted in medical journals about it. I have to sit with a glossary of medical terms as I read a journal understand what the researchers are saying in the medical journals, but I want to be as knowledgeable as I can. And that's why I encourage you to do not to try to tell a doctor what to do not at all the doctor has superior knowledge. He or she has spent a lot of urine school years in school, but they are not God and you need to manage your own healthcare. You need to be your own advocate, and you need to be prepared with knowledge. And not just be there like a sheep doing whatever you're toll. I encourage you with your wallet. To be a smart consumer. I encourage you with your health is well to be smart. Consumer. Gregory is with us on the car coward show. Hi, gregory. How are you? I'm doing great car. Thanks for taking the call. Certainly. How can I be of service to you? My question is regarding having a loss for teen. And I've heard you say several times that rough can have a team if they a team can have a loss, if they have earned income, and I have a twelve year old, that's replacing my mowing company, and I want to know the mechanics behind, you know, the documentation, and the limits in all the mechanics kind or if it's fantastic. So you've got a twelve year old who's going to have a Roth. Well, I hope to so the money that your twelve year olds earning. It's from neighbors. No, he he's earning money for me. I replaced him with my service that I used to have. So the service. Dollars the service. But now I'm paying him. All right. So just keep good records. Keep a record of what you were paying the service, you're paying your son to do that job, but it will really help if your son picks up at least one other neighbor, who's yard. They do. Because the IRS is always suspicious when a family members paying a family member, particularly when it's a minor child, supposedly doing a job, obviously, your son is doing a real job. And if there's, there's a neighbor's yard, this kind of small, it'd be great for him to pick that up. Then you've got a really solid case where he's earning money for it. He keeps alleger of what he's paid. And he can put in a Roth up to the amount of money that he earns in a year doing yard work. Okay. And so with Ross, there's now the ability with the low cost some of the low cost companies to open one with basically one dollar where it used to be you had to have three or five thousand dollars to open a Roth Vanguards still at a thousand but with fidelity and Schwab. You can open custodial Roth for your twelve year old with any amount of money essentially. Okay. That sounds great. So this is great. But your son part of what he's gotta do is, he's gotta keep a record of what he made on wet day in have that encase. He's ever challenged in your documentation that you're substituting paying your son. I assume less than you're paying it outside lawn service. But anyway, the you're paying him for what you're already paying an outside firm is documentation that deals with the IRS thinking you're just pulling one over on them. Yeah, I have that. Okay. But especially get him into somebody else's yard, even even occasionally so that he's got money coming from somebody else to okay? We'll have to see about that if you end up doing one for him at Schwab or for. -delity. I really liked for him to go with you and be part of the process of setting up the account and being, you know, appreciating that he's becoming an investor in the long term benefit to him, the neatest thing about doing the Roth. Is that if your twelve year old looks like college material money in a Roth is not going to harm your child and qualifying for a good financial aid package at a college? Okay. Great. So that's all good news because money in a young child's Roth becomes worth of fortune, down the road and on my investment guide at car dot com. I have suggestions of what funds you could look at, at fidelity Schwab or he's got to have the thousand to do vanguard, Newton, remember, you never put him more than what he's earned it a year. Ray is with us on the car coward show. Hi ray. Hi cartel. Are you great thing? Thank you. You've got a question for me about a method being touted to wipe out mortgage debt a whole lot quicker. Absolutely. What's the story about, oh, quite a year ago where basically what you're doing is, you're taking using your credit card to put like a lump sum on your mortgage? And then you pay you print out of your income towards your credit card. And then you can totally pay that off until you get everything paid off, and you do it again. You can continue to do it until you basically are mortgage free. I haven't done it yet because I am sort of afraid to do it. I would check with. She see what your thoughts were. Did you hear that? Little noise running in the background. Yes, sir. I don't know if you're going to play it again for you. This is something that comes up in waves. Although I must say you're the first person ask about it, and maybe the last year and a half. But there'll be times it will be being promoted on the web, or on TV and suddenly, I'll get a Russia calls about it. The ideas, you did your fixed rate mortgage, which right now, we have varying low historical rates on fixed rate loans. What's your mortgage at? And you replace it with a floating rate home equity line of credit is the idea of this. So you take something that is a fixed cost and you go into a floating rate where you can end up having your wallet just shredded for you. You don't wanna give up in an environment with fixed rate loans being so favorable. You don't want to give that up for something with a higher risk. The promise they make is that every time you get paid it instantly pays down a portion of your loan balance. That's figured on an average daily balance instead of how a mortgage is calculated on a monthly basis. But what this doesn't bring into account? And this is why it's important Ray to stay away from this. Is that paying off a mortgage and Lou of everything else? Is not a panacea, particularly when you have mortgage money at three and three quarters percent. Right. It's a much higher priority for you to be saving in retirement plan. If you have one available to you at work saving in your own Roth IRA doing things where you're building up a decent supply of money for your future, and that paying off a mortgage as the highest priority versus other forms of debt. I don't recommend either. So stick with what you got. You got something good that works, and don't being ward in by one of these things, tying in with a home equity line of credit. This is a recipe for financial disaster. Today. Val is with us on the car, coward show in Val, you have a question for me about dumping an old phone to go to a bargain Android. Tell me about that Clack. Yes, I've had the old iphone five for many years now. And it was just wondering if it's time to get the Moto, g sakes. So the motor g six are you saying prices on it like one fifty to two hundred is that about? Yeah. But one funny nine one forty nine t six is a dated phone. It is a very good phone. It has a screen size. Is it like five and a half inch screen, but I'm gonna make a suggestion to you that you may be look at the g seven even though it's quite a bit more money than the g six. Okay. And the reason I would say the G seven is six point two inch screen and is a brand new phone. Real answer. Your question. How much are you really on your phone doing things? Are you in occasional user, or you on your iphone five all the time? I work a lot in between. Yeah. I would say, I, I don't know maybe an hour at the most of the day, okay? I would like for you to go to maybe a place like best, buy or somewhere, where you could see the g six and the g seven side by side, or even as a, as a compromise between the two the G seven power, the G seven power is a six point two inch screen phone, it retails at two forty nine but you can find it cheaper from time to time and it has a five day battery life. Okay. So you're probably having to charge it all the time. Yeah one day, so think about not having to charge a phone day after day after day. That's why I'd go look at him. In person, the G six is a great phone with a lot of people love it. And if one fifty so what you want to spend, it would be fine. But just go look at the others and see if that really is what you wanna do. You're listening to the Clark Howard show. Thanks for joining us today. The Clark Howard show is produced by Kim. Droves, Joel LARs guard, Debra Reese, and Jim Ayers and remember, twenty four hours a day where there to serve you at Clark dot com and Clark deals dot com.

Clark Howard Matt Clark cancer prostate cancer diabetes New York Schwab prostate Cancer Foundation Philadelphia Connecticut Roth United States UCLA medical center Chris Debra Reese journal of the American Medica Yan obesity
Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer (EP.39)

The Peter Attia Drive

2:31:54 hr | 1 year ago

Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer (EP.39)

"Hey, everyone. Welcome to the Peter Attiyah drive. I'm your host, Peter. Drive as a result of my hunger for optimizing performance health on jeopardy critical thinking along with a few other obsessions along the way, I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize. What I've learned along the way to help you live a higher quality more fulfilling life, if you enjoy this podcast. You can find more information on today's episode and other topics at Peter Tia, MD dot com. Everybody. Welcome to this week's episode of the drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast. And why instead we've chosen to rely entirely on listener support, if you're listening to this you probably already know, but the two things I care most about professionally are how to live longer and how to live better, I have a complete fascination and obsession with this topic. I practice it professionally and I've seen firsthand how access to information is basically all people need to make better decisions and improve the quality of their lives curing and sharing miss knowledge is not easy. And even before starting the podcast that became clear to me, the sheer volume of material published in this space is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this information. With you to take one example are shown outs are in a league of their own. In fact, we now have a full-time person that is dedicated to producing those and the feedback has mirrored this. So all of this raises and natural question. How? How will we continue to fund the work necessary to support this as you probably know the tried and true to do this is to sell ads? But after a lot of contemplation that model just doesn't feel right to me for a few reasons. Now, the first most important these trust. I'm not sure how you can trust me. If I'm telling you about something when you know and being paid by the company that makes it to tell you about it. Another reason selling ads doesn't feel right to me is because I I just know myself. I have a really hard time advocating for something that I'm not absolutely nuts for. So if I don't feel that way about something. I don't know how I can talk about it enthusiastically. So instead of selling ads I've chosen to do what? A handful of others have proved Ken work overtime, and that is to create a subscriber support model for my audience. This keeps my relationship with you, both simple, and honest, if you value what I'm doing you can become a member and support us at whatever level works for you in exchange. He'll. Get the benefits above and beyond what's available for free. It's that simple. It's my goal to ensure that no matter what level you choose to support us at you will get back more than you give. So for example, members will receive full access to the exclusive shouts including other things that we plan to build upon such as the downloadable transcripts for each episode. These are useful beyond just podcast, especially given the technical nature of many of our shows members also get exclusive access to listen to and participate in the regular ask me, anything episodes. That means asking questions directly into the AMA portal. And also getting to hear these podcasts when they come out. Lastly, and this is something really excited about I want my supporters to get the best deal possible on the products that I love, and as I said, we're not taking at dollars from anyone. But instead what I'd like to do is work with companies who make the products that I already love and would already talk about for. Free and have them pass savings onto you again, the podcast will remain free to all. But my hope is that many of you will find enough value in one the podcast itself and to the additional content exclusive for members to support us at a level. It makes sense for you want to thank you for taking moment to listen to this. If you learn from and find value in the content, I produce police consider supporting us directly by signing up for a monthly subscription. My guest this week is Dr Ted Schafer, the chairman of urology, Northwestern University in Chicago is your August who specializes in the diagnosis and treatment of prostate cancer. His high quality work has earned him the trust of people like Ben Stiller is operated on and who have spoken very publicly about his own battle with prostate cancer. In this episode, we go through all of the current and basic best practices for the screening and treatment of prostate cancer from the latest drugs to the surgical options the conversation net. Naturally leads to our volving understanding of cancer and the most exciting areas of research in prostate cancer. Specifically, we also touch on the controversy around the role of things like Tata stran- replacement in the development of prostate cancer. And even the controversy surrounding prostate screening using things like the PSA and finally if you're an MVP HD student, which realized might not be many of you, you'll wanna listen closely as Ted has some of the most pertinent and unimpaired most important advice for those who are deciding on how to thread this needle of being clinicians and scientists so without further delay, please enjoy my conversation with one of my closest friends from residency Dr Ted Shaffer. Hey, man. How are you? I'm great good to see through. It's kind of weird when I go visit my friends from residency. I see them in their grownup close and their grownup offices. It it kinda makes me feel like I failed. Well. Your office is stunning. The view over the lake in Chicago and admittedly. This might be the best month of the year to be in Chicago. But it's like we're in the elevator coming up here. And I feel like we're supposed to be doing. Like, we always did. And I'm like, wait. We can't goof off he's now that chairman of urology, we we got gotta be serious. It's true. When I when I look at looking at you here doing this recording. I can't help but just chuckle. So we'll get to all the med school stuff or the residency stuff because that's obviously where we met. But let's talk a little bit about your decision to even do a PHD. And you have an interesting story there 'cause you weren't on the typical MD HD path. Right. Yeah. I, you know, people ask me about my life. And how I got to where I am. And there's a couple of principles. I think about and their common themes that we share together. But one of the things I teach our talked to my trainees about is. You know, you never walk by an open door without looking inside. And so that's how I ended up being at the NIH doing my PHD. But even before that, I think the way my brain was built was that. I always wanted to see what was inside the open door inside the alarm clock inside the watch and so- conceptually as I move through my my training. I liked biology because I wanted to understand how things worked I loved organic Chem. Stray love putting the puzzles together making things happen. And so as an extension of that when you're in medical school in learning about the pathology of why things fail understanding out of the soil level. Just always appeal to me, and I loved the ICU I love the, you know, the physiology of the human body and how you can measure all that. And so I I think about that a lot 'cause I, you know, read in been failing your blogs in your life. How you analyse everything you do. And so for me in medical school was a lunchtime thing I went by this open door, and there is his opportunity apply for a scholarship through Howard Hughes Medical institution to really go. Study science at the NIH, and I had started college and school early. So I had a buddy I felt like I had a year to kind of play around and see what was interesting to me. And it was something that was out of the box for me. But I just you know, when you find something that makes sense, it's no longer risky to you. You're not exposing yourself to anything. It's really just. Exploration. And so that that came very natural because I'm not the type of person who likes to take on risk do different things. But for me, it wasn't arrested just leave medical school and go to the NIH. It was an opportunity when you were in college. Did you know you wanted to go into medical school? I think so. Yeah, I loved I love biology. I love understanding the way things were and how they worked, and, you know, the most complex of all those things is the human body and just a living organism a multi cellular organism is just incredibly fascinating to me. So I was always attracted to that. And so I thought that was a natural extension. But I remember when I was in college. There was a very famous anthropologist at university of Chicago who was one of these dinosaur hunters. And so I just I loved I loved the idea of just discovery I love that idea of anatomy and discovering. What dinosaurs were like and how they did that. Right talk to my father, who's a physician and. Said, yeah, I wanna go off to grad school and be an anthropologist, and he's like do what you know. But that concept of discovery innovation. Figuring things out. It's just something. I've always had in me. So you don't just go to NIH. How did you wind up in the lab of a Nobel laureate? Well, it was through a friend of mine. So when this program, I was in, you know, you went in new interviewed in in different labs, and you basically decided what you wanted to do in some people. It was an incredibly talented group was about forty medical students from all over the country. So some of these people, they're just amazing. They knew what they wanted to do. They knew what field who they wanted to work with and so forth. I wasn't sure what I wanted to do. I knew I wanted to pursue this idea discovery and pursue it at a high level. And I remember there's a guy named Jonathan Ashwell. He was an immunologist. And I thought well, maybe I should do him in allergy mostly because I didn't really understand image. Analogy very well from my medical school class. It was a week kind of class for me. So I went talked to him. And he said, you know, he's a really tough guy. Very successful hardcore scientists in at the NIH aetiology. There was just really really just amazing. And he said, listen, you just got to pick a guy is really tough. He said look just a man up pick pick something and you'll get into it. And you'll love it. And I thought you know, that that was actually good advice. You know? And so I was shopping around for somebody who was motivated who is driven and who was smart to work with and a good friend of mine who's actually here at northwestern grant perish. You should look at this. Go talk this woman pants Wurzburg. She's a post doc in the Varmus Labban. She's looking for a student, and she's really good. And so I went interviewed with her. And she was exactly what I wanted me brilliant scientists and she happened to be in Navarre slab lab. But you know, the Varmus lab was a bunch of post docs, who would be effectively. Associate or full professors at any other university. They were just incredibly smart people on I got to you know, these these individuals are just amazing. So I met her, and then, you know, work through her with him in the plan was always to she had already been offered a position as a researcher at the NIH, and she was waiting to transition to her own lab. So we yes, technically, I was a Varmus lab member for six or nine months, and but all along I was mentored by this woman pants Wurzburg, who is just a brilliant scientist, and when she was a tech in her lab at Columbia. She was making, you know, she was had covers of sell, you know, she was brilliant so herald attracted people like this in his lab group, and we stayed part of his lab group, although independent throughout my kind of experienced there. And I always considered our group to be equal, but part of his group. So it was it was a lot of fun to interact with him on a weekly basis during lab eatings just to see how he thought I mean, you know, like, you I like. Surround myself with people are just incredibly smart and by being a member of his lab team. I by the faulted that not just him, but many many other people so is really fun for the listener, of course, held Varmus in and Michael Bishop shared the Nobel prize probably in the late eighties early nineties, eighty eight eighty nine ninety something like that. Right. They basically were the first people to elicit the relationship between viruses and oncogenes is that correct? Right. Yes. So the concept of their their prize was in probably butcher this. And the the real scientists out there will kill me for. But you know, the idea was that they described that there's this, you know, you could pass on a cancer through a viral induction. And so these violon jeans was what they described. So they were an active alteration and the cells normal machinery to to induce a cancer. I've never met Harold, but I did have the privilege of having dinner with Michael Bishop once a few years ago, and it was a very intimate. You know, there's like four people there, but everyone was either Nobel laureate or will be a Nobel laureate sort of thing. Luke, Handley David Sabatini, Michael Bishop. And you know, it's just one of those nights. Like, you don't want it to end, you can't believe that you know, we were at a steakhouse, and we were sort of sequestered in our own little room, and we probably spent like five hours they're talking about their work. It was amazing. You said something a second ago that I love I didn't know this about you, actually. So this is the funding of interviewing your best, boys. Is you still learn something part of the reason you're attracted immunology as you felt it was a weakness and having spoken with a number of very good. Scientists I find that to be very common thread, the great ones seem to go towards their weaknesses rather than away from them. Steve Rosenberg who was my mentor at the NCAA always talked about the reason he did he always knew he wanted to be any knowledge is always non negotiable. But he did his PHD biophysics because he didn't want to be intimidated by these differential equations when he read papers like he really wanted to understand field of science that the didn't come you know, sort of easily to him. So that's sort of an interesting aside about you. Yeah. I was funny. I had a great mentor and worked hard, and you know, on paper had a great. A PHD. And I remember was degree granted through the university of Chicago. So again, I wasn't in a formal PHD program. There was an open door for me to do this. Great. You know, this great program not between at the NIH. I went there for year. I just loved it. I loved the research environment and from there. I petitioned the stay in additional year. And I didn't really know what it meant to have a PHD. I mean, I wasn't going there for a PHD going there to do science, but I had friends that were informal MVP programs at university of Chicago. And they were like man, you know, what you've done is PHD students would die for. And I was like, well, I don't know. I'm just doing my thing, you know. So at that time, I was an idiot, and I was kind of ballsy. So I wrote a letter to my Dina's at all I think I should be. I should be someone should give me a pin the stuff, and they said, well, why don't you fly back and much give a talk and I did near like, okay. Yeah. You do not you're talking about. And what you had public. You have actually a very similar story to another good friend of mine who was innocent. Where he basically was in the right place at the right time. Right. Was in a great lab. Very well mentor d- great project and was willing to go to wall for it and ends up getting a a first authorship in science and hater, and it's sort of like you just have to hand those in and that becomes a PHD. That's the idea, you know. And so yes, all the critical thinking and how to develop and come up with a hypothesis and tested. I did all those things. So I mean, I met all the former criteria for it. I just did it in a I wasn't in a structured way just happened to be in a good environment. Where what was the most interesting question you were asking during your time at and I well, I mean, I think immunology and really I think I was more in cell, signaling lab. And so a lot of what we did was biochemistry and the idea was, you know, well, you would take a single protein, and you knock it out or turn it on or whatever. And it would have a huge fact, I think at that time people were thinking really, very linearly. No I had. I mean, my my PHD was pretty much the most amazing experience, you can imagine. So on my floor and building forty nine. It was in the old center. This is this is before for the news lentils under which was building forty nine was genome institute, it was across the street from the NCI buildings which I think were thirty five and thirty seven or something like that. So on my floor was herald Varmus, you know, Varmus lab, I was technically in our own lab with Pam, but we shared laughs face with Francis Collins. So you know, it was just I mean, you couldn't just pick a better Florida have just people on. So at that time Gino mix in transcript dome X in this is the mid nineties this is ninety seven ninety nine. So I mean, people are just starting to do homemade microrays and looking at expression, and I remember people like take a muscle cell, and they compared to a fiber glass, and they like, oh my God. You can see these different expression changes in these homemade microwaves. And so that's when everything. Was taking off a member loose doubt. Who still at the unite-, you know, an I h who was working on. There was a Howard Huston working on lymphomas and just characterizing the different genome FINA types of them and people still use that stuff today, it's pretty mazing. So I was there when all that was happening. I was I remember when I went there, you know, at university Kogyo people really weren't on the internet, and then I show up and I go to the lab, and there's t one lines of the NIH and the internet, and I remember downloading the Clinton tobacco, you know, in reading that in detail. And so there's all these just amazing things that happened in science and happened in technology that were going on at that period of my life and that period in the world. It was pretty it was pretty amazing. So so the thing that's a long answer to the concept that when I went there think people are still focused on single, gene single change. They're still looking for the like will you have this mutation? You get this cancer this mutation you have this FINA type, and you know. The human bodies apologetic organism. And so at last count if there's twenty thousand human genes, I believe there's something like seventy three, but I could be wrong. Let's just call it a hundred round up there about L only a hundred disease states that result from single genes, right Asians. Yeah. At a twenty thousand genes. Yeah. So you know, that was the big thing that big transition in Francis Collins's really leading that where there are people hunting for the gene for type two diabetes at the time. I was there, of course. Now, we understand a complex equation. And so within immunology when I was there. It was also a transition. So it turns out that the tiresome kind. As is that I worked on my PHD are really involved in fine tuning the t cell receptor, signaling. They're really Rio stats they really find tune the signal. It's not offer on just like, you know, you have a mutation and XYZ offer on. And so I think one of the big themes of what was evolving at the time. I was there was this concept. That was a fine tuning. And I remember we would do analogy retreats in the Roseau another way to explain this. Maybe for the listener. Because of course, I hear reestablish. I think about reestablish because I'm engineer digital is a signal it's honor off as zero or one analog is like the volume button on your radio. You can go from nothing to full blast. But an infinite number of iterations in between, and that's what you mean by modulating the signal, right? And I think that that Trent that was a period of transition and science for maybe we people always thought that that happened. But people were developing the tools to begin to test that and understand that. And you think about cancer me -nology, and Rosenberg lab was a huge player on campus. When I was there, which was ten years before you were there, and they were hunting for single tumor antigens. Right. That was but then they were realizing that that it's a complicated thing in its there's multiple factors that come into the role in the play there. So for me that was maybe conceptually something people had always thought about but the tools to. Floor that the tools to to test that on multi levels were kind of coming online in science at that time. So as a pretty fun time to do that talk a little bit about a tyrosine kindness. I mean, these these are so ubiquitous in biology that and they just come up over and over again. So explain to someone who doesn't understand what that is what it is. And why it's relevant and how and maybe where it shows up. You have your DNA everybody's born with it. It's an every single cell in your body. But the skin cells in your body make a certain amount of melanin that make you darker than I am. And so within between different people, there's variability in what the individual cells do what the DNA and then within the human body, there's different cell types. And they used the DNA the code differently that code then is incredibly its modified right by exposure to the environment. And that's the genetic change and what results is a protein and so. Once you have a protein, that's really what kind of constitutes a lot of what's in our cells in our body, but they're not inert. They're constantly changing. And so one of the ways that they changed and one of the ways of the signals change within an individual cell, how the cells communicate with each other excetera is by having kind of temporary modifications to those individual proteins. And so one of the ways that happens is through this these tight these kinds, and there's different pieces of the proteins that can be modified. So one of them is a tires in kind. But there are other types of kindnesses and these are temporary modifications that happen within a protein within a cell to typically transmit a more acute or change in within the seller between two sales and so forth. And of course, these have become a very attractive target for drugs. Yeah. So one of the obviously, the the idea in cancer biology is to find alterations to find mutations to find changes that you can quote on. Quote, target to do precision oncology precision medicine. And so these are one of the ways that were beginning to think about advancing the kind of medicine in that in that special way. Glee back targets tires, and kindness, doesn't it? It does targets specifically altered fused, gene. So it's not just adrenaline tiresome kindness. It's tiresome kindness. That's altered by specific mutation within a cancer. Amid was that was house originally described? And so yes, it will it will target those AMAN have specific affect and that was, you know, work done on the west coast in part by Charles lawyers. Who's now memorial who's, you know, a an idol of mine, but he wasn't the only one involved in kind of finding the fused mutation. It's sort of one of those exceptions to this rule. Right. Where if you have that mutation which basically if I recall only showing up in C, M L and GI storm tumors. Right. Then you do have the one hit wonder, you is this drug is at least in the it seems curate. I don't recall if it was actually curative in just. Yeah. G trouble tumors, or if it was just basically could render at a chronic disease for the GI strong will tumors. Snot my my space, but yeah, it works. But it does there is resistance at develops. I think in both models now, but in general for the liquid tumors. It's much more durable. And for GI struggles. At does help to suppress growth of those tumors. Some of them do recurring come back, and that's the concepts of how we manage. And we've converted, you know, HIV aids to from a lethal disease to a chronic condition, really those basic principles of multi targeting of the particular cell, so like for cancer single agent like leave AC isn't gonna work because the the cells chain alter but doing double a triple targeting will be affective long-term approach for those just like we learned from each v management. So I'm sure today, you know, you're now that chairman of urology, so you are in you encounter, lots of residents and medical students and one of them. To you and said, hey, Ted, or I guess they'd have to call you, Dr Schaffer. But you know, I'm really thinking about doing a PHD, and what advice would you give them to select a good lab. In other words, you describe so much of your trajectory is the is your the beneficiary of having been exceptionally well mentor, and you know, you've talked about Pam now. And before and we've talked about just when you have an amazing mentor. It's like everything works out. And yet the account lists go into labs that just couldn't waste more time. They don't actually learn how to think properly they come out as dumb as they were when they went in and the field has not advanced so in his much as surrounding yourself by the right people as the best first step, you can take what guidance. Would you give somebody to you know, what questions should they be asking? What things should they be looking for either positive or negative to help them think through that? Well, I think in you've had an opportunity to interact with brilliant, scientists all along and for me, it's the brilliant scientist. It's brilliant, clinicians is brilliant people. So what are the essence of those people? That's how. I would think about it, and mentorship matters, obviously, brainpower matters, motivation matters. So, you know, why is it that some PHD's tunes are not successful? Sure. You can attribute some of it to mentorship. But I really think that it has to do with motivation and drive, and that's such a critical part of it. So then you'd say, well, why somebody not motivated why aren't they driven? I mean, I guess some people are biologically built that way. But I also think maybe, you know, if you wanted to be nicer about it, you could say we'll maybe they just haven't found what they're passionate about. Because I think that Dr passion there very soon that they come from the same part of your heart, your brain. And so I think part of that is just that, you know, have they found the right area. Now, there are still having said that there are people that are just super passionate about something. They wanna do it. And they they just can't, you know, maybe they need to kind of move along. But I think that in my experience in grad school is that there are. Usually, you can it's not that hard to identify grad students aren't successful. It's pretty easy to find out. Well, they they're missing a major one of those components. So you head back to university Gago, you wrap up your last two years of medical school at which point you have to decide what you wanna be. When you grow up and you pick your allergy yet. So I went to university of Chicago undergrads. I I spent eleven years at university of Chicago and the first four years where the toughest years of my life for sure the the undergrad I learned only one skill set in that was how to use my brain out of think how to think critically, you know. That's why we became I think friends instantly at at Hopkins was that I feel like that's how your brain is built to and you've simplified that throughout your whole career. So for me, I went there. I learned how to think I decided I wanted to pursue biology at at a deep level and I wanted to pursue human biology. So then I went to medical school now for me, I think one of the key components of having an affect. Active research career to date. I guess would be that. I had a clear understanding of this idea. Translation, so you can do science for signs sake. But to me to make really big impacts you have to be able to translate that to the human condition. So I did three years of medical school before I left. So I went away after my third year. And then I already had a year of clinical medicine under your belt. Yeah. And so for MS that's also very unusual. It's definitely different. But I encourage all students who are MD PHD's do clinical time before they do they're so that that's that might be the nugget of the podcast right there. Because I don't think I knew a single MS teepee student who didn't go straight into their PHD after the preclinical phase. Right. So for me was just so impactful to be if you say in hindsight, well, what was the distinguishing factor of the virus lab crew. They're all MD PHD's. They had all done clinical. So they knew. Really key nuances that were important questions to ask. And it doesn't you don't have to be an MVP to get that, you know, one of my good friends is his PHD who developed a genomics company that we may talk about later, and he's straight PHD, he should know prostate cancer like he does. But he really gets the nuances of it. So I did three years of my med school. I went to the NIH I did pure science amid think about humans at all thought about mice and signaling in mice and T cells in mice and so forth. But in the back of my brain is always like Kay. How're we gonna change going to think about the human condition human disease, breakdown know, rebuilding all that? So for my perspective. I had I had a jump on. You know, the other straight PHD's in the group because I had I had an idea. Now, why did I choose urology? Well, this goes back to just an early childhood imprinting. So there's a couple of facts number one. My dad is an incredibly famous urologist. My father was the chair of the department of urology at northwestern for twenty five years before I took over the job, and he's an incredibly successful. Scientists doesn't do cancer biology. And I I didn't even know he was Iran is a kid. I just knew a miss my dad, but one of the backstory's was that when I was in seventh grade eighth grade and beginning high school, we used to go visit my dad's parents they live in northern the Anna, which is about a hour and twenty minute drive from where we were and over that time. My grandfather got sick. And I have this vivid memories of seeing him. And and they're really snapshots in my brain. I recall weekly of just becoming sicker becoming more frail becoming bed bound, and then dying and I never really asked what he died of. And I don't think I was I don't think could process it what it would have meant. Anyway, if I had asked, but when I was a medical school, and I was doing my PHD I asked. My parents what he died of and he died of prostate cancer. So I was at the NIH I was doing science. I had done some clinical work. I realized what people in DC not in science. But in politics were interested in their interested in cancer biology, and they are interested in prostate cancer. I saw at other people are interested in and I had this very vivid memories of my, you know, my father migrant, my grandfather, having prostate cancer and dying from it. And I decided that that's what I wanted to do. So when I came back to medical school. I knew that I wanted to be to be a prostate cancer biologist and understand the disease. I also knew that I wanted to be a surgeon. And so I didn't to be a medical oncologist. Although that appealed to me a lot, and I'm always flattered when people think of a medical colleges because those guys are smart, they're smart. But I knew I wanted to do something I love working with my hands. So for me, the I. The of being a surgeon. Scientist was just it just made sense. I loved the biology I love, but I still love the idea of not just conceptually deconstructing something and putting it back together. But actually, physically deconstructing something putting it back together. So as a perfect fit for what I wanted to do for the listener to put some things in context at the time that you and I began our residencies. I don't really think there was any debate about what the best urology program was in the United States. I think there is a good race for number two or lots of programs that would have competed to be the second best urology program in the country. But but Johns Hopkins was hands down in a league of its own. And they only take two residents per year. So if there are four hundred or five hundred medical students graduating who want to go into urology only two of them get to go to Hopkins, and you were one of them, which perhaps isn't surprising. Did you wanna go to Hopkins for reasons other than it was the best program? Was there something about the environment? There. There that drew you to it. Yeah. It was a people. It's an amazing place that I think about think about it all the time. So I interviewed there and the chair of the department. The time was is the godfather of my field. He made all the contemporary modern discoveries in prostate cancer. And it was real simple. He looked me in the eyes. And he said, I looked at your CV. I know what you have the ability to do. And I wanna help you get there so pet well selected you as much as you selected Hopkins. I guess you can say that. Yeah. You know, it was a perfect fit because as we've talked about mentorship is just so much of everything. It's everything in life. Really? If you're motivated, and you have drive, it's, you know, even if you're not motivated, you don't have drive you need a good mentor. So for me, I showed up for the interviews. I'd interviewed all over the country. There was places I could have gone that. I could have made a good opportunity. Good experience for me to be trained. But when I showed up at Hopkins, I was like, okay. This is I got to go here. So I think it was a good fit. He was interested in having me. Train with him. And I was interested in training with him. So it was pretty heal your father. He must have must both chairman. Yeah. It's an interesting story. He I met him at a met him at a function in the fall before I started. So before I had interviewed and he was a function with my father. And so my father introduced me to him. And he said, well, you know, what you want to go into a new finish. Her medical squad said, well, I'm actually interested in your allergy. He said really, and he said will wear you applying. And I said why applied to all the great program? So and he said well the to Hopkins, and I said, I sure did. And he said, that's wonderful. And then I find out from my father that he grabbed my dad when I had walked away. And he said, I just learned that Ted applied to our program. Did we give an interview? And so I made me feel good that you know, I had gotten this interview at the best place in the country without using my father's coattails to kind of get the job. And then it showed up, and it was just an amazing. I mean Hopkins was an amazing place. I know I know you have many fine memories of the place. And I'll never forget just the pursuit of excellence is something I think about all the time. And that was really the pitted me of Hopkins for me, it was the pursuit of excellence among everybody there to be honest with you even the chairs of the departments they pursued excellence in, but it trickled down, you know, a trickle down to the everyday employee's, the physical plant people, the people who clean the floor that they had a pursuit in a passion for excellence that at the time that we are. There was amazing. I remember also being so struck by that when when I arrived, because of course, were each thinking about it through the lens of what we're gonna do you're going there because of your allergy I'm going there because of general surgery the neurosurgery. Guys were going there. But we all had this common. First year. We were all I don't remember. How many there must have been twenty eight of us doing internships in general surgery? Six of us would go on to do that track. Two of you would go onto do urology. There might have been three guys in ENT an Ortho neurosurgery cetera. But within about a week. I was like oh my God. This is like the all star game. Like these three guys that, you know, I still remember everybody's names. Like those three guys that were our classmates who went on to be neuro-surgeons were out of control. They really good. Yeah. The Ortho guys Ortho guys get a reputation of being kinda jokers. These guys were fantastic. Yeah. You know, they were everyone is just so exceptional. So yeah, you're right. It's you pay a little bit of price. You gotta go to Baltimore. Yeah. I thought was Spade. That's right. Although we both met our spouses there, so and I had my kids there. So there are some upsides to it. But the reality is that, you know, it's funny because Pat walls, my mentor. They're always talk about that. He would always say, well, it's negative. Election people come here because they want to pursue excellence. They don't come here because there's a good, nightlife. It don't come here because of XYZ they come here for that single reason. And that's a great point. I never really thought of that. But it's so obvious because I remember being so sad about having to leave California to train there. Yeah. But at the same time realizing and talking a lot about it with Steve Rosenberg was like who had done his MD and PHD at Hopkins that you only get one or two train at this. This is the phase of your life to do this. So go to the best place, you can go that fits with how much you wanna work. Let's talk for moment about PAT's work because I don't think it can be overstated. And I don't think I mean in many ways, I think Pat Walsh was a very unique mentor to use specifically. But in many ways the field of urology today is different because of him. And I don't think I've thought about this knowing that we were gonna talk today have spent the last couple of weeks thinking about this. This. And I have a hard time coming up with people in the modern era that rival him John Cameron potentially being one with respect to pancreatic surgery. But I can't think of someone in the last thirty years that has so fundamentally changed the course of one operation it's impact on one diseases, Pat. Now, am I missing an obvious example, while within urology, I think I think I can't think of anybody within urology, and the other point is I'm sure that there are brilliant out. Outstanding people that have changed operation in a way that alters the the course of those individual patients, but one of the things I think about a lot is that Walsh would always tell me, you know, you you can't make important discoveries unless you work on portent problems. So prostate cancer is a it's an important problem in it's incredibly prevalent problem. So yeah, there's probably some guy out there who came up with the best way to do a knickknack whatever surgery, but if. Doesn't have a high impact probably is not noticed. So. Yeah, I think that what he did in our field was you know, really was never been done before. And probably won't be done again. And he did it for a problem that was incredibly important. So let's talk about the state of prostate cancer surgery for men prior to PAT's work if a man had prostate cancer, what would be back in the early seventies leaving late seventies. Right. What were the treatment options for him? While at the time that Walsh was training. Very few people with prostate cancer had surgery, and that was because it was a potentially life-threatening operation. People would die from extreme blood loss. People were incontinent people were for sure impotent. Let's stop there for a second. Because this is one of those things that I think of unless you've been in an operating room. It's hard to understand why the blood loss from prostate cancer surgery could be so deadly. It's the same reason until you see a trauma where somebody is shot through the pelvis. You can't understand how. That person die people get shot in the chest, and they walk away. Sometimes if it's not through the heart or a pulmonary artery or vein and yet across pelvis gunshot. Wound is often quite fatal. What is it about that anatomy that makes it so deadly? It's the large number and variable distribution of veins in the pelvis, general and wise at the veins, not the arteries. I love I love. I love it. I do this with you. I mean, you know, the the vein is just the the wall of rain is this thick as a piece of paper. So it's prone to tear, and it's hard to repair it if you do tear it and an artery as much thicker, it has much more resilience to it, and it has to do with the amount of flow going through both of them and pressure. So so, yeah, there's a lot of anes in the prostate in the pelvis. There's a lot of anes around the prostate and the distribution the exact location is incredibly variables. So they're more like Venus plexus versus a actual vein that you can name. But if you get into the environment caveman, you're in trouble too. There's no doubt about that. I've that's happened to me a couple times. So point is at anytime, you you know, artery is the real deal, but it's just easier to control it. And oftentimes if you cut an artery, I'll go into spasm, and they won't even he'll stop leading on. And that's not true for Bain. So for one, and then also there's there's the depth, right? There's the actual exposure is really tough in the pelvis. You know, it's it's one thing to, you know, look at the kidney where even though it's in the retro. Neom. You can be staring straight in the face without too much work. That's not really the case in the prostate. Yes. So I mean the way that Dr wells describes it as that people had done anatomic studies for many many years, right? I mean for for decades before surgery for the prostate kinda was attempted to be performed, but the anatomy when you fix a body. And you study it it really compresses a lot of these sinuses. Don't really fully appreciate where they are. And what's happening and so forth, anatomically arteries preserved. But these kind of being this plexus were not. So the anatomy of the pelvis was not appreciated, but I will say that in nineteen oh four at Johns Hopkins. The first radical prostatectomy for cancer was performed by the chair there at the time. And he did it through a pair Neil approach, which is the space between your scrotum in your basic. Early. And when you do it the surgery that way, you will. And the reason is that's the closest place that the prostate gland is to the outside world. That's right. And if you do it that way, you'll void a lot of the veins that bleed just catastrophically when you approach the prostate from kind of above versus from below. And so that operation had been was in, you know, was being performed, and it was considered to be, you know, was definitely saved me in this life threatening blood loss did not occur in the problem. Was it wasn't very good cancer operation. Why's that? Well, it had to do with exposure number one. I mean, you're doing, you know, the prostate is very deep in the Pella. So for the lay people the way, I explain we'll wears the prostate. I explained to people that the pelvis is like a ring of bone and off the ring hang a bunch of muscles. And that those muscles form a hammock at the bottom of the hammock is the prostate, and so it penetrates to the muscles. And then that's where the the Eureka throat the two that you urinate through comes. Through the pelvic floor muscles. And then goes out of the body. So it's deep in the pelvis. It's hard to access. It's hard to access from the paradigm. And it's hard to see what you're doing, and it's harder to kind of excise tissue widely in that area, the exposures tough when you do it from above, but it's even tougher from below. So the life threatening bleeding wasn't there? But part of the reason that the bleeding didn't occur when you did a pair. Neil approach was because they were leaving the prostate kind of in place. They were staying away from the air where the big Baynes were. And so when you were you do that, it would be safer for the patient, but less oncological sound. So am I can't believe I'm blanking on the forefathers? Obviously, Halsted owes slur. Kelly who was the and Kelly was the gynecologist Oastler the internist halted the surge in what was the name of the urologist. The first urologist at Hopkins was one of halston ads trainees that was Hugh Hampton young. So Hugh Hampton young was a hall stead trainee. And so people probably don't realize, but many sub specialties of medicine came out of. The hall steady and era at Hopkins. So orthopedics, radiology urology, these were all sub specialties that basically were halston telling Hugh Hampton young I think we should start. A, you know, an institute our program for people with your logic problems. Now Kelly was doing some of that also at Hopkins just more on the female side. But but that that concept came out of hall stead, really assigning, Hugh Hampton young to do that in the story is that he literally bumped into the hallway until you're gonna go work on this. And he didn't really really wanna do it. Because at the time, it wasn't very sexy. But he did and said from there, he really be began the whole specialty of urology. Yeah. That sort of thing about Hopkins that never got old actually was to walk through Blaylock and look at the photos of all of these old photos of people who literally created the field of surgery, you know, the lineage there was sort of staggering. Yeah. I think one of the things that you. I'd certainly didn't. Appreciate was to really take it all in at the time. You know? I mean, I had the pleasure of being hard too. When you're sleeping, you know. I think in everage of twenty eight hours a week or respect. Right. Exactly. But, you know, the idea of what we did was pretty amazing women we had Sunday school writer love something. We would show up. When can you explain to the listener what Sunday school is you? And I might have been two of the weren't many people that probably loved Sunday school. But you and I had great it. So when you know when we were interns at Hopkins there was no work our limit. And you know, the expectation when you got there was that you'd work seven days a week. We would work eight days a week if they're eight days in the week. And so Sunday's was a day that you'll go in and you'd sit with the chair of the department one of the most famous surgeons of all time, really. And he would lead the discussion on a topic for the day. It often started with history, right? We would do history of surgery history of surgery at Hopkins. And that was those are some of my most. Favorite kind of discussions was him. Just talking for forty five minutes about somebody. And then we would present cases. And then we would talk. We would practice are suturing member. We I'm sure I think Julianne Sosa who's the Jared UCSF now is taught me how to tie square not. You know what I mean? So and also once a year, we each took a turn presenting something back to the group. I still remember what I presented on it. Presented on the war in shunt. Really? There's an operation that I never got to see because even by the time. We were residents interventional radiology had completely nullified the need for that operation. But as a medical student became obsessed with the history of that operation because of how dangerous it wasn't how complicated it was. This was an operation for the folks who may be don't spend a lot of time on the at Warren shunt Twitter handle. I know. Someone creates after this. It's an operation that was done for people with elevated pressures in the liver. And this is something that happens when people get sarosa. So this was basically an operation that would alleviate that by creating a shunt in the liver. But I still remember that and I I remember like typing it up and this was back in the day when I would cut pictures out of textbooks and tape them on and make photocopies, and it was all old school. Yeah. So that was eight to ten every Sunday morning, right? Yeah. And so those kind of things I wish I could just, you know, people say which would go back to high school, which go back to college in many ways. I mean, I do internship all over again. I would I mean, we we were there what one hundred and thirty two hundred thirty six hours a week. But Mana I would do it all over again. It was awesome. We did have amazing times. And I feel fortunate. I mean, there was just a great group of people we met you at you. And I met immediately on day one and then worked together we were together September September of our intern year. We did pediatric surgery together. And karen. Kling was our fellow. She is now an attending in San Diego. I bumped into in the grocery store like a year ago. She was great. She was in his edible. Yes. She is awesome, John Vogel as our John Vogel was our senior resident in your me. How to put an end G tube in that served me as a gastric tube for the listener is a tube that you sometimes have to put in a patient's nose down behind the farrington then into the sophists and into the stomach. This is something that is so ubiquitous in surgical care. But so wildly uncomfortable for a patient because the patient is usually wide awake. When you're doing this. And I remember one day Vogel. I remember where we were it was just at the ground level of CMC. He sat us down there in the playground and said, look you two knuckleheads. You have got to learn how to put an end G tube in without killing somebody, and he didn't mean literally killing, but he just meant torment, and you remember the vocal technique. I do still remember him telling me it was like because everybody thinks that you're supposed to put the energy to up the nose have. And he's like, it's straight. Back then things like you get the Cup of ice get the ice water Cup. You put the G tube in you put a wicked bend on it. You put the light occasion Gelian? And that's exactly the key point. Do not go up go directly back, and you curl down. And then you give them a little straw. And you tell them exactly once you hit the back of the aura ferrings take too big sips. And we and this was a game changer. Ted. It was there for the rest of my residency. I was throwing Angie tubes. If you looked at me, you got an energy to, but and it didn't hurt the thing that the listener will not appreciate is is the layer of comedy associated with this. Because this was done in what you described as the first floor the pediatric hospital, which was called the zoo. Right. Yeah. And so this is this is a brilliant surgeon, John Vogel. He's the head of colorectal surgery in Colorado, teaching Peter t a brilliant surgeon Ted Schafer just getting by in front of life sized stuffed. Animals of like, giraffes, and and lions it was hysterical. Right. It was just comedy. Yeah. That entire that might have been certainly the best month of my interns. Yep. Was fun. In terms of had great many great runs up your jokes. So let's go back to Pat, I got us a little off topic. I actually got his way off topic because we were talking about the bleeding. But there was this other enormous complication of a prostatectomy which was it virtually guaranteed that a man would not be continent with respect to urine and would not be able to regain erectile function. And so I'm guessing that many men when faced with an operation that's going to leave them in a diaper. Unable to have an erection might opt for not having surgery. Yeah. So people had radiation and radiation has changed a lot too. So it was bad radiation or bad surgery effectively. But you know, when you can actually see what you're doing just for the listener pudding doing something when it's pitch blackout bursts daylight makes all the difference in the world. And so. You, you know, you would go into the opera around with him, and he had just had a mastery, and he could control he understood where the veins were he controlled them by suturing them before they started bleeding and by doing that, you could actually see everything. And once you could see everything it was like obvious, you'd be like Hello wire people doing this or that. Now, the ability to maintain potency, and preserve, you know, sexual function was something that it's not so obvious how to do that. But he figured that out by working with some anatomist and really just studying and talking to his patients and listen to what they had to say, he also recorded all of his cases, which I do now to my studied them, and he learned how to kind of didn't know that about Pat, he would record all the operations and study them, and I didn't realize that you were doing that either. I do now it's much easier. Now for us when we hit the button, but every single case I record it, and we're working on working on with one of my residents just making a. A photo video library. So what was hard for him? And he's published and he put out on DVD, you know, his operation, you can see it on YouTube, and it's brilliant thing. But one of the things that makes doing any surgery fund is that there's so much variability in Adamy. So what I'm working on now as a video library, so ten Blatter neck's fifteen of these because there's so much variability and how the tissues present themselves to you. And then how do you handle that net part of what take surgical skill and hours in the cockpit do for you? So we're doing with one of our our laboratory were just taking all these videos, and so whenever I do case, and the anatomy was really nice for ex wires evil, while tell them pull that case. And it's in the third twenty minute clip and pull it and make short just make a clip of that for particular steps of the procedure. Was there a moment? When Pat realized he was onto something, and that this was were basically witnessing a paradigm shift, which is such an overused. Term except here. It's not at all. It's actually an understatement here, but such a paradigm shift in how an operation was going to be done. I mean, this would have been in the early eighties. I'm guessing it was well mid to late eighties or late eighties early nineties. And so it was I think he knew all along he was onto something. And he was very confident, you know, he's not a shy guy. He'll tell you that. So he was incredibly confident that he was on to something. And that what he was doing was the right thing to do and was very convinced that was convincing that when he spoke about a publicly I think that the general community was less convinced that was what he had done was really happening. But I I mean, I I saw it. You know? I mean, I I was really training there. The heyday the peak of Brady urology Johns Hopkins urology, and so I got to see it in real life, and I never saw bad surgery. That's the thing. I mean, we trained at his place, and you didn't really rarely did you see people do a ban operation. So parlor is good stuff and the bad stuff and put it on the perspective. And we didn't. Have most of the time that didn't happen there. So I saw it. And I think he was convinced of it from the get-go. So you're saying it just kinda took a little bit of time for the day to speak for itself. I mean result. So so if a patient today goes to a highly trained competent urologist and his going to have a a prostatectomy, and this it's a sixty year old man, what can you guesstimate about his probability of regaining sexual function? It's not a hundred percent and thought one hundred percent because it used to be zero. But now it's well the nerves that we preserve at the time of surgery to optimize recovery of sexual function or not Mylan aided. So they're incredibly sensitive to any kind of manipulation any kind of trauma. So, you know, one of my good friends is the hand surgeon, and he does micro vascular nerve grafts all the time and the nerves regenerate and re gained function. They do that because they're mile needed. They're incredibly protected. I didn't realize there were such thing as non Mylan aided nerves are there. Other places in the. Body where these exist. Besides the prostate. I'm sure there are I I'm below the belt guys. I don't know there in ever luminary reason that those would not be Mylan in. I don't know. But we can call Pat Walsh up when we finish this, and he'll tell me for twenty minutes when I am in Hyde. And know that. Can we record that this? Good. Okay. So that's a very interesting point that I actually was unaware of. And I can see now why that makes it that much more difficult right because you can preserve this tissue. And you can do it in a way, that's minimally traumatic for the tissue yet. It's not a guarantee that they'll be one hundred percent recovery of function or any function recovery. Right. And so that is the variable. And that's the fact that still hasn't changed like, Dr Walsh would always tell me if if we could do the perfect operation. There'd be no dispute about doing prostate cancer surgery. Perfect operation, Connor percent, cancer control and no side effects. So I think in this day and age you can be nearly perfect for kind of urinary control. You're never going to perfect. So when people say that none of their patients of your nearly doesn't make any sense because if you actually survey sixty or one hundred sixty five year old guys four percent of them will have your nearly mean. So incontinence is something that happens. It's much. More common in women particularly aging women, but it's also occurs in aging men. So to say while I do a hundred percent of my cases. And there's no airing on it's kind of it's better than the baseline. So it's hard to believe. Yeah. But you can get people up to very very close to that number. I always tell people for me personally. Ninety eight percent of my patients are totally dry where one small patter liner day, which often people just wear 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. That's what it does. So how do we use it as a tool to screen for prostate cancer? While we check the values of. The PSA in the blood. So since the prostate is sexual gland. If you check the values of PSA in a eight year old boy, it would be zero because there's no testosterone. And that boy, there's no sexual development that boy. And therefore, there's you know, there's some but affectively no before puberty there for a little levels of testosterone. There's no effectively prostate epithelium, and there's no PSA as a boy goes through puberty to become a young, man. And then as he goes through the aging process, his prostate develops, and the then it starts to produce PSA as part of the components of the seamen. Now, there is a certain amount of leakage of the PSA fluid into the bloodstream, it's not quote unquote supposed to leak into the bloodstream, but it can and as the prostate gets bigger. So think about this concept of this underground sewer system, the New York City sewers, right? They're getting older. They're getting leakier. And the bigger the prostate gets in the prostate gets larger as we get older some of these pipes get leaky. And some of the PSA leaks into the blood. So it was discovered in the eighties that there's this prostate specific protein that you can pick up in the semen, and you can also see in the blood, and so it is not cancer specific it's prostate specific, and is actually very good biomarker for prostate size. The bigger the prostate. The more leaky it is so to speak and the leakier it is the higher. The numbers can go in the bloodstream. So there's two variables that can progress over time the size itself, which can you could talk about that independent of size. So to thirty year olds one guy's got a five grand prostate. The other guy's got a hundred grand prostate just to make sure him you should see a difference. But also to guys with the same size prostate that are two decades apart you might see a higher PSA in the older. That's right. So if you do, for example, like we were always taught in residence, even though I wasn't urologist you still once in a while have to you know, we still do your algae rotation. If I recall, you wouldn't check a PSA on a man right after doing a rectal exam because in theory that could artifice have raised the PSA presumably by creating more of an insult and increasing that flow Shing, some of it into the blood the blood, Jim so what can make the PSA rise. Besides just having getting older and having a larger prostate. Well, if you get an infection in your prostate. So think about that like you got your city you have received or network, and there's an earthquake all the pipes are rattle bit, and they all are extra leaky. And that's what an infection is not infections in the prostate or either all are none really they're not focal. So the whole prostate gets more leaky in the PSA number can go way up the other way to think about it as if you have a cancer and the the analogy would be low. There's there's a city block that has the pipes. You know, the sewer systems clogged. There's more backflow into the bloodstream, and that's how he pick it up. That's not really how it happens. But that's a good way for patients think about it. So what is a normal PSA? Well, a normal PSA is age adjusted so normal PSA for a forty year old is around point five two point six nanograms per mil for fifty year old normal. Meaning this is the median for all the population for fifty year old it's one, and so it kind of goes up stepwise by decade. So there are age adjustments that we do for the PSA number. Now, what are PSA numbers that tell you? You don't have a cancer. There's no PSA number that is one hundred percent, no cancer. But there is proportional rise in cancer detection with rising PSA numbers. So the Ridgely the cutoff set at a PSA of four we do, you know, we think about things more based on the individual scenario. So if you're a younger person if your PSA more than two point. Five that usually considered to be abnormal and may want you may need further work. You don't need a biopsy right away these days in my opinion. But unique further workup so depends on the age of the patient and depends on how also their prostates so many guys will go and when they get their PSA check. There's another thing that gets checked called the free PSA. And then a number is reported, which is the percentage free, which is obviously that if their PSA is three and their free PSA as one the percent free is reported thirty three percent. What is that mean? These are different ways for urologists try to find tune this prostate specific antigen test to make it more cancer specific test. So again PSA's just goes up when you have an every man has it's not cancer specific so percent free. PSA was the first way that urologist began to look at what what's the chance that a PSA of four is coming from a cancer versus a PSA. Four coming from just benign overgrowth. So remember, there's a lot of factors in play. One would be if you had a man who's prostate volume was eighty grams that big and his PSA was four. Well, that's of low ratio. That's something called PSA density. How much PSA's made per gram of tissue. So you'd say well that guy it's very low chance at he has a cancer. That guy would also have a high percent free PSA. So percent free PSA is another way to just look at what how much of the PSA's produced from benign cells versus cancerous cell. So if two guys have a PSA of four and one has a free of one so he's twenty five percent free. And the other guy has a free of three which is seventy five percent free. What's the different physiologically in those situations? Well, there's less bound PSA in the lower percent free, and that's more often associated with prostate cancer. So that just a correlation. So it's not. Like, it means that in other words, you we can't infer what? 'cause I I would I would have assumed that the binding protein is in the periphery. It's in the plasma right? Yeah. It's it bound up when it comes out of the epithelial Celso and just how it's processed. So PSA's process is not a full length protein when it's born in. And so the other way that we now so just for listener. So we have absent cutoffs PSA four in older man, two point five and younger men, but they're all really case specific in my opinion percent free. PSA was the first way to say, let's try to find tune what the PSA means. So a high percent free PSA's associated with the big prostate less of a chance of prostate cancer. A low percent fee PSA is associated with a higher likelihood that that PSA's produced from gland with prostate cancer in it the other variables that we use our PSA density. So that's highly predictive of what's going on in the prostate. So. Easy threshold or cut off for for for you. Peter. We talk on the phone about some of your patients percent, free, PSA density, more than point one. It raises a little bit of a red flag. A PSA density of more than point one five that raises a red flags think about it and median prostate volume for a sixty year old guys forty grams. So forty grand prostate PSA left corner four it's probably it's it's pretty safe a PSA of six six that raises red flags in you know, this mural in patients that okay guy, probably has something going on. So that's how I think about it. Now think about the eighty grand prostate with PSA a four, oh, you have these patients in your practice. They don't have cancer on average right percent free PSA helps with that. There are two other new tests that yes, so you got me onto the four K two years ago. And I really consider it a game changer for the guys like me who were in the peanut gal. Lary? So I don't you know, I I make it my job to know as much as his knowable with the time that I have about every possible disease. It could afflict my patience. But that means I need to spend as much time thinking about colon cancer as I do coronary artery disease as I do prostate cancer. So for me the four K which again, you didn't. I mean, you did me a great service. Not only did you get interested in. But you introduced me to Andrew at Memorial Sloan Kettering, I'm blank on Andrews Landreau, Vickers Vickers. Yeah, amazing guy. And I mean, the guy couldn't have been more generous with his time. I mean, just gave me the schooling early on this topic. So good, and we put together a patient hand out on this thing. And he even edited it for us. I feel like not an I'm worried not enough patients understand that. And I'm worried not enough primary care physicians understand the importance of the four K test. Can you explain how that has changed the way we do things? So this test or looting into and there's another test that performs equally well called the prostate health index or ph test. These both leverage off this idea that prostate cancer cells make PSA differently than benign prostate cells. And so the four K score is the fork calico tests takes PSA percent free PSA intact PSA and age Kate to it takes those four prostate specific proteins produced, and it has a calculator really just discriminate between a cancer cell and benign cell P. H I uses the similar concept. It uses something called minus two pro PSA, which is PSA for all the scientists out there, plus two amino acids on the five prime side of it. So minus two pro PSA, right? And you you measure those specific PSA base proteins in the blood and the four K scores. Great because Andrew Vickers, and Hans Leah developed it with this other great urologist, Peter Scardino memorial. And what they they looked at was. Will what's the chance at this person is diagnosed with and has high-grade aggressive lethal prostate cancer, and it gives you a percentile chance. So when you get the four K report, it's actually really nice report. It'll say two percent chance twenty percent chance and so forth. And so now as you start using this in your practice, they may now also give you the PSA. So you can see the PSA, and then you can say wait a second disguise PSA six but his four case cores to it's safe. What I really like about it is. And so when we do our usually with our patients in their second year sometimes in the first year, but using their second year, we do a cancer screening program where we kind of walked them through every single cancer that you could possibly die of. And then we go cancer by cancer risk by risk. And we it's very lengthy process on the back end for the patient. We simplified it takes about ninety minutes to go through it. But for the males when we come to this. I always view this as one of the better, I said, I wish every cancer had a test like this because. As we'll come back to, you know, pretty much every guy is gonna die with prostate cancer. But fortunately, most men will not die from prostate cancer. But their job is to figure out when a guy has prostate cancer as you alluded to earlier resist the bad one. Yeah. Or is this the one that if you around too much, and so what I guess Vickers in his team have been able to do is figure out that there's now enough data that you can basically turn this into a binary test. You know, which so that the so PSA would be a continuous variable. Right. And when you want to test the sensitivity specificity, but continuous variable you have to use something called a receiver operating characteristic curve, and it becomes quite complicated. Because the question becomes what cut off, and as you alluded to it's very difficult with PSA because it has to be age and volume adjusted so now it's a three dimensional receiver operating characteristic, Irv where you would have a different a UC area under the curve for each point in time and volume that becomes almost inconceivable. And yet the the four K has basically allowed us to say the following. If you're four K score is less than seven point five percent. And I might butcher the numbers a little bit. But that's right number. If it's less than point five percent, the probability that you will be alive at the probably that you will die of metastatic. Prostate cancer is one point six percent in the next twenty years. Yeah. That the the lifetime of the patient, and that's based on this data from Andrews partner, a co developer Hans Lilia where they had this incredible database, you know, mouse Weeden so they could track and then the verses if you're greater than seven point five percent. I think it's like sixteen or seventeen percent chance in twenty years. They that's the the binary office seven point five percent. But it's a continuous variable. But above that, it's continuous. It's not like if you're bub that. Yes. Fifty so berries based on the number. So where are we today? Let's take us take a journey backwards in time in the late nineteen eighties. Forty percent of men who. Who were coming in with prostate cancer had metastatic at the time of presentation. Just like a lot of cancers other cancers we diagnosed today, and that was how it was then every there was an epidemic of deaths from prostate cancer. We're getting a better hand on how to control cardiovascular deaths. People were coming in with aggressive, advanced cancers. Prostate was one of them we Tom. Steamy took this P S eight test, and he I made the observation that you could use it to actually follow men after their cancer treatment. And if the number went up gosh that meant that their cancer was back. It was the game changer. Right. This is the first time this was ever done. And then Bill Catalina who's one of my partners here. One of the godfathers in the field. He said why don't we use it to screen people to pick up cancers when they're early incurable? Not when they come in an advanced. So the chain what year was that? That would have been nineteen ninety to nineteen ninety. FDA approval. So they cut they set up arbitrary cutoffs. This is what this idea of mass screening took off. And you know, it's been sold to the public like will the urologist route there just to make money. This is what we are doing to get rich. No, it wasn't that it was because at the time the test was developed. It was the first biomarker for cancer pick up a cancer early. If you pick it up treated in cure that patient now over the nineteen nineties and early two thousand what we realized as well, guess what we're picking up a lot of cancers where treating a lot of cancers number one were increasing in reducing the deaths from prostate cancer, reducing the incidence of metastatic prostate cancer at presentation. It was forty percent in basically nineteen ninety forty percent of men coming in with prostate cancer metastatic at the time by two thousand it was four percent. Now, the skeptic is going to say this is such a controversial topic. So it's so good that we're. Doing this the skeptical say, well, that's just lead time bias. I mean, all you did was catch a bunch of men earlier. So you have a much bigger funnel. Right. Right. So by the way, the same controversy exists on mammography. So I can't wait to actually sit down with Ted Schafer quivalent of breast cancer at some point. Because I realized that an episode like this is probably a little bit more geared towards male listeners or probably the female listeners who have males houses or people that care about going through this. But it's interesting to watch the rise of mammography and the rise of PSA go through this parallel thing and Kohanovsky though to a slightly lesser extent that really being the big three mass employed screening while it's and it's been written about Al Peter you've written about this. So Peter Albertson is a nother Hopkins alum, he's Charon Connecticut, and he's an anti screener effectively for prostate cancer. And he wrote about this, and he showed that if you just look at incidents of metastatic prostate cancer incidence of metastatic, breast cancer. There's no change with implementation of. Mammography? There's a huge drop in the incidence of medicine prostate cancer with implementation. So why is he anti screener? Well, he just he was historically. He wrote this paper and showed that there is a huge difference. So now with screening you have increased detection, and what we've learned is unlike let's say pancreatic cancer where most of the time if if you picked it up early if you did nothing it, you would die not everybody who has prostate cancer has a lethal variation of it. And so initially we developed a biomarker to pick up all prostate cancers that was the PSA blood test. We pick them up we treated them, we reduced deaths. We also over treated people people who had a cancer that would never have been lethal in their lifetime. That's the dying with the dying from. And this is something you and I used to talk about nearly twenty years. I remember sitting in the cafeteria because you know, even though you know, you. We were still interns, and basically two knuckleheads you knew you were going to do this. And you were always head and shoulders above everybody else in terms, which when I said, I remember asking like, I don't get it. Like, why do some guys get prostate cancer? And it seems to be relatively uninteresting like, yeah, they and another guy though at it and they're dead in two years in it's his devastating pancreatic cancer. What is it about the biology of that because it strikes me as more a function of the biology than the environment? You're the host. But but I could be wrong, of course. But I remember talking about the Salahdin and really coming away scratching my head thing. I don't but clue what's going on this disease. I mean, I'm still scratching my head about it. Because that's my whole research program is all about his will what's the molecular biology, lethal prostate cancer? So we'll talk about that in a second. But to circle back to our story. So we diagnosed many men with prostate cancer, we treated men, and we save their Lisin reduced deaths from prostate cancer period. It's not debatable. But along the way they. There were people that were pulled in and were treated who did not need treatment. But you know, there's a lot of smart people who've studied the biology of prostate cancer, and we realized that not everybody who was diagnosed with that needed to be treated from it. And so the four K score and the prostate health index help us a dentist by men who have life threatening or lethal can't potentially lethal prostate cancers. And so those are great screening tools. They're not considered or the government doesn't like them as first line screening. So you should they recommend you regular PSA blood test. If it's at all abnormal. Remember seventy percent of men have normal PSA's. If there such a thing, and by the way, what do we have a sense of what percentage of those men can still harbor a lethal prostate cancer? Well, Vickers would know that data and they published on that. It depends what you say normal and not normal is you know, below Amina PSA below three. There are still men that have if you just do one test, it's assuming it's not. A lab area miss. Yeah. No, no below three. I still think the Fourcade data says it somewhere around I wanna say ten or fifteen percent. So it's not it's not a single digit and other big opposition in the screening world is the quote, unquote, unnecessary biopsies, and I say, quote, unquote, not because I'm diminishing or minimizing that, but the idea is like a prostate biopsy as trans rectal procedure for most men, it's a morbid procedure, it's not comfortable and just as it's not comfortable for women to have a needle put into her breast and the fear is hey were doing too many of these I want circle back to that. But my view on that today is diffusion weighted MRI, and you know, the is that we have today have have really cut back on those biopsies, but I wanna get your. That's just my take as a non urologist with my patients, but I wanna come back. Also, the government said in two thousand eight I for people over seventy five and then in two thousand twelve for all men that you shouldn't do PSA testing. And when the internet. Scott. Go ahead. Did not do it. I mean, it's easy to not do it. Right. You just don't do it. So what would you predict would happen? If you stop screening for prostate cancer while you would predict it would go up, and it would depend on the time horizon of the disease. So if you stop screening for prostate cancer, you'd predict that the detection of prostate cancer will go down right year out looking for, but you're gonna have you're gonna have a greater number of late presenting diseases or lethal disease. So we published and some of my good, friends and urology published that yes that in fact has occurred. So if you look at starting an OA or in twelve when these two big shifts occurred since that time, there's been a rise in the incidence of more advanced prostate cancer. So the cancer's that are picked up today. Even with the short, you know window where we stop screening aggressively with the internists that there's now more aggressive more lethal disease as of today, I still believe that the formal recommendation for screening for prostate cancer. Is each physician and patient should discuss together. There is no formal recommendation because we when we go through each cancer with our patients, we show them what the ACA with Cancer Society says the US taskforce on preventive services, the NCI the New England Journal medicine did a review on every cancer. And there's one other one other oh, the CDC is the fifth body to weigh in. And we show them. Here are the recommendations from all five of these for every cancer. And I remember when that shift changed to for prostate cancer. There's no more recommendation while the recommendation is talk about it with your doctor pass the buck besides the I think the American kademi of family practitioners, and they don't recommend PSA screening still. I'm not sure why. But you know, that's a different discussion. But the bottom line is that almost all the guidelines now say it's a shared decision making process, which I think makes perfect sense. That's how I view mod modern medicine. Yeah. It does it. In theory, makes great sense. What I worry about Ted is theirs. A bunch of patients they get caught. They don't have doctors like you or me who are willing to be able to have had the luxury of the time and the ability to educate themselves to do that. Because I still see a lot of patients that show up and they're not getting screened because their doctors basically saying, well, obviously, this is quote, unquote. Controversial, you know, I sort of remember hearing that we shouldn't have been screening. So we're not gonna do it. And that's that's sort of my fear with these things. Well, I think I think shared decision making it require also. So then to me conceptually, it makes a lot of sense in reality. What does that actually mean? Well, that's the next question. That's the next unknown. Right as well house. Our shared decision making process, how does it occur? And when a patient sees you that's different than when a patient sees an average internist, let's say, and it's different. When a patient doesn't see any doctor. So, you know, the idea that there's the bus that rolls up that just does your bloodwork and send it back in the mail. That's terrible. I mean, I did that when I was a resin they pay me fifty bucks. Go man the bus and do that. That's not really doing that patient, those individual men any, you know, any they're not helping those people because you don't know their whole health history. You know, and all that. So I experienced that. And you know, I got into it with Otis Brawley about screening, and you know, he raised that point in. It's valid. I did that when I was rather than because I was told to do it. And it wasn't that. That's a mistake just bringing up the bus and doing blood tests in the WalMart parking lot. That's not a good answer. Having a discussion with the vision is their internist is a good answer because I have many patients where the bus parameters, by the way, eight men between eight any guy who showed up literally any duty shows gonna free PS. Yeah. You know? And then they'd send it how did I not know you were doing that? I did it once or twice, you know. And I was a lab year. Resident they'd say go ahead. And, you know, do you want to earn fifty bucks? And I drove to some civil war town in northern Virginia. A cool town. You know, did it you know, on a Saturday for half day. And I did you know, and it was. Like, you inside you say, okay, I get it was worth doing. Because now I understand how bad that wasn't. What a mistake that was now, Conversely, I have pay a lot of patients that role in their super healthy sixty eight year old guys with TSA's of twenty and have a bad rectal exam, and they had a PSA when they are sixty and it was three, and you know, and they'd come in. And I had a couple experiences where you know, the spouse is just hysterical because she's like, you know, how could this guy the her husband's internist just stop the test and not discuss it with us and to be clear where is the screening recommendation on rectal exam. Well, it's variable. I mean, I think rectal exam adds value many of the kind of intern. It's society's say that you don't necessarily need to do it. I do think it requires experience. But I think it's part of the physical exam. So you should do it. If you do it enough, you'll get an idea for what's really bad. And what's not, you know? And so I I have a lot of really good internists that still do. It. They do a great job. And so I think it's regional and it's also varies by the country. I I could probably use a tutorial on it. But I I do it a lot. And I realized that it's can you insert like a zipper noise. I'll show you how to do it. I want the technique, but I can see that. If it's something you're just not doing frequently. If it's something you would only do on someone who shows up with a high PSA, you're not getting the wraps. Gotta sorta know what normal feels like. Twenty year old. Let's art. Yeah. You know, when you listen, you don't need a twenty year old process. And but you listen to the heart of everybody, and that's how you detect pathologic prom. You got all of those you did trauma. You got to see a lot of normal prostate. So I think that the guidelines have come to a medium. Now, the pendulum was both ways. I think that prostate biopsies are these days a relatively safe procedure? They're not overly traumatic for men. There are some that have complications. I think that that's a little bit overly dramatized by people who are anti screeners. The other thing that urologists are doing today is now doing transparent, Neil biopsies. So they're not trans rectal anymore. So so if a patient's listening to this, and they need to go and get a prostate biopsy. One of the things I always tell patients is you should always, you know, it's one thing to know what the average complication rates are this risk of infection this risk of leading. It's also important to ask your practitioner their personal risks because medicine is not homogeneous. Quite heterogeneous. So what would we say nationally would be the risk of infection or bleeding from a prostate biopsy? Well, I tell people most men have some degree of bleeding after the biopsy when you when you have a Bob movement. There may be a little bit of blood. Let's say bleeding that rookie Eire's. Right. So they're showing the if you talk if you talk to if you go on blogs about non anti screeners, they'll say, oh, you know, eighty percent of men have bleeding in the rectum and hunter percent at blood or urine. Yeah. Sure. May there may be a little bit of pink Nisa redness or do microscopic exam on the year, and there's blood that's ridiculous. Of course, you can have it. But is it requiring admission to the hospital? We wrote a paper on that looking in the Medicare population the numbers, it's hard because you look at these big data sets to no granularity. They say about seven percent of individuals will be admitted to the hospital or seen at the ER within thirty days of a biopsy that number seems high to me, I tell people at our institution we monitor by ups infections. It's point four percent drought. So somebody shows up at northwestern. Knowing that seven out of a hundred guys are going to be back in the hospital month, and you can say actually, it's in our hands. Yeah. Our series. It's Ford thousand if you better with an infection. I would say that you know, it's probably about one one the two percent show up at the ER something for an evaluation. They may be have because you can have some problems urinating 'cause your prospect can get a little bit swollen. So overall, it's it's low at you, tell them the result and the as you looted to before in my practice. You know, I don't by everybody. I by people who I think have clinically significant prostate cancer. So I start with the P H I test. We have it within our system here. And so I use the forget that there's any reason to to switch from one to the other you pretty agnostic. No, the Hans Lillian Andrew Vickers show that they perform identically in the same serum. What patients so the four K was developed on a cohort of what sounds like pretty homogeneous patients. Right. What was the H? I developed on what was their cohort similar? I mean, most of these tests are done. In developed in Caucasian men. I wanna ask you do. We run a riskier. If I have an African American patient, and I might can I be misled by his four K, should I be well, that's a good question and the opco team just published a paper based on validation cohort of VA patients where there is fifty percent African American and it performed as well or slightly better. One of my partners. Here has a prospective trial. I'm it's him and myself looking at PHI African American men and the early Tako messages, it looks like it performs as well or better. So so this gift with me you don't normally get this in biology. This is exactly the kind of tests that can go awry because you can get fooled by differences in leaving example. Right. You look at non alcoholic fatty liver disease. Nafil d I mean, if you wanna study that disease in Hispanics, and then try to make even a the mildest inference about what's going on African Americans your host. I mean, they're they're they're not even the same disease. In fact, even diabetes is quite different across races to think that something is ubiquitous. Has prostate cancer. Even though it might be a different disease because I know that African Americans were gonna talk about this. I'm sure have different versions. But even from a screening standpoint that they could be you'd have one tool that is so good in both yet. There is fortuitous. Yeah, they're good tools. And then so after if there's an abnormality in the P H I R four K score. Then I moved to an MRI. And then there's been good day. Can you just because I mean, we talk we geek out on this stuff because I'm super nerdy about what type of MRI to do for what thing, but for a patient listening to this Ted who's going to go to their doctor, and whose doctor is hopefully cooperative enough. What do you recommend because not all Emmys doing the trick here? Yeah. I mean on paper what you want a multi parametric prostate MRI, the most important phase the most important parameter in the multi parametric MRI is actually the diffusion weighted imaging which is the most operators dependent. So it really requires a skilled technician and escape. Killed interpreter. Radiologist to look at those DWI images, that's the most important one. So we do get patients contrast. But people showing you can get a lot of value out of just non contrast DWI based the one we use. No contrast, but it's their DWI's exceptional. I've sent you the images I think if they're Schaefer approved I'm happy. They're very good. Yeah. T one t two DWI an multiplayer MR is if you're listening to that. And if you and if your doctor refuses that I think those are the kinds of things that make me think you need another doctor because at this point and look your insurance might not cover. You may have to foot the Bill for that. And that's that's horrible. Well, wouldn't cover that? That was true. But there's recently reported a large multinational prospective clinical trial, looking at the utility of Mariah used for screening for prostate cancer. And the study was half the men got an MRI of their suspicious lesion. They got that lesion biopsy. And they increase detection of high grade cancer reduce it over. Detection of low grade prostate cancer. So it was a quote, unquote, positive study. We haven't had problems in the mid west Illinois getting 'em is approved. But that randomized trial based out of reported out of the UK that really has changed a lot about what companies are approving for Moore is for screening so rate to here. So so if somebody has an MRI if there's an Adra malady on the MRI, I'll recommend a biopsy. Now, there's a lot of data that says you shouldn't just sample the suspicious lesion that you should do the suspicious lesion plus doing a Sexton. Bob Sierra, kind of what I tell patients is right left top middle bottom that adds value. Not just in the detection of cancer. But if someone is gonna move to surgery, for example, and I don't do a biopsy in ninety year old guy. Even if they have an abnormal Marai, do it. If I think that person's gonna live a long long enough to benefit from treatment in those scenarios. I do those systematic by because I want to know exactly where the extent of the cancer and one of the problems of them arise it it doesn't. Actually, see the true boundaries are true. Borders of the tumors within the prostate, very well. So they're often especially the DWI because it's not really an anatomic. Yes. The way a t one way to images traffic. So if you take if you take the lesion on T to for example, it often under sizes the tumor by between five and ten millimeters. So pretty significant for prostate, which is generally pretty small. So so I do those to get a better roadmap. Put it all together. Now, talk to the patient what the treatment should be. So my album is if you have an MRI done, and you have an abnormality you need a biopsy if you have an MRI done, and it's negative no lesion, but you're wissies your quiz for the day. Peter, but what is high your PSA densities high? So you have nothing suspicious on 'em are, but high identity you need a biopsy and sorry in that situation. Ted do you further stratified by four K? Well, I have done the four K R P H I up. Front which was high enough? So you're already talking about a subset of patients who have a high, and I think something's going on because twenty percents. So then you're gonna use the twenty time. Moore is false negative jot it so the now you're using the prostate density, and we you and I actually shared an Email exchange over this about six months. He has density is so easy. And it is so good. So high PSA density, usually, I would say more than point one five depends sometimes point one depends on the age of the patient their scenario, they need a biopsy anyway, and you know, twenty percent time MRI's are negative. But if they have an MRI no lesion hype. Yes. A and a lo PSA density. They don't eat a biopsy. So we published our series on that. It's not a, you know, it's not a randomized trial. But what we showed was that we looked and compared the doctors at use that algorithm. And those did not you reduce biopsies by about one third you reduce detection of low grade cancer by about one third, and you actually don't compromise the detection of high-grade disease. So again, you have. Tools building off of this very simple PSA blood test to I think offer people very sophisticated screening for their prostate cancer. We've talked about that a bunch. Yeah. So let's talk a little bit about the biopsy because every patient here who's had a biopsy or know somebody was at a biopsy there. There's this word Gleason. Yes. What's your Leeson? Yeah. Could be like a t shirt. So Donald need to do a fundraiser here that could be the urology fundraiser north lot of things put on t shirts. Yeah. I mean, let's take a step back. So as you know, one of my best friends from medical school, my roommate for medical school. Matt McCormick is now a an excellent urologist up in Reno, and I just met I've couple of weeks ago, and we were kind of just we have a patient in common by total luck. So the patient came to see me and he lives in Reno. And I said so funny, my roommate for med schools up in Reno and names, Matt McCormick. And he's like, Dr McCormick is my doctor. I couldn't believe it will how what has small world. But I remember medical school. Like one of the things that drew Matt to urology because we all saw it. Matt was going to be an orthopedic surgeon. There was just like the most amazing athlete in the history civilization. This guy's going to be an orthopedic because that's what you expect your athletes to do. But then when we all started are doing our rotations. He sort of fell in love with urology. And I think a big part of it had to do with two three two things. One was it's a field where you can't take yourself that seriously. Like in the end. It's it's a funny funny field like it's there's there's just a lot of dick jokes. No way around it. And if you find that if you don't think that's funny, like you're not gonna wanna be in that you gotta make it funny. And the second thing was the patients are so grateful, and again, I think if you're a medical student in you're listening to this. You've gotta be able to think about what kind of patients you want to interact with that has a lot to do with your chosen profession. I remember there were people in my class who loved being around older patients, and they wanted to go into cardiology for that reason because they're like, look my bread and butter the patient. I mostly gonna see is going to be like, my grandmother and my grandfather. And that's that's why I came to medical school. That's what I love. And that's what I wanna do. And there's just something about that urology patient as again urology abroad field because there's male urology, female, urology cancer, non cancer. But but for the most part as you said, you get to fix things in people that are causing them real trouble. And again, I'm not minimizing the stuff that I was in. Trysted in which is like pancreatic cancer. But when you take a person's pancreatic cancer out, they don't necessarily feel any better. That's true. They usually feel worse because it's a big huge operation and Celikkol. Can. I mean, I think that there's a lot of urology that. I mean, look the patients that we take the people in urology are great, you know, and so going to work every day says the blast. I mean, everybody's smart. Everybody's fun. They don't take themselves too. Seriously, that helps the patients are wonderful people. They're incredibly grateful, and then urologist, also, you know, we own the diagnosis. So a lot of other surgical specialties. Let's say colorectal surgeon example, very fuel the diagnoses come from the clinical surgeon, and therefore if you own the diagnoses, you own the pre-treatment, the the predigested work, you do the intervention and you follow the patient afterward. And so one of the nice things in urology is that you have this great longitudinal care with patients. And so many of my patients followed me from ball. Damore, and you know, my nurse her Marie who's fabulous. She she hates me. Because you know, I'll I'll have like a fifteen minute return double book, but it's one of my old Hopkins patients, you know, I'm in the room for two hours. And she's like what were you doing in there? I'm like our talking about our kids, the Goto, the whatever, you know. And so that part of it really makes it super fun out about the goat. Yeah. I love to go. It's yeah. So in trying to get goats goats are trying I'm not winning what they don't. They're not allowed in your town. No. I just I can't convince the family to get the go. Oh my God. You gotta go to pygmy goat cutest thing ever. They're so cute. They stink. But they're super cute, and they're incredibly smart, and they're very social. So they do not like you can't just get one vote. They really they actually they they do terribly if they're just by themselves. So anyway, so, you know, that's the fun part about your allergies. You get you get these patients. So they all have a may every I mean, I I love just talking to my patients. Dr Welsh he had a way to to do a history and one the second thing he asked what they did for living. And it wasn't the kind of a checkbook check. It was just to say how you're gonna talk to this person. And for me. It's I like to ask the max, I love just learn about what they do. They're so many cool jobs out there. You know? So, you know, sound engineer for a big theater in Chicago this or that it's just awesome super cool yet you've had quite an Austrian career. That's not even close to being over. Which is also includes I know, I know you don't think much about this. And I think it's more of a nuisance than anything else. But you've also now basically become the urologist to anyone in power that seems to need just as Pat was basically when we were at Hopkins every VIP on the planet came to Hopkins, and I can't even as a general surgery resident rotating three Raji, I can't believe the people that walked through that hospital, which was also true in pancreatic surgery in, you know, all sorts of other surgeries. But and so of all of the sort of people, I don't I again, I I don't wanna use names because I don't know how many of them have ever publicly talked about at the. One who I know his public talked about it as Ben Stiller because of course, you and Ben went on Howard Stern together. So how did you even get introduced to Ben Stiller? And I know Ben was very private about this couple of years. You guys went if my remembering correctly, it was probably a year or two after his surgery that you guys even went on the show together. Right. Yeah. Was two years or so after that in and I met him through his internist this great really one of the best internist I've ever interact with Bernie Krueger, you telling me like, I don't know who he is. I am saying the audience Bernie's great for the listener head introduced me to Bernie four or five years ago when I was starting to practice in New York, and he said Bernie's the best internist I've ever had a referral from probably because he trained as a medical oncologist. But he said, he's really freaking smart, and he knows his stuff. And if you're going to be in New York, you've got to meet him. So you introduced us. I went to meet Bernie, we hit it off like in seconds. Yep. And he just said why don't you just come in my office? And so to this day, I still sit next to Bernie, Bernie's great. So. Bernie was taking care of Bandon. Bernie was a guy who did all the right stuff. He did. He did the blood work, and it was abnormal for him and his his age and got up in New York. And then he came and met he met with Dr walls because Dr walls wrote this has mazing book, Dr walls guide to surviving prostate cancer, and Ben had gotten it. And so he came down to meet with Walsh, but Walsh wasn't operating anymore at that time. And so we I'm that's how I met him was through Bernie and through Walsh. I have a copy of the book for you, by the way, because I convinced Dr wells to do a final edition of it just came out in may. It's really really good. So all the listeners out there. It's a great resource. So that's how we met and then he had interviewed with the bunch of folks. And he decided to have surged with me, which was I was honored to be able to do. And then he did great. And so we he's been an amazing person for the field because he's not afraid to talk about his journey and what he did. And he really he's an amazing person. He's just a down to earth. Good guy. So. For me. I've you each of my patients as VIP's, you know, I really honestly my heart-to-heart do. And so yes, I'd take care of people who are, you know, important in many, different professions and walks of life. And so it's fun to help all of them. And it's fun to go on Howard Stern with Ben Stiller. That was a great experience. So by the way, you know, it sort of occurs to me when you say this that you were still relatively junior as urologist you'd probably only been out of your training for six seven years when you operated on Ben did that ruffle any feathers at Hopkins that that you became the heir-apparent. I I mean people tell me did, you know, I never really thought about age in that way. You know, I have always pushed myself to to be the best surgeon. I can be and always tried to measure up to Pat Walsh for one of my other mentors assist guy. Balch carter. These guys were the brilliant surgeons at Hopkins. And so I to me it didn't matter that they do. Doing it for twenty years and I had done for one year. I wanted to be as good as they were just like, you know, you the same way. And so that's how I always viewed it, right? And so and it was just the environment. I surround myself with. So for me when Walsh said, you know, listen, I want you to become my partner and Benchley want you to take over my practice when I started quote unquote, as his partner he was still top of his game. And was the was the man I benefited from that because he was so busy. I, you know, he would refer me cases. And at the very end of minot our relationship or time at Hopkins, you know, he was an operating more. And so I if he had patients needed surgery, do it and everybody I think on the outside thought that this is this easy thing. It was a gig. But listen when a guy you operate on not only reports to you how he's doing. But how to Walsh how he's doing? Then that's serious. You got to be on your game yet. It's like an eternal fellowship never left. Right. So, you know, he would call me and say, you know, selling so says incisions crook. And I'm like, oh my God. You know? So like, you know, you couldn't get anything. And so it makes you better, right? Definitely makes you better. So let's go back to the t shirt raffle thing, and what's your Gleason? So what does this Gleason score? So Donald Gleason is a pathologist. He was a pathologist in many people, including the folks at Hopkins were coming up with the way to grade prostate cancer. So we grade cancers, and that's a way to measure how they are. And usually cancers are kind of high-grade low grade or a one two three kind of system and Gleason came up with a way to grade prostate cancer based on the appearance of the gland. So if you go back to our knowledge or discussion of the sewer system, effectively, you know, there are these channels that the prosthetic fluid comes down and out of and these channels will grow abnormally in in a cancerous state and so- Gleason was describing how these channels appeared under the microscope now one of the interesting things about it was. Unlike a lot of other cancers where they would describe the rate of cancer based on a high power view, like a very, very close view, Gleason graded his prostate cancers and a lower power view. So he got a better sense of the Roman architecture. It's an architectural thing. So it's the tree not the leaves. Whereas a lot of grades are the what is the leaf look what's the edge of the leaf Lindley. So so he did it. And so the way he did it was he said, well, what's the most common looking abnormality? What's the most prevalent abnormality on the view on the of tumor, and then what's the second most common kind of glandular architecture. And so the Gleason some is those two things the most prevalent and in the next most prevalent and that went from and so it was a one to five scale. So the lowest Gleason score originally lease other ten combination. Yeah. The lowest Gleason some would be to the highest Gleason some would be attend. That was how it started out. But then over time so meaning one plus one. Or five months five. That's right. So overtime at evolved in the lowest Gleason, some would be a six three plus three was kind of typical read. Meaning because if you're already at the point where you're doing a biopsy, you're not gonna see ones you're shouldn't be seeing ones and twos. If you're doing a biopsy is at the thinking, I think that there were some general organizational 's architectural features that everybody just agree were low grade, not aggressive, and yes, you could occasionally, you know, occasionally, even how concede see on final pathology report Gleason with some pattern to in it. And they would try to explain to me the subtleties of the difference patter to an apparent three. I think most pathologists called a they would just call it a three. So that's where it was for a long time. But there are some subtle differences in the Gleason, some that actually have real big differences for what the patient's outcomes would be. And so in two thousand fifteen late two thousand fourteen the international society for your logic pathology. Just so we're talking about dork central here. I mean, you know, real, you know, real super geeks bread. Really good the holidays. They are kind of. Yeah. They got together along with rocks, radiation, oncologist, medical oncologist urologist. We need a better way to to transmit this information to patients and to internist in a way, they can understand. So now, there's a great group and the great group goes between one and five the original kind of old school Gleason some of six that's a one a Gleason three plus four equals seven is a to a four plus three seven is a three a four. Plus four equals eight is of four four plus five equals nine or five. Five is a five. So this step wise Gration into five bins of aggressiveness called the grey group, actually, translates very nicely into step wise clinical outcomes glaucous. So that's the new kind of way that we talk about a talk about my. She's just a great group. So you're a group one two three four five. So do you do any other testing do use like type or any of these other genetic testing algorithms to further strata fi or to those only become things that are done post surgery to determine Edwin care? So I think that they can. Yes, a good question. So I generally speaking don't because I think I know what the patient what they need. So what only my that? Well, you taught me when we are in terms, you know, don't order a test. Don't do a test unless you know, what you're what you're going to how it will yet. So funny. I was just having discussion with a patient yesterday. Yep. Don't order a test. If it will not alter your management, right? So I don't do a prostate biopsy in ninety five year old guy. Who's got an L that I don't do it. You know? So, you know, I don't urology concept to the coronary. I see you, you know. So I don't do the test unless it's gonna change by recommend for the patient so prostate biopsy, I'll do it. I think I change something. So I don't do the Tesla's that chain something I recommend. And for me. It's there's not many cases where it will change what I recommend. So meaning what do I mean by that? Well, again, we don't actively treat all prostate cancer today. People who have great group one prostate cancer. Generally, we recommend active surveillance monitoring the tumor to see if becomes more aggressive versus and to be clear. These are patients who these are the quote unquote, Gleason three plus threes. That's right. And were saying we're going to actively monitor you and would your once you have the pathology in your hand that that grew that Greg report the googlies Gloria is anything before that matter anymore. In other words, does it matter in your thinking that this guy had actually four K of seven point five percent versus twenty percent. Yeah. Does matter and Murari results matter to this is the ultimate basin experience. Yeah. You know, that's why the genomic test. It's funny if you measure new compare genomic test, and there's a bunch of amount their head to head with PSA density, PSA density, performs pretty much identified. Well, right. It's pretty amazing. And do you get the grams? I mean, the MRI does tell right there until you get that. Can you get that alter sound catch and has a Namara we measure the ultra at the time of the biopsy will measure, but the you know, generally speaking, we get it off the mariah's what I use. So a Gleason six I generally recommend surveillance unless they're super high volume six, and I know in my brain that and that's independent of age. So a forty year old. I mean, we have a mutual patient who was a Gleason seven, I believe at the very young age like forty five correct? Yep. Did his age being forty five versus sixty five change the way you managed him. Well, so he came in with a single core. Seven really wanted to do surveillance, and that would be one opportunity to say. Let's do a genomic test on this on this individual. And let's see how Gress of a tumor looks under the no under the true microscope, the molecular profile the tumor, and so we talked about doing that and his biopsy. The molecular test was favorable. But you don't forget about those patients. You actually, follow them active surveillance. So we re biopsy them, you know, after repeat MRI, and he had a lot more. As m r I was actually pretty favorable. This was an MRI invisible. Even and he had multi-core seven. So we then we took him the surgery that very well. Yeah. I I always think of his case just one of those examples of I don't know what the term is. Because I don't wanna use the term precision medicine because that's become so stupid and meaningless. And I don't even wanna use the term multidisciplinary because it really wasn't multi-disciplinary was mostly Schaefer disciplinary. But it it. It's just the nuance of the fields. Just that's that's the medicine. That's that's the that's the hard part. That's the part that you don't necessarily. Figure out in residency so easy. I think to go through residency learning the technical stuff learning the surgical judgment. You know, what do you do if this person's got a post operative bleed versus in infection? Who do you sit on who do you take back to the those are very important skills? But this is like kind of next layer judgment stuff that I mean aside from talking with your colleagues and surrounding yourself by people who are you try to surround yourself by people smarter than you. How do you continue that evolution of learning? We have a what I call adult only journal club every fried every other Friday morning. So it's all the oncologist, and our group Maddox rat on urologists, your logic oncologist, and I call it a dull only because it's not really for the residents. It's during their teaching conference, and we just pull articles that come up every day. So I- every Friday morning. I get a feed from the H about new prostate cancer articles any article of prostate cancer in it. I get that link. It's about one hundred eighty two two hundred papers week. I. Review that list and any looks good. I pull it and I'll look at the abstract era, pull the paper. And so I send those to the group and on Friday two days from now will go over my prostate articles, plus my partners bladder cancer articles or kidney cancer, because I I don't read those. So I have them tell me what's important in those fields. So that's how I it's really fun. Because it's just like, you know, what we been school again it's being in school. It's decide of continuous learning. So that's how I think about and try to keep on top of at meetings are okay. But you know, I think that people get bogged down in just the politics of a meeting so thing reading reading what I try to do most of slits pivot to another topic that's germane to prostate cancer, which is kind of a two topic that goes hand in hand the first the role of testosterone the second of the role of dihydrotestosterone. So we can explore this in any order, but I wanna definitely touch on the notion that is there a real or perceived effect of patients who are on five zero dictates inhibitors. So for the list. Males make a hormone testosterone just thrown is converted via an enzyme called five after reduc days into a very similar molecule called dihydrotestosterone abbreviated DAT. Dat is actually any slightly more potent steroid and in men who fifty times more potent. Yeah. So the in men who are susceptible to baldness DHT, drives that process D H T also probably plays a role in the enlargement of the prostate is correct. Most of the five for duck days enzymes in the prostate. So yes, reducing Anderson's in the prostate by reducing effectively. Reducing DHT production reduces the size of the prostate. So a lot of guys take medication to reduce DHT either to reduce prostate volume size of something called benign prostatic, hypertrophy or to re minimize hair loss, and it's usually the exact same drug given it slightly different doses. And sometimes even come up with different names for the same drug. So proc-. Car is financed. Rated five milligrams. And I think pro-peace says the one milligram nets. Right. Okay. Now, I remember many years ago, and I don't I'm sure this has been revised one hundred times, but maybe ten years ago, maybe less, but a paper came out that said look in guys who have suppressed DAT levels when they get prostate cancer. They're more high-grade is at my remembering that correctly. And there's been definitely case reports of that. It's hard to really study that over I gotta yeah. So what is the current thinking on five algebra dictation habituation, and that relationship to prostate cancer? Well, there's was a very large randomized trial to see if you could take that medication with the idea that if you reduced the relative amount of Andhra Jensen the prostate by preventing the production of his potent androgen DAT. Could you reduce the risk of prostate cancer in those men and the answer was if you took that medicine that reduced potent Anderson? Hugh could. So there was a oatmeal study. This was in men starting out who did not have cancer. That's right. So it was called the prostate cancer prevention trial, and it was over seven years at the trial is conducted in Thompson was the PI on the trials of big study. It did reduce the chance at a man would develop prostate cancer overall, you know, reasonable amount of time. But one of the problems was that there was increased detection of more aggressive cancers in the men who are taking the finance. Right. And so then the question was, well, what is that? From is it inducing, a more high grade cancer, you know, and whether or not that's true or not as or is it selecting for it because any cancer that comes out of a low DHT environment. Well, yes. So I personally think that what you were just saying as is true. So yes, and there's case reports that people with low testosterone, or for example, people with low PSA's because PSA is only made when there's testosterone around, for example. That those individuals have more aggressive cancers. Now, this is what I've been focusing on in my lab for like the last four or five years now. And so one of the cool things we did in this collaboration with this company genome DX in this great, scientists alight of an she Oni was to look at the biology of prostate cancer, how grass if they were and compare the gresh Innis of the prostate cancer with the Anderson output of the tumor another nuanced way to normalize things a bit. Yep. And so we had this ipod uscis that the tumors that had the most amped up Anderson, signaling the most Anders output because prostate cancers and ginger tumor that they would be the most aggressive, and I say that way 'cause you know, the answer stieg's act posit the tumors with the lowest Anderton output or the are the most aggressive tumors. So it's somewhat relates to PSA, but not entire. Fairly like there's not a is on a true, you know, linear correlation. So the high Anders output tumors. They can be aggressive, but they are not as aggressive as Alterra low once's by modal distribution. And this is a good way to segue. Talking about these molecular tests because this is a commercially available test from genome DX might tell a funny story about ally. Before we go down there. Sure, I've told this story before but now we get to put a name to it. So I hope he doesn't like like I said, I'm telling it was it was allies the guy who called me one day when I was in the airport, and he's like here. My wife just got me this book. It's it's it's a great book. And you're in it. And I was like what I had no idea what he was talking about. And he goes you had called biggest tools. I was like, wait. Do you mean tools of titans? They'll say, that's it. That's great. I know I've stories, but so to this day like anytime talking with Tim Ferriss, like I'm like, I expect to be referred to as the biggest tool that is really he called me too. And he's like, dude, I'm reading this book. But he didn't call biggest tool. That's awesome. That's really funny so allies start of this company. That was Juno, Geno, Mickley transcript I'll make lease so looking at the Arne levels within prostate cancers. And so he has a commercial product. That's very very good to just tell you the aggressiveness. It's basically genetically score. It's more sophisticated that, but that's what it helps you to do. But when he when he looks at each tumor. He captures about one point four million data points on each tumor. He uses twenty twenty one of them for his test. But we use the other one point three nine nine nine million of those of those data points. And so we developed this algorithm. Look at this. The thing that's pretty cool as we've been able to model and show with allies grew. That you know, because it's one thing to have a kind of prognostic biomarker like your prognosis is good or bad. But. Precision medicine is really the can of the predictive stuff. So we've been able to take all this data. We've been able to show that these low. Anders output tumors are the most aggressive tumors now. Hi, Andrew output, very high air output tumors are also passive, but as you would imagine the tumors are sensitive to different drugs, so high air output tumor, they're exquisitely sensitive to energy deprivation, which is one of the mainstays of treatment for metastatic prostate cancer low. Anderton output tumors are not right. They're not dependent on it. They don't use it as their fuel for growth, and we've been able to model other compounds that they are sensitive to and so were moving those things into clinical trials is sexually pretty exciting times. So what is the current state of the art or the current thinking on testosterone replacement therapy? And again, I'm referring to this in the in the confines of what we'd call physiologic testosterone placement. So you've got a guy who's walking around with a free testosterone at seven. Grams per deciliter on a lab where the upper range would be twenty five and you know, he's replaced two twenty my reading of the literature says I'd have a very hard time. Making the case, it's that's increasing risk of prostate. Can't with that. And I think my data suggests that the tumors that we don't know how they develop but the tumor where we segue like five times. But the ideas that our data shows that the most aggressive tumors are the ones that have low androgen output does that mean that they developed in a low energy state? Maybe we don't know that. I don't know. But, but for sure it's telling me that I don't like you said, I mean, the literature that we've discussed on the phone many times. I don't see any clear evidence said physiologic replacement of testosterone is gun to accelerate or cause a cancer to develop. What do you think the role is of Estra dial in this some have argued that as Estra dial is going up that may be playing a greater role in prostate cancer either through its? Direct interaction or indirectly through its receptors. I think I don't know the answer to that question. But I do know that it's not just a testosterone thing. Remember when we talk about benign, your logic conditions, testosterone values decline over time and over simplified the whole PSA discussion earlier so remember that PSA's rise over time. But at that same time testosterone values are lining. So I do think that a lot of the prosthetic growth not cancerous grow Senator necessarily, but but nine growth are influenced by the ratios of TD, so to speak testosterone estrogens Anderton's estrogens which wanting his it seems to me that you're at your highest risk when your testosterone is going down your estrogen going up. Yeah. Now the question is what's the lag time yet? So at in real time. Yes, that's true. But we know that all cancers prostate cancer for sure. Among them is something that occurs from mutations of the DNA from decades prior probably so yes at the time of diagnoses, there's probably higher Esther dial lower tea, but I think about it like what happened to that in that patient ten years beforehand or fifteen years is there anything about the mighty Qendra in the processed. The prostate has so many odd things about it. And we're gonna talk about the difficulty with immune surveillance in a moment. But is there anything about the the mitochondria within the prostate that are unusually sort of either ramped up or ramp down relative to other epithelial cell derived tissues? That's a great question. And I hope you know, I try to ask request. I say that because we just had last Saturday. We had our kind of prostate cancer working group meeting where all the kind of, you know, deep thinkers get together got together on a Saturday. Just about to say the fact that she goes through this on a Saturday just another bit of evidence to like the level of obsession here that I love. Yeah. So we I re roped in this brilliant radiation oncologist named David Geiss works on hormonal dependency and breast cancer. And what he focuses on is on the Maya Qendra. And specifically these superoxide dismutase is that really get rid of reactive oxygen species. And so he has a whole model, and he knows about aluminum be breast cancers, and how they can become resistant to Tomasa thin and so forth, and it's driven by basically, the might Conroe and still mitochondria in the prosecutor follow the Warburg effect. Do they become more? Do they do they favor an aerobic metabolism? Over oxidative phosphorylation. I I it's hard people don't we don't know. You know, people don't know a lot about the metabolic environment of the prostate. I've had a lot of thoughts about where what about the? I mean, it's it's a very dense, Oregon. There's not a lot of blood vessels in. It's on a big blood supply. You know? And so I thought a lot about just for example, are there regional differences in the P H within the prostate and his dad what's causing these because I think about in relationship to these Andrew independent tumors. My my brain is defaulted this idea that will the high A R output tumors are ones that are occurring in oxygen rich parts of the prostate. I mean, I don't know why just assume that you know, and that these lower air output tumors are occurring regions the prostate have lower PA. Oh twos. Different P H is. And they're forced to use alternate growth pathway. It's hard to test that you know, I've thought a lot about it. There's nothing published on it. Really? It's hard tested, but the sky David guys. Has a lot of really interesting data looking at the tune in pathways through might Akon rea- regulating. The homeowner dependency are hormonal regulation of prostate cancer. It's a brand new area for him. So in other words, the tunes, which of course, can either turn on or turn off genes. The idea is in this is certain to or a different, sir. Three sort three. I see. So it could be up regulating or down regulating production. Basically, he has a certain three manganese super oxide dismutase pathway worked out, and it regulates resistance to Tamaki if an aluminum breast cancer, so and he's made these observations, I publish this and sell and I want to say, oh seven or eight on certain three in brass, but he had some data in there and prostate. So I kind of we hang out with the money wanna king out with like a deep thinker. So he has his preliminary data, and he has more interesting data that there may be a role for this. So I do think that there's something. About metabolism in the prostate. I think it's hard to study. You know, it's tough. It's hard to model at an amount at all. Like, you can't do it you cannot model in a mouse by do think that there's some good people on campus who think about it and are going to be able to study. Well, he's he's the guy. You know? I'm seeing Chen del tomorrow, who is a mutual friend. Didn't you go to med school with? I mean, he was in grad school when you were in med school or something he says that he was my TA and undergrad, but I just note, you know, known him. I think we've figured out I've known him in nineteen I met him in ninety three or ninety four. So he's really one of my oldest friends. I have you know, anything should know about now. But well, I know, of course, because we played Patty cakes on Easter Island for awhile. And well, do you know what his nickname? No. That's the thing. There was a nickname. Yeah. What's his nickname? Well, just for the listeners. Knob deep is this. He's about what six foot three suave good-looking. Yes. Good looking guy long hair. So it's nickname was swab deep. I mean, I've ever seen the ta ta class where there was it was like ninety percent women, you know, had questions for him afterward. You know, awesome in med school. Great. And did you also go to school with Matthew Vander head? I did he was a smart kid my med school class. Yeah. Matthys I know Matthew, obviously, not as well as you. But I don't know him that. Well, I just know him and relate broke up in the field of cancer metabolism. Yeah. I'll be I gotta get up to Boston to see Matthew who actually works and collaborates very closely with another very very close friend of mine for medical school may Mark Palmer, who's a medical oncologist, Mark. Yeah. He's great. I love that. All like, all of these independent circles of my life, have overlapped and prostate cancer and cancer in general. Yeah. What is the most exciting area of research that that you think of with respect to prosecutors specifically, maybe I'll even prime the question by saying immunotherapy seems to finally becoming into its own a little bit with some cancers. But of course, the prostates kind of a weird immune protected odd organ like does amino therapy play a role in this. Or are we talking metabolic therapies or read? Resolve gonna. Be coming down to earlier detection of lethal cancers. Certainly early detection cancers is important. I think the most exciting stuff in in your logic on college is really moving beyond these prognostic biomarkers to predictive biomarkers. And so there's a lot of really cool new things that are, you know, great. So there are some predictive biomarkers at you can pick up in the DNA of tumor or the DNA of patient, particularly Braca. One Brock to ATM lost. He's different kinds of DNA damage repair pathways. That people didn't really think matter for prostate. We now know within the last three years, they really matter. So I didn't. That's that's news to me. I I never really understood the BRCA one BRCA two should be looked for in males as well. I mean, I did from breast cancer standpoint. But not from a prostate cancer standpoint. Yeah. So so there's a one of my heroes in in your logic on colleges is this guy Pete Nelson. He's at at the hutch and Seattle, and he published a paper, and they look. At the germ lines of men with metastatic castrate resistance with the most end stage prostate cancer, and what they showed was that. In contrast to the general population of men that mutations in these different DNA repair, pathways or significantly enriched and individuals who had metastatic prostate cancer. So about eleven to twelve percent of men with metastatic, castrate resistant prostate cancer mutations. Particularly Brock to Braca one ATM RAD fifty one these different pathways that are involved in DNA damage repair. If you look in the tumors of men with metastatic, castrate resistant prostate cancer, it depending on where you look over one third of the tumors. The cells will have mutations in these pathways, which makes them incredibly sensitive to park in addition. So that's a huge game changer. The other thing that people now look at his kind of the total genome scorer the alterations in the genome of the individual cancer cells will that make them more sensitive to immunotherapy? Fear. Not that's more coming online. But the idea that there are things in the semantic DNA of the tumor cells, and in the germline of individuals that you can use to screen for not only, you know, prostate of breast pancreas excetera that's a huge game changer. And then as we touched on earlier, those are not just prognostic biomarkers, but their predictive of drug response, which is pretty amazing. And then I think allies test the version two point. Oh, or the beta version of it which has a lot of these built in biomarkers at predict responsive drugs that now are being tested in clinical trials with with the idea that let's test the ability to predict response, it's pretty mazing. Stop actually. So obviously, you specialize in prostate cancer the field of urologists so much bigger than that. Right. We haven't even talked about renal cancer bladder cancer, and to do so would only be to do it an injustice. You know, given that we've been talking for a little while. And I know you've got a hard stop here in about twenty minutes. I wanna talk a little bit about benign stuff. So I'll tell you personal maybe someone embarrassing story. But it sits good illustration of of this. So when you were treat at the extra large peanuts clinic at happens is the Mike the peanut insert or. Yeah, reductions exactly see those are the kind of jokes. We can only tell in the euro. So by two years ago. I remember calling Ted. I don't what's going on man. Every time I p like it's just burning like crazy. I did a quick check. I don't have a UT. I never had a youth. I'd seems unlikely I would have been fumbling around. And I'm wondering I must have prostitites. Right. And I guess my question is Ted. What anti-biotics should I take and our member I was actually in Baltimore at the time. But I was heading up back to New York because I was going, you know, working New York that week where I spend quite a bit of time. And you said well, first of all you're in luck. Because my dad wrote the paper on prostitites, and it's I forget what year it was. But it was in England Journal medicine, and I downloaded the paper. And I I read it on the train ride up to New York or maybe it was still in Baltimore. Because I remember you had any you've written me for some flow Maxwell what the long and short of it was a came away from reading the paper. And I said, well, my takeaway on this as I need a prosthetic massage not an antibiotic and you said, Yep. So go ask Bernie to give your prosthetic. Massage and I had been in pain. And he we had he did that to get a sample from the prostate because when you do a urine urine check for infection. You're sampling predominantly the fluid the urine in the bladder. So I said, yeah, find your urine cultures negative, but let's check your prosthetic fluid fern infection and think it was clear, but it was clear, and here's the amazing part of the story. I had been suffering for a month. And Bernie being the great Bernie like he didn't just give me a little bit of a prosthetic massage. I mean, he eviscerated me I was one of those Chevy Chase moments. I was like using the whole fist there Moseman river. I actually I will say it was one of the most painful things that ever experienced. This was this was a different level of of pain because it wasn't the rectal. It was like the prosthetic massage to generate the various sensitive. Yeah. Yeah. Especially when you're inflamed as I would later come to realize, well, here's the most amazing part of that story within about three days. Everything was. Better. Yeah. I didn't need a single antibiotic, and somehow that massage probably, you know, somehow turned over some of that inflammation, or you know, there's something. Yeah. I mean, we had you on some anti inflammatories. And we had you on some other symptomatic stuff. But yeah, I mean, definitely, you know, so we don't really call it prostate is anymore. We it's kind of binned into kind of this chronic pelvic pain syndrome, kind of concept, but within that concept, you can get acute bacterial prostate Titus. That's what happens for people after prostate biopsies, and they get very very very sick high fevers went oh, three one four like bad stuff. That's an incredibly wear thing. But what you can get basically, non bacterial, prostitites inflammation in the prostate. We that's the thing. I think a lot of people don't understand Itis, means inflammation. That's right. You can get with an infection. But Itis does not imply inflection so process height as mass. Titus these things don't necessarily have lie that there's a bacteria that can be sterile. Right. So people will have, you know, acute inflammation in their in your prostate. Which is what I thought you had on the phone. I said look have Bernie do actual culture of the of the prostate. Then typically for most people that goes away. We don't know what causes it. You know, we don't know what is that's causing inflammation. That's what my father who's very prominent researcher in this field. That's what he works on. But we know we can we try to treat the symptoms and ride it out. And then we, you know, we try to just risks that we prevent kind of from coming back and so forth. So some of the things that can cause it, you know, we talked about this, you know, constipation. So if you one of the ways, it's easing constipated just going to a transcontinental flight cause dry, and you know, just they'll those little subtle changes make a big difference. So so those things come into play now that falls within this greater scope of something called chronic pelvic pain, which is. I know a field that is you know, has some work in it. But it's still evolving. It's really just been recently described. My father was one of the people described that was some other folks. And so, you know, that involves, you know, just burning or pain in the you know, that you re throw in the bladder women used to be called interstitial cystitis women. So some foods will trigger these things. We don't have a good handle on at all. So we try to manage the symptoms. And then from there, we try to just prevent what's the state of the art with using injections within the bladder about talks to alleviate women who have interstitial cystitis discussion about the. Yeah, it's not we do use boats in the bladder for people who have you know, hyper Krant contract till the bladder. But we don't use it for people who have interstitial cystitis for people. There are people that have deep-seated infections in their prostate that we can document or sometimes we can't document, but we have a suspicion of them. And in those individuals you. Can you can actually directly inject antibiotics into the prostate or an in fact, my my feeling is that actually the typical night Nitis for this persistent factions actually the seminal vesicles, which is attached to the prostate. So what you know, we'll have individuals who have recurrent bacterial infections same bacteria same sensitivity to the drugs. So they don't become resistant. They're equally sensitive all along to be a bacteria that you aren't clearing that's outside of the field of scope. That's right. And so in I feel like those are often or you can you can't get the concentration high enough into into that tissue. And so they're those cases will do intro. How is it difficult? You do that transact delay friends regular, but it's you know, it actually works under Alday sound guidance and how easy to hit a seminal vesicles, sue, breezy, even your even you can do it, even I do that's it across the street. I was going to ask you about. That's thanks for bringing that up. I was gonna ask you about injects you need to do come to share with me. When that the awesome. I'll actually been on the robot. Have you know, we gotta do get out, man. How many going back to that for a second? So we didn't really get into the deep surgical technique. But I do wanna linked to any videos that we can. But what percentage of your prostatectomy do now use the robot for verses open hundred percent your hundred percent robot now and MOS one hundred percent robot, obviously, so most men now getting their prostate removed will do it the the robot. I mean, I think that there are very few people out there that actually can comment on which one is better, you know, robot mercy's traditional open, but I've done I don't know fifteen hundred opens and twenty five hundred robots. So I have a good idea for which ones are better. And was the last time he didn't open case three years ago two years ago. Is there a party that sad that like if you went back into an open tomorrow, you wouldn't be as good I wouldn't be as good. But even when I was good robot. It's I I'm better using the robot. It's just incredibly precise. I'm just a super Taipei guy. You know, you get four arms to control island two hands. Right. So you can just retract everything. Exactly. What we want the magnification the optics are just unbelievable. And you would just you just die. It's just like the Davinci. Yeah. It's like we're in twenty x loops you think about you know, you had two point five that used to walk around with. I, hey, hey, hey, I up graded the three point five those are tough. I had from four axis and is harder min the, but it's amazing. Right. Depends on the case. But even but even anything where my loops were every open case I did. But you know, even the difference between two point five and three point five a big difference. So think about ten x I just put a four x magnify on. My Bo so you have a clarifier in that sits in the peop-. And then you have like a magnifying that sits on your scope, and I've been shooting. Probably up to seventy yards and kid. And then I went to a two x and I was like, oh, this is good. And then I went to the four x, and I I just don't know if I could ever go back. That's the thing. I was one of my mentors, surgical mentors Sky Bow Carter, and he always did his cases what you know without loops. And then he's in Pat made him switch. And so we would talk about it. And he said, you know, it's just literally different operation. And so people who do open prostates without loops I what they're doing. 'cause I mean, you know, you just see everything right? You see it all now think about the robot? I mean, I can act out individual little arteries at our one two millimeters has made it difficult to teach residence. It's easier to teach them you gotta come come by tomorrow. Doing a case. It's usually talking to have tomorrow must pose to do that not at seven AM night. Boy doesn't roll out of bed before nine. Take you up on that. Yeah. There's a lot of other stuff. I want to talk about I know we're getting real close. You've got a hard stop in ten minutes. Now, do you know anything about male contraceptives this atomic that? I is there is there male contraceptive on the horizon outside of a Secta me. I mean, the only way to really prevent sperm production is to block testosterone in the testicle. So that's the way to do it. And there's a couple that are coming online. They've been tested in small groups of men. I don't know if they're really ready for prime time. And I don't know of men are ready for that. You know, what about bass activities, they work. What's the reversal right on them? If you need to worry about that. Well, I mean, I have a partner here. Bob Branagan who's you know, he's one of the he's one of the top three guys in the country. And you know. Yeah. If it's the right if it's if the Secta me was done correctly, the first time, you know, by professional so to speak, so not in the parking lot. There's there's a surgeon. I'm not gonna have professional who else is do. Invest sect Amies out there. GB guy who just think about there. Yeah. Okay. Not saying to them if there was a urologist him. Yep. Nickname Khodadad hands of death and destruction. Anyone any Hopkins resident from our era listening to knows exactly who we're talking about. And that's right. So as long as you don't have a Khodadad. Yeah. You can they can be reversed. But the reality is eighty percent ninety percent. The Peyton c is. Yeah. I think it's over ninety percent for a well, a good micro, vascular era guy, who's deciding who sort of waffling on this. It seems to me that donating a bunch of sperm putting sperm into into Bank. Yeah. Having a really good person. Do the vests ectomy is a short fire way to just go ahead. I mean, most of the time, you know, you can have. I mean, you know, the reproductive technology is just ridiculous. So, you know, individuals who have kleinfeld Thor's where they really almost have no no sperm production who are told ten years ago. You can't have a child. Now, you can you. Can do these procedures under the microscope and find individual nests of sperm within the testicles of these men and allow them to have kids which is had no clue sung with Klein filters could do. So. And then of course, you're doing it anyway because you want to be selective for writing. You're getting the right Chromos. Right. So so I I mean, I think there's nothing wrong with us ectomy. It's very effective way to do contraception. I think you know, if you're single and you're dating around I think you should also use protection, not just contraception. So to me, so this'll be are public service announcement not to be confused with the other PSA this'll be. Yes. PSA on on them. Yeah. I think not just for protecting your not having children. But for all the other reasons to do it is there anything else that we can talk about him five minutes. That's not going to get one of us in trouble. Well, there's lots of fun things that we we can talk about like, watches or pens or cars yet you and I have shared. We don't never since isn't going to work cut. It. All right. So on each of those if someone could someone walked in the door today and said, Ted, I'll I'll buy you any watch you want, you know, within a reasonable price frame. Don't just pick the most expensive watch. But like is there watch you'd love to just have sitting on your on your desktop when you walked back into your office, courtesy of some Santa Claus. I notice you're wearing a beautiful hulk today, I do I wear that on my non-clinical days. It's I do like it. I didn't I didn't wear it a lot. I would say I'm look I'm in the mar this always ask you, I'm in the market for an elegant dress watch. I've never I've never that's the thing. I I have to say that, you know, I'm pretty satiated from watching these days. I'm good. But I I don't know. I I wanna elegant dress watch. But I could travel with it, and it would have GMT. That's my challenge to you. Oh for heavens sakes, you had to throw the GMT see if because I want to be able to wear a dress watch to a meeting, and I want to be able to go the meeting change my time zones. You know, I wanna go to the meeting. And now have nobody know what the watches, right? 'cause you know. Yeah, I can get that in a Rolex, whatever. But it's you know, it's sometimes it's nicer does not, and I will take this on as a personal challenge. If you're willing to give up the GMT, I'm really I don't have it. I might never have it. But I'm really obsessed with two Vacheron out. There one is the altri thin and the other is the nineteen twenty one which is a remake of the famous driving watch. Yeah. Those would be, but you know, you're not going to get a second time zone on either those. I just think you know, you travel a lot to right. It's so nice just know where what your times on his at home. And that's why like about that. I like that. That's my newest thing by love that. So I'm looking for a GMT watch. Because that to me is like so important. So so if you could get home to San Diego and find any car in your garage. What would it be? It's a tough question. And I seem you mean a car that will only be driven on the street is not going to be on the track. I'm not taking the tracks. For you for I for San Diego y-. You know, you've definitely got me more and more interested in in Porsche. And I think that the nine eleven turbo, you know. So when I don't let's just say I could if I could get an early jump on at nine nine to nine eleven turbo. That that might be. Yeah. That great vehicles that engineer. Yeah. They're they're really special cars, and they're so drivable. I mean, there are other cars that I know you and I have driven. We we have friends who have beautiful cars that have given us there for eighty eights and four fifty eight and all those things, and they're they're incredible. I mean, I I actually I love the four fifty eight. But you just you're not going to drive that car every day. And there's something else that comes from it, which is is I guess, I just deep down always feel a little self conscious. Pulling driving around in the bright red Ferrari, and I don't think you feel sell. You don't think you don't have that same level being self conscious driving around and certain other cars, but but that said, you know, the four eighty eight is a blast Seattle. I have a long torso. Yeah. I can't. Get the seat. Right. So I'm not looking at the head the head the pillar. Yeah. So, but it's a great. It's a great car. They're great cars out there. But as a daily, you just can't I mean, I you know, that nine eleven turbos are pretty amazing. Yeah. I've never actually driven a McLaren. I don't know if you haven't. But I've heard those are really I I I have a couple of friends that have them, and they always have an open votation to go. Visit them at MacLaren's in other cities. And those look like really special cars, you know, part of that's emotional to have emotional connection to McLaren because of Senna. Yeah. So I don't like the son of though, I don't like the looks of that car. I think things going to be just a beast. I cannot wait into these. But I mean, it just doesn't you know, I like the functionality that they put in our cars, you think that the Senate looks better or worse than the P one. I think that P one looks better. But I haven't seen either them in real life. I seen seven twenty in real life, cool car. Look great aero cars. He won in in person once in New York City of all places that never understood that lot. Yeah. Right. What would what would possess? You wouldn't matter. How much money you have? What would possess you drive? He one in Manhattan. Yeah. It's crazy. Just like it's almo I knew somebody who had had a law had a nine eighteen and a p one and he sold one of the three because he said just wasn't fun to drive around. Let me see if I can guess, I know maybe the LA Ferrari, the P D's P one because it's just too much of a race car. So he said that you, you know, on the set on the track it's just ridiculous. But the he said that he sold it because on the streets just we couldn't even begin to enjoy it while it's so cool, though, actually think all of those hyper-cars like I love watching Chris Harris take those cars around for the listener, certainly the last generation of hyper-cars were those three cars the Royal. Ferrari, the Porsche nine eighteen in the McLaren p one only one of them ever broken minute thirty on Laguna Seca, do you know, which one I would guess the P one? But I don't know. No. It was the nine eighteen went one minute. Twenty nine seconds point eight nine seconds by eleven one hundreds of his second the p the nine eighteen broke a minute thirty goodness sake, the only production car to ever do. So now, my favorite little ended tell you so which so the nine eleven turbo ass is faster than the nineteen at the ring. I know so unbelievable on the leave arrival. But then of course, there are fifty thousand dollar track cars that will go a minute nineteen run that Laguna Seca, which again is the always the great thing for people to understand the difference being trackers streetcars, Ted. This was awesome. I know this was a bit more of a male Centric episode. But I think one guys will get a lot out of this. But also, I think, you know, for women who know a man who's going through this or we'll go through. This. I mean, I think there's a lot here and will be sure in the show notes to link to a ton of the stuff that was discussed would be great villa linked to any videos have on your on your surgeries, if people want to learn more about you. I mean, obviously at northwestern the website will, you know, linked to your bio, your CV and all that Dr Edward Shafer get all the links, but an M R, northwestern, medicine dot dot org. Is a good way to find me DR. Dash Schaefer dot com is another way to find me. Okay. Do anything on social media? Are you? I'm my handles at Edward Shafer. Okay. Cool. Ted. This was awesome. Thank you for making the time. And for your your hospitality with insights. Yeah. Thanks, peter. You can find all of this information more Peter Tia, MD dot com forward slash podcast there. You'll find the show notes readings and links related to this episode can also find my blog at Peter TMD dot com. Maybe the simplest thing to do is to sign up for my subjectively, non lame once a week Email where update you on what I've been up to the most interesting papers, I've read and all things related to long jeopardy. Science performance sleep etcetera. Unsocial you can find the on Twitter Instagram Facebook, all with the ID Peter Attiyah MD, but usually Twitter is the best way to reach me to share your questions and comments now for the obligatory disclaims, this podcast is for general informational purposes. Only does not constitute the practice of medicine nursing or other professional healthcare services, including the giving of medical advice and note, no, doctor patient relationship is for use it as information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice. Diagnoses or treat users should not disregard delay in obtaining, medical advice for any medical condition. They have and should seek the assistance of their healthcare professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of interest very seriously for all of my disclosures companies. I invest in end or advise, please visit Peter Tia MD dot com forward slash about.

prostate cancer Johns Hopkins NIH Hopkins Scientist university of Chicago chairman Steve Rosenberg MVP Ted MD PHD Chicago scientist Ben Stiller Pat Walsh Pam Peter Attiyah Peter Tia Peter Ken
Episode 72 - October 15, 2018 AFP: American Family Physician

AFP: American Family Physician Podcast

24:27 min | 2 years ago

Episode 72 - October 15, 2018 AFP: American Family Physician

"The AFC podcast is supported by the American Academy of family physicians and by ATFP tips the transformation in practice series, featuring easy to use tools and interactive learning to improve patient care and tackle operational challenges. Three. New topics are available including clinical, data registries continuity of care and team documentation. Learn more at AFP dot org slash AFP tips. Welcome to the American family physician podcasts for the October fifteenth twenty eighteen issue. The J addition, I'm Jake. I'm Joe Jenna. I'm Jeffrey just getting I'm Kim. I was just feeling left out. We are residents and faculty mostly residents of the university of Arizona. College of medicine Phoenix family medicine residency today on the podcasts. We're gonna talk about shingles. Vaccine urinary retention the flu shot high blood pressure in children and adults long acting musk Rennick antagonists use in asthma and we'll finish up with the review of prostate cancer screening. The opinions expressed in the podcast our own and do not represent the opinions of the American Academy of family physicians. The editor of American family physician or banner health do not use this podcast for medical advice. Instead sear own family, doctor for medical care. All right. First step. We have a steps looking at shingles. Remember step stands for safety tolerability effectiveness, price and simplicity hit us Kim this steps. Evaluates the shingle expect scene which is the new recombinant zoster vaccine, it is a two dose intramuscular injection for the prevention of the herpes zoster virus also known the shingles in adults fifty years and older please note that this is not indicated for the prevention of primary various L infection. So how safe is it serious adverse events, those that resulted in death hospitalization. Disability or required medical or surgical intervention occurred at a similar rate with the Shing were expecting and assailing placebo. This was about two percent at thirty days after vaccination, the most common reactions were local reactions pain redness swelling, which resolved in one to three days the most common systemic reactions were myalgia 's the Teagan headache about ninety five percent of participants completed the two DOE series. So it was tolerated. Pretty well. L okay, guys. But is it affective the shame expecting prevents shingles? And over ninety six percent of people aged fifty years and above for at least three years. This is compared to the live vaccine, which is over fifty one percent effective for this indication, although the duration of the immunity of the Schumer, expect scene is unknown. It is overall more effective at three years post vaccination than the live back. However, there has been no direct head to head comparison of the Shing wrecks and Sasa vaccines and trials as of yet. So that sounds promising. What's the price the recombinant vaccine is about one hundred seventy five dollars for the complete two dose series compared to two hundred and thirty dollars for the lives. Ostra vaccine. It's important to note, these prices are in top of the cost of administration. So the Shing were expecting may end up costing a little bit more due to additional dose. Finally in terms of simplicity. The Shing Rex requires two doses. Intramuscularly two two six months apart. It can be given to those fifty years or above regardless of history of shingles or immunization with the lie. Vaccines and also may be co administered with the influenza vaccine and the CDC states administration of PC thirteen or p p s v Twenty-three is acceptable provided that different sites of injection are used what's the bottom line here? Well, Joe the bottom line is at the recombinant saucer vaccine, also notice Shing Rix has been shown to have greater efficacy and protection than the existing live vaccine local and systemic adverse reactions may occur. But they're short lived and self limited. Although it requires two doses instead of one it's more than ninety percent affective and has a longer duration of protection. Therefore, it is the preferred shingles prevention vaccine for all adults over age fifty for those who received the live vaccine the recombinant vaccine should be offered within five years to ensure continued protection. All right now, we got a main topic here urinary retention in adults evaluation and initial management and this comes to us from Dr Serlin huddle ball and stuff from the university of Michigan. Okay, guys. Here's a common scenario, you're on call for the hospital service overnight. You get paged by nurse who says that Mr. blank and blank has a Peavey are of two eighty five. Do you want to place a catheter listeners raise your hand if you've struggled with that one before? So urinary tension is the inability to voluntarily pass an adequate amount of urine. Unfortunately, there's no consensus on a cutoff al-yaum to define acute urinary retention. The American urologic association has recommended a value greater than three hundred for chronic retention. But there's no evidence to support us fisa specific Peavy our threshold sounds like there's no magic number to guide us yet. Sadly, we're left approach. Urinary retention the old fashioned way starting with history and physical doctoring professor. Actor Moffitt would be proud. Joe? Thanks jenna. So evaluation should begin with a detailed history, including a thorough review of medication. Physical exam. Includes pal patient of the bladder and abdomen as well. As the pelvic organs in women, a digital rectal exam should be completed in men while complete pelvic exams should be done woman. You also want to complete a neurologic evaluation despite its limitations getting a post. Wade residual is a simple non invasive tests to help guide management when available. All right. Let's talk causes here. The most common sources of retention are obstructive nature in BPH counts for fifty three percent of the cases. So not surprisingly the incidence is much higher in men infectious. Sources of retention include prostitites imbalan- Itis in men UTI's can also trigger retention in both sexes. It can also be a post op issue as well the strongest risk factors here are older age and the presence of lower urinary tract symptoms. Pre-operative alpha blockers have been shown to. Decrease this risk. And then there's medications that can cause retention the most common culprits have anti colon urgent properties such as first generation and a history means or tricyclic antidepressants. Of course, urinary retention can also result from many neurologic conditions. These patients should be managed in conjunction with urology and neurology due to higher risks of morbidity from retained urine, regardless of cause determining whether retention is acute or chronic is the first order of business. Acute retention is a urologic emergency. It comes on suddenly and is typically associated with super pubic pain, bloating, urgency or distress if a valuation suggests acute retention, a catheter should be placed urgent urology referral is recommended for any history of difficult access such as Yuri thrill stricture in these cases patients may need a coup day tip catheter or endoscopic placement. As opposed to a traditional sixteen French catheter after catheter placement. The bladder should be allowed to drink. Continuously for at least three days starting in alpha blocker such as tansy low sin at the time of insertion increases, the likelihood of a successful voiding trial super pubic catheters improve patient comfort and decrease bacteria in those require catheterization for up to fourteen days up note, a Cochran review found the catheters coated in silver alloy. Don't prevent catheter quired UTI's antibiotic impregnated catheters don't produce clinically significant reductions either. In contrast, chronic urinary retention is often ASEM dramatic and should be managed base on its underlying cause for patients with non neurologic chronic urinary retention, the American urological association recommends classifying patients by risk and then by symptoms catheters should be placed in patients with high risk chronic retention defined by associated findings hydrant af- roses stage. Three C, K, D or recurrent culture. Proven UT is patients with symptomatic chronic urinary retention warrant catheter placement or a trial of medication as appropriate such as antibiotics for UTI. These patients will generally report moderate to severe urinary symptoms on the American urological association symptom index ASEM dramatic patients without respecters should be monitored periodically for the development of these features that would place them at higher risk. Hopefully that will help answer the questions about Mr. Blancan blink and his retention. All right. All right now, we have a practice guideline influenza vaccination recommendations for twenty eighteen twenty nineteen updates from the AC I p and guys it's Tober, right? Which means flu shots better. Be the buzz in the office. I got mine me too. Not yet. Last year the flu season was bad. Right. There were over one hundred eighty pediatric deaths in as of this recording. There's already fifty six confirmed cases here in Arizona. Wow. So I know I'm preaching to the choir here, or at least I hope I'm preaching to the choir. But get your flu shot. They man. Did you get your flu shot yet? No, I never get the flu shot. Nixon fatigue as not the way it's been. Show. After the Brig limited on the Sean. The ray. All right. So let's hit on the highlights from the twenty eighteen twenty nineteen recommendations, I remember annual influenza vaccination is recommended for everyone six months or older without a contra indication. And when we say contra indication, it's mainly a history of severe allergic reaction to the specific vaccine or vaccine component. Let's talk about what are not contraindications. So what about eg allergy? Yeah. People with a history of a allergy can receive any age appropriate licensed influence vaccine those with a severe AAC reaction can still get it to they require supervision though, by a healthcare professional to manage any adverse reaction that can happen. The ACP specifically recommends observing these patients in a supine or seated position for fifteen minutes after the vaccination so eight allergy is not a contra indication. Well, my aunt Dorothy got the flu shot last year. And then she got the flu. Joe? Yeah, I'd love to ignore that one. But it is a common concern that I hear right? So we all know, we can reassure patients that you cannot get influence from the flu vaccine it's off, but I had John Bray syndrome. I thought I'm not supposed to get the flu shot. Right. Yeah. So history of GPS within six weeks preceding the flu vaccine is a precaution. Not a country indication. I'm sick, doc. Sorry can't do it. Moderate to severe illness with or without fever is another precaution, though. Not a conscious negation that I'll make sense. Yeah. And vaccination should be offered by the end of October. Although vaccine administered in December or later is still likely beneficial in most influences seasons, I always get confused about dosing kids. Need two doses. When it's their first flu vaccine, right? Yeah. Sort of. So luckily, the recommendation is a little more clear now so children six months to eight years of age required to doses of axion this year, if they've not received two doses of the Tri Vaillant or quadrivalent inactivated influenza vaccine before July twenty eighteen or in the case of someone who has no idea about vaccination history. They would get two doses. But this means to doses total ever. So a seven-year-old gutter first flu shot at age five, but only got one dose and then got one dose again last year at eight six she only needs one dose this year and last, but not least let's talk about the reemergence of the live attenuated influenza vaccine. Right. So in contrast to the past to influence, the seasons that internationally administered live attenuated influence a vaccine is an option this season for appropriately. Selected patients to to forty nine years of age the live attenuated influenza vaccine should not be used in children ages two to four with asthma or a wheezing episode in the past twelve months, it should not be used in pregnant women. You mean compromise persons or close contacts or caregivers for severely immuno-compromised people who require protective environment of note. This is actually where the AFP an ACP recommendations differ. So the ACP says there's no preference between the inactivated and the live attenuated vaccines. However, the af recommends preference for the inactivated formulation. And this is because while the live attenuated formulation was adjusted to include the H one in one strand. There's no population based results to conclude that it's more effective. All right. Any questions Kim? Get your flu shot done. All right. We're moving onto another main topic high blood pressure in children and adolescents from doctors Riley, Hernandez, and 'cause NIA from the university of Michigan again, okay guy. So this is an important topic. As high blood pressure in children in Adelaide essence is becoming much more common yet. And it's a diagnosis. That's commonly missed as a result, the American Academy of pediatrics updated its guidelines just last year for the screening and management of high blood pressure in children in Adelaide essence. All right. So let's review that updated guideline. Okay. It is recommended that children be screened annually beginning at three years of age or at every visit if risk factors are present. So what's the definition of high blood pressuring kids? Well, Joe and children wanted twelve years of age this is based on the normative distribution of blood pressure in healthy children of normal weight. And it is interpreted based on age height anthrax. Elevated blood pressure is defined as blood pressure greater than the ninetieth. Percentile in hypertension is defined as blood. In the ninety fifth percentile or higher. What about for older adolescents over the age of twelve so beginning at age thirteen? Absolute blood pressure values are used hypertension is a blood pressure of one thirty over eighty or greater and for both children and adolescence the diagnosis is further. Categorized into stage one or stage to hypertension, Jake. Do you know why this is becoming more common in children in adolescence? Not really, but we do know that primary. Hypertension is now the most common cause of hypertension. There are several secondary causes of hypertension, including hyperthyroidism drug induced renal disease and obstructive sleep apnea. Several additional causes are outlined in the table and article oftentimes in underlying cause can be identified based on a detailed history and physical exam alone. But it is recommended to perform targeted screening tests evaluate for underlying cause other cardiovascular risk factors and target organ damage once the diagnosis if I pretend has confirmed the mainstay of. Treatment is you guessed it dietary and lifestyle modifications. So make sure you encourage regular physical activity. The goal is thirty to sixty minutes of physical activity three to five days per week dietary recommendations include eating a diet high in fresh, fruits and vegetables, fiber and low fat dairy, but limit sodium intake who should be treated with pharmacologic therapy. That is a good question in general children with symptomatic, hypertension, such as headaches or cognitive changes as well. As those with stage two hypertension without a modifiable risk factor. This also includes those with evidence of left ventricular hypertrophy on echocardiographic or those with chronic kidney disease or diabetes. There's no consensus on the best initial anti hypertensive medication, but ace inhibitors arbs thighs Zaid diabetics and calcium channel blockers are all safe and well tolerated. All right, guys. Now, we've got a poem. This poem looks at the question are long acting muscular, Nick and. Agonise a useful adjunct therapy to inhaled corticosteroids in patients twelve years older with persistent asthma the answer. Yes, the authors examined a total fifteen randomized controlled trials with over seven thousand patients, and they found that adding a long acting Musk's antagonist to inhaled corticosteroids was superior to adding a placebo with a significant reduction of asthma exacerbations requiring systemic steroids with a relative risk of zero point six seven when comparing long acting muscular Nick antagonists to long acting beta agonists as add on therapy to inhaled corticosteroids. There was no significant difference in risk of asthma exacerbations, requiring oral steroids rescue medication or quality of life scores. Also of note, the authors found that triple therapy with a long acting musk Granik antagonised Laba and inhaled corticosteroid was not superior to lava plus inhaled corticosteroids alone. So. These are really interesting findings yet. You know, definitely makes Lama seem like an option for supplies therapy and asthma now, definitely all right? We're going to close out the episode looking at prostate cancer screening, which is a hot and complicated topic. This issue of the AFP actually includes an editorial by Dr Stemmer and doctor Fink as well as the US PS Jeff guideline and putting prevention into practice case study, we're going to attempt to address the question should we perform prostate specific antigen or PSA based screening for prostate cancer. Remember a good screening tools should result in identification of early cancer. And lead to associated decreases in morbidity and mortality prostate cancer is not particularly aggressive, although the lifetime risk of being diagnosed with prostate cancer is about thirteen percent. The lifetime risk of dying from prostate cancer is much lower at just over two percent. Also the median age of death from. Cancer is eighty years elevated PSA levels can be caused by other conditions, like an enlarged prostate or inflammation, think BPH prostitites this leads to a high false positive rate. So it does lack specificity evidence from RC tease show PSA based screening programs in men fifty five to sixty nine years. Prevent three cases of metastatic prostate cancer per one thousand men screened one RC C in particular found a number need to screen of seven hundred eighty one to prevent one man from die of prostate cancer after thirteen years our CT results showed no reduction in all cause mortality from screening. This may be because the majority of cases detected by PSA screening are low risk their considerable harms associated with PSA based prostate cancer screening, mostly due to false, positives and over diagnosis one major trial had fifteen percent of men experienced a false positive over ten years when screened every two to four years. This leads to unnecessary procedures like prostate biopsy and their complications such as pain Amato sperm Mia and infection. It's important to note that the rate of false, positives and biopsy complications are higher in older men over diagnosis is when the diagnosis of prostate cancer is made in men who never would be symptomatic in their lifetime and treatment is pursued without providing benefit about twenty to fifty percent of men diagnosed with prostate cancer through screening, maybe over diagnosed treatment with radical prostatectomy or radiation therapy may cause erectile dysfunction, urinary, incontinence and bowel symptoms such as fecal incontinence. Adequate evidence suggests the harms of screening and diagnostic procedures are at least small and that the harms of over diagnosis and treatment, or at least moderate how does this translate into USPS recommendations while the USPS Tf recommends for men aged fifty five to sixty nine years the decision to undergo PSA. Ace screening for prostate cancer should be an individual one based on the discussion of harms and benefits and incorporating the patients values and preferences. This is a great see recommendation for men age seventy years and above the US PS Tf recommends against PSA screening for prostate cancer. This is a great d- recommendation. But what about screening for those minute higher risk think African American older age or those with positive family history of prostate cancer, African American men are twice as likely as white men to dive prostate cancer of the three main are CT's only one included race specific demographic information and unfortunately, enrolled only four percent of African Americans which was not enough to dress subgroup analysis based on the available evidence the US P S T F is not able to make a separate specific recommendation on PSA bay screening in African American men they do recommend and for me African American men about their increased risk. To allow an informed personal decision to be made regarding screening those with a family history of prostate cancer in a first degree relative are thirty percent more likely to be diagnosed than those without a fairly history. The USB T recommends informing the patient of their increased risk and potential earlier Asia onset to allow a personalized informed decision. Regards to screening, okay, the USPS Tf recommendations are pretty clear to these differ from the AFP recommendations prostate cancer screening falls into a grey area where the US PS Tf and American Academy of family physician guidelines, do not perfectly coincide for deeper analysis referred to the editorial by doctors several more and Fink regarding counseling. Patients about prostate cancer screening, this editorial discuss the recent softening of the US Bs Tf recommendation on PSA based prostate cancer screening in men aged fifty five to sixty nine years from a great d- recommendation to its current grade c recommendation, this is a change from recommending. Against it to concluding it should be an individualized decision. Also knows patient share decision making that seems fair. What does the af piece about that? The AFP does not recommend routine. PSA bay screening for prostate cancer for men aged fifty five to sixty nine years who are considering periodic cancer screening physicians should discuss risks and benefits and engage in shared decision. Making the AFP recommends against screening for prostate cancer in men age seventy years and older. Check out the table to in the article for more details. Hi, this is Jocelyn Boker. I'm an intern at the U of a family medicine residency here in Phoenix. I'm from North Dakota that state in between Minnesota and Montana. Our podcast team is Sean Abe ru Jake Anderson, Steve Brown, Jennifer Buchanan. Sarah, Coles, Kim Koo gate, and Joe Sealdah are sound and technical grew is Tyler Coles are theme song is written and recorded by family physicians. Bill dabs, Ryan Evans and Justin Jenkins this podcast is brought to you by the residents in faculty of the university of Arizona. College of medicine Phoenix family medicine residency. We'll talk to you soon for the next of the American family physician podcast.

prostate cancer urinary retention flu Joe American family physician Elevated blood pressure Kim Koo PSA AFP American Academy of family flu vaccine Shing Cancer Joe Jenna university of Arizona College of medicine Phoenix lower urinary tract symptoms university of Michigan
EPISODE 2 WEB RADIO TODAY

WEB RADIO TODAY

36:07 min | 7 months ago

EPISODE 2 WEB RADIO TODAY

"Hey came back thank you so much everybody. Welcome to episode two of the Web Radio Today. Podcast WE ARE ALL ABOUT FAITH. Fitness Fun and positive attitude most of us in our sixties and seventies some of. Us involved with a serious disease. But with God's help were moving along singing a song although today's episode is dated May Second. I'm actually recording on April seventeenth. I'm here in the Nashville area. And everyone is still stay in safe from cove in nineteen in their homes so it kind of make sense that. I'm I'm recording. Today's web radio today. Podcast from my home studio here in the quaint Little Nashville Tennessee. Burg of Nolansville Tennessee. Since right here on the South East corner of the music city named Skip Roman. I'll be with you for twenty to thirty minutes every Friday hosting the Web radio today. Podcast this episode is part. Two of three episode cluster. Right here at the beginning of the web radio today adventure the purpose of these first three episodes three days in a row here in the first week of May is to fully introduce myself and to introduce you everybody to what the Web Radio. Today podcast is all about. I've designed all three of these first episodes to give you well all the background. You need what it is all about few. Listen to all three of these episodes before you start listening to the the regular weekly episodes of the web radio today. Podcast you'll get a real clear background and idea about what we're all about. I'm trying to keep each episode. No more than twenty to thirty minutes law. So it'll only take you. I don't know around ninety minutes for you to listen to all three of these introductory episodes at your leisure however today's episode. Everybody here I am on the second episode already breaking my Tom Limit. Rule because this episode will include my cancer story which in itself goes for twenty minutes. It will break our thirty minute time. Limit Rule because I think this episode will probably come in a little closer to forty five minutes on this episode. Today I'm GonNa try to very quickly introduce you to the seven elements of the web radio today. Fitness model that models designed to keep you fit get you fit and keep you in good health and prevent disease however the meat of today's podcast about twenty minutes of it is going to be my cancer story because my cancer story became the genesis the beginning of the creation of the web radio today. Podcast that story. It's about my battle with prostate cancer. And how the Web Radio Today podcast planning for that thinking about. It became a positive AL growth of my cancer and this is so important it actually helped me to deal with this cancer and also later on in the podcast today. I'm going to play you a pretty cool song. That'll be later in the show but let's get going run now everybody. It's time for a very brief it many workout and everyone moving around if you're sitting down and you can't get off for some reason. Maybe you're driving a car or something like that. Start moving any and all parts of your body that you safely can if you're doing a workout right now as you listen to the show crank that workout up for the next two minutes. Everybody's moving those heart rates up on web radio today Dan Okay you can back down. Keep moving but much more slowly as as we enter this brief cool down period bringing that heart rate down right now on this episode two of the Web Radio Today. Podcast WANNA take a few minutes to tell you Mark Cancer Story. You know everybody. Though ideal for the Web Radio Today podcast came to me at a at a very scary and pivotal time in my life. The story of what was going on in my life at the time this podcast was created. Should be of interest to help to other folks who may be in similar situations and also as we start this podcast. Web Radio Today podcast. He'll give you a little more background about me where I'm coming from. I'm going start my cancer story. On December twenty four twenty nineteen. It begins on Christmas Eve. In Columbus Ohio was in Columbus to celebrate Christmas with my daughter and her family and my wife's family. What a wonderful evening. Everybody together view. These people only see him once a year but I love them all and we're all thinking what a great year twenty twenty is going to be all of us looking forward to exciting things in the New Year especially because my daughter Diana is going to have another baby in May a new grandchild wonderful. You know everybody thinking about that night looking back on it now. It's funny and I was thinking that you know you really know nothing about the future. No way that you can't predict what's ahead. You really only say. Hey today's pretty good tomorrow's looking okay. But beyond that we know nothing about our future Little did I know on December twenty four th two thousand nineteen. There was a pretty good chance I wouldn't be around on Christmas Eve. Twenty twenty during the last few months of twenty nine thousand nine. I was having some what. I'm going to call old man problems needing to get up too many times at night to use the restroom so I was pretty happy there on Christmas Eve and I was looking forward to January sixteenth twenty twenty hour scheduled to to have an appointment with a urologist and to get this problem which had been annoying me for a few months fixed full disclosure and I think it might be helpful to other guys. Listening out there I hadn't had a digital prostate example or PSA test for several years. I don't know why I don't know why my primary care doctor didn't do those tests. But I knew that that on this January Sixteenth Appointment. I was going to have to have the digital exam. But Hey if it got me fix all. It's funny because in the past. I was actually slashed foolishly. Happy at the end of of every physical exam. I was getting them every six months that I didn't have to go through the digital exam process. I thought it was Yawkey. Well everybody I can summarize my January sixteenth. Twenty Twenty. Visit with my urologist. I can summarize that one sins. It did not go well exclamation point. The urologist was very concerned about the size and knew about the feel of my prostate. And oh I needed to be scheduled for prostate biopsy immediately like the very next week that biopsy the next week was well. It was a pretty simple procedure. Not Painful at all and I was actually kind of proud. When I was told that I had a really big prostate. Then I got the news by phone. Two days later. Stage three prostate cancer gleason score of Eight. That gleason score means that there was already a chance that it was spreading. Or this is worse or it could have already spread to other organs. I was immediately referred to a surgeon and a radiologist and scheduled for scans to to see what the next steps would be. Oh and just a side note. Large prostate bad. Not good options on the table at that time based on whatever. The scan results were surgery. Radiation Difficult Chemo. Maybe a painful death. The scans would give us more information you know. I've been a Christian. My entire life raised in a somewhat fundamentalist church baptized on a beautiful summer. Evening at age. Twelve in a lake near Lakeville Ohio. I accepted Jesus then as as my personal savior even during my time in the air force. I decided that I wanted to go back to school and and studied to be Lutheran Pastor. Well for a number of reasons that didn't happen. Perhaps it's story for another time at the time of this cancer diagnosis. Of course I believe in Jesus and I guess I can describe the way I practice my Christian faith. Just you could describe it as casual less casual sometimes more cash at others. At the time of diagnosis I was a member of a church. Occasionally attended services parade once in a while when I needed something so there. You have it my spiritual diagnosis. Going into twenty twenty as well as mock cancer diagnosis. After getting the results of of the prostate biopsy. This sounds cliche. Hope it isn't but in terms of my spiritual diagnosis. All that changed after that cancer diagnosis. The Bible says God will use the very thing that's meant to destroy you to deliver you that everybody is so true. Of course I started praying several times a day. Don't let this be cancer. Police helped me keep this cancer from spreading. Let the scans be clear. Make it possible for me to have the surgery. Assist me to have a good recovery. As the days and nights went on my prayers became deeper more analytical. They became well a profound examination of how I was living my life. I talked with God about things on needed to change. No matter the end result of this cancer God was going to be more deeply involved with my life. My talks with God well. They helped me to to realize that I needed time to shine my light and and make a positive difference in the lives of my family friends. People that I don't even know. Is this newfound deep faith just a cliche because I happen to need God? Right now are the things. I'm saying just latitudes to get me through this fight for my life. No everybody. This isn't a cliche. These are not platitudes. I'm all in if fail if I back slide if I'm really full of crap if I'm just using God right now telling everybody it's all going to be out there for everyone to see especially with the web radio today. Podcast I thank this cancer though for challenging me to learn change and grow and I'll tell this cancer these things. Thanks for teaching me to. Stop and listen. Thank you for reminding me what is truly important. You can go now my more intense relationship with God my wife my family my newfound positive attitude and my high level at least for my age of a fitness have been and and will continue to to be very important and fighting cancer battle foreshore. Yes this cancer can go now. The surgery so bad. I want this cancer out. No radiation I want. The surgery want this cancer in order to be able to have the surgery. My scans needed to be clear on February thirteenth. Scans were were done at Vanderbilt Medical Center. Prayers have been answered the scans indicated that the cancer had not spread and it appears it appears to be contained within my prostate now to convince the surgeon to allow this seventy three year old man to undergo robotic prostate cancer surgery Terry and I met with the surgeon at Vanderbilt Medical Center in addition to well in addition to being a world-class surgeon. She's a professor at Vanderbilt Medical School. And she's the head of the Residency Program. Vanderbilt hospital needles to say I was very confident in her Tomasz. Surprised and maybe disappointment. She spent the first part of our meeting explaining that radiation was just effective as surgery and then went through a long list of possible negative things that could happen with the surgery especially because of my age stroke death multitude of of really bad other things. I didn't WanNa know this but I found out that seventy-three is is kind of old for this type of surgery. However because of my overall physical fitness my good body mass index felt that that I might have some advantages that maybe other seventy three year olds didn't have but as she pointed out even with my ideal weight and fitness had seventy three year old parts. It was clear if I was going to get this surgery needed to make my case I wanted. I wanted everybody. I wanted the surgery so bad so I told her about my life and my plans and then I finally said to her so hey let's pretend but that I'm your seventy three year old. Father has your father. What would you suggest my treatment should be her? Answer with a smile. Well Dad I think we should do the surgery as you say you are in really good condition for seventy three year old. She said that that am briefly. Observing my personality Mas Zest for life positive attitude. She really felt that the radiation coupled with the hormone treatment which has to be part of that radiation treatment would change me in a way that that might cost profound negative effect on my positive attitude zest for life my desire to stay physically active and then these words lutts schedule the surgery so I went a robotic prostatectomy robotic prostate surgery was performed on me on on March fifth. I was wheeled into the operating room and I got a quick glimpse of that huge spider. Robot believe me. It is so much bigger and scarier than it looks in any picture then a short blink of my eyes and I woke up in the recovery room. Six hours later. Terry's beautiful face smiling down at me with my cancer. Prostate gone now. I have to tell you everybody. I cannot imagine how this recovery would have gone without. Terry's help almost daily twenty four hours a day. There were things that that I had to do for myself. Or someone do for me which you had no idea how to do terry learn them all and perform them all. What a trooper. What unbelievable sacrifices she made so with her help. The recovery process win by quickly and really without any problems. I started walking to and then three miles a day beginning within a few days after the surgery this is important everybody to other members of my family. Both nurses were so much help. Terry's sister Laurie was on the phone. Almost nightly with instructions and health for Terry and I and then early in the process and then through the recovery process talking with my sister. Marcia was an unbelievable comfort for me. Marshes recommendation of the book getting well again was a talisman that got me out of my initial depression and then on the road to my new relationship with God and trust everybody much-needed needed and effective positive attitude. And by the way I'll be talking about that book on episode three the the May third episode of the Web Radio Today. Podcast seen so to bring this long rant about my cancer story to a close. I want to let you know that tomorrow again. Recording this on April seventeenth tomorrow. I'm adding running back into my workout six weeks. After the surgery I follow up. Appointment is next week and at that time we'll find out what next steps will be. Hopefully I'll be able to provide you with an update on Web radio today episode. Three whatever happens as I've been saying since January sixteenth. It's in God's hands everybody. Not all men will die of prostate cancer but all men will die with prostate cancer. That statement may not be totally true. But but it's close to true if you look at the ages in the numbers and every man. I know every guy out there that I can reach with this web radio today. Podcast needs to know. There's a killer out there and it could be living in your body right now. Lease have a digital exam each year. It's Yucky it's uncomfortable but it's a lifesaver also. Please have your doctor do that. Blood draw and test your PSA every year. If you know that you haven't had the digital exam or or a PSA test and over a year make a special appointment. Here's the thing the earlier you start getting. Psa test the more effective they can be because your numbers they can be tracked over time prostate cancer. It's now hitting manager at a younger younger age also seems to have black man at a higher rate. And you're having any kind of urinary issues. It's your doctor right now. I urge every guy and every now get and stay in shape. Being in good physical shape helped me to to ensure that I could get tolerate and recover from the surgery at my Vance to age of seventy three the goal and why. I'm starting the web radio today. Podcast is all about getting you healthy and in shape guys and gals. It's about fighting cancer. It's about fighting all life threatening diseases and even more important than that. We're going to spend time on the PODCAST. Spend time on our faith and our positive attitude become somewhat of an expert in dealing with life threatening diseases lease Rumba respective of the patient or the person who's WHO's trying to avoid serious life threatening disease. I'm going to continue to research that information and share it on web radio today so it goes without saying I want you to be part of this podcast and I'll be here every Friday to spend twenty or thirty minutes with wow. That story ran a little long. And it's GonNa make the podcast today. Be a little longer than usual. But I'll try and keep it s sank from this point on us. I can by the way. There's a written version of that story at the Web Radio Today. Dot Com website. Just go there. And Click on the Genesis Link. And you'll find a written version of that story. Let's lighten the mood just a little bit right now with some music and then after this song is over. I'll take just a few minutes to introduce the elements of the web radio today. Fitness and disease fighting plan. Joe College has been a good friend of my podcasts. In the past he provided music for both the get fit pod and the interval training workouts. So it just makes sense that I would give you the opportunity to enjoy maybe move and groove a little with Joe College cover of Sambat sway mapping with rain Shum. Wash away my shame. Rain Shumba Live Bill Shumba so bird. June bed off BLOUSE DON'T SHOW. Sham your Joe College Shambala on episode two of the Web Radio Today. Podcast The may second episode. I hope everybody that by telling my cancer story that it gave you a chance to to see some of the advantages that I have going for me. Is I. Fight this cancer battle. I honestly believe Firmly believe that if I had been overweight out of shape combine that with my age that they may not have allowed me to have the surgery and if I did have it I would have significantly high risk of something going wrong with the surgery and I know for a fact that I survived the surgery without problems and recovered so quickly because I was in good physical shape. Now I hear a couple of you out there saying but it didn't stop you from getting the prostate cancer. No it didn't and I am sure that there are some other reasons that contributed to me getting this cancer. I talk with you about them in future web radio today podcast because I'm going to add correcting those problems into our plans to stay healthy. Avoid disease and wage a battle against any life threatening disease if it comes along. Aren't I mentioned at the top of the podcast at there are seven elements to the web radio today fitness and health model those elements being faith fitness diet attitude positive imagery music and knowledge along tomorrow's episode of Web Radio? Today that'll be episode number three the final introductory episode before the everyday Friday weekly episodes of the Web Radio. Today podcast began and on that episode episode three. I'm going to introduce you and a little more clearly. Define the elements of the WEB radio today fitness model and we will spend some special time talking in detail about the very important knowledge element. Of course we will have our little two minutes many workout and I hope to play another great tune for you on episode three all three episodes. They're published now so you can listen to episode three whenever you want every episode of the Web Radio Today. Podcast is available at Web Radio Today. Dot Com or die. Tones are literally anywhere else. You get your podcast and don't forget you can email me skip at Web Radio Today. Dot Com. I read and respond to every email. And I'll talk with you on the next episode. Thank you so much for listening. Have a great day bye everybody.

cancer prostate cancer Terry Twenty twenty Nashville Tennessee Little Nashville Burg Yawkey Skip Roman Columbus Bill Shumba gleason Joe College Vanderbilt Medical Center
Boomer and The Millennial The Relationship Episode 5

Boomer and The Millennial

58:16 min | 2 months ago

Boomer and The Millennial The Relationship Episode 5

"Okay. Johnny. It's weird because I know that we were cord the banter. First of all, that's British. And start saying the word banter until I started watching British TV and I think that's a problem. Banter is known. For the Brits eight a lot there. Bente. Banter. Little Banter back and forth. But now that I know that we recorded little with the Baiter I'm trying to like. No no, it's fine. It's We don't need to do a whole lot of that. But. It's a spontaneous. Now see your overthinking I. Really Think. We got to start the PODCAST. No gotTA remember to Banter. Than what is. What do I do in the banters? WanNa make that. Funny. I just want that to be funny. That's always the first thing you here and it's always like what is he talking about right now that story of my life really get well. I don't know how you do that. You can imply you're thinking about you were like. I don't know like whatever. Okay. Here we go. Guys we're starting the podcast now we have. Know yet the Improv Banter Right. Scripted that's weird. That's doesn't have to be. Really stressing. Promise. Well guys. We are yet again, another episode a you know what I'm GonNa say we back at it like crack ethnic. Okay. Episode. Yeah. I don't know six early survey. Back, we don't want to date ourselves. Exactly. So don't worry about what episode number it is just listened to the episodes. Welcome to boomer and the millennial I'm dome, and I'm Armani the Millennium we back at it flagged crack. That is not tag, but you made it. So yeah, I don't know why you keep I but when you get all of the male and like email. Email social she'll be social media. Listen I. don't care man we back at it like the crack attic. So here we are. Yeah. Thank you once again Dangerfield newbies show to them. You know for hooking us up with our intro music, go check them out and Music Dope Dangerfield newbies I. Love that name by the way. Yeah. Check him out and we got a lot coming up on this podcast. We hope that you stay with us. You know we do these things we try to every other. Week every two weeks and it's just keeping up with what's going on in this country's been really really a little difficult but our mind he's got some things on his plate including relationships. We can talk about you are you are you ready to talk about that their relationship thing he broke up with his girlfriend and I don't know why you gotTa Promo of business out there like that well, we may not be willing to talk about it. You can always it out. Not. Only that let's we'll just I mean we'll talk about it and not only that I think a lot of people thinking about cancer and cancer awareness, of course, with the passing of. Bozeman. Yeah. But also this is prostate cancer month and for those of you who don't know, I, am a prostate cancer survivor and also had been working on a prostate cancer documentary for a number of years and we're gonNA share a little bit of that with you in a segment coming up. So stay tuned for that and of course, we've got sports and we've got entertainment and a lot of other things for you. So we watch to hang around and okay I'm trying to speed up man like why do you have to say everything we're talking about in the beginning because that's what they say. You don't have to do that. But that's what the podcast one on one says. Do. Have they been making millions of dollars for making podcasts? No, I did so understand why. Like was on the podcast I wasn't do that. So we haven't been making millions of dollars, but but again, they have they written a book on podcast Dan. Okay. Whatever. So anyway, I just WANNA. Let you know that you got it I'll I'll follow your level of expertise your this is your thing I'm just I'm just here for the entertainment I'm just Here to no, no, no, no you. Yeah. We we want. You know I to I, want you a millennial perspective on everything lineal perspective different any as we talk about what's happening social justice in this country, which has become a major major issue as we head into the election in November but not only that I mean, we've been dealing with this for decades. And and yet another Here we go. Again, Kenosha Wisconsin Jacob Blake for those of you who may not know our mighty there was a sixty year old black man that was killed in Savannah. Georgia. So here we go with Georgia again this is like the third. In the last three months you really surprise. Yeah. I mean this Guy Vadim police ended up in the ditch was getting out of his car and he was shot in the head. Police officer I think now it's been charged and arrested God down in. Savannah. Georgia near my hometown of Savannah. It continues it continues to happen in the issues of defunding police and people not understanding what that means. It doesn't mean that the police not getting funded, but it means rerouting funds to areas like mental health and a lot of violence happens around domestic disputes. So having somebody there that can kind of the escalate the situation I think that's important as we look at this new whole policing, the way local municipalities and just about everybody do policing I think that's so important for us to get to that point so. But again, in order for us to get past this, we've got to have people in the White House and people in government that are willing to look at it and to Realistically Affect Change and you know you gotTa vote. So we talk about doing this part that's not happening any time soon until trump is at office well, you know you gotTa, you've got to vote and if you haven't voted having registered registered to vote. And then if you are registered early vote if you're GONNA do a mail in ballot now was soon as you can get your application or whatever your estate. Whatever the guidelines are, do it on the front end so that you can take care of it and we can move past and I think it's safe to say that if you're tired of seeing all this injustice across the country, I'm not saying we're not saying that just by voting it's going to eradicate these these incidents that keep happening and it's GonNa fix things overnight? No, but it's it's a part of the process, right? So please go not only from a boomer perspective, but also a millennial perspective like. Because it's super important and part of the chain starts there as well. So every vote counts every vote is important and trust me you're GonNa want to get this guy out of here. So and not only that I mean vote. Local. Elections Yeah. I mean just yeah. Really pay attention to WHO's running. Yeah I talked we're vote I mean everybody is geared up for the big vote yes. So I remember when you voted for the first time yeah as do I and had a little sticker on you had your low voltage are posted thing I'm sure you can re post it. It's Okay For us a parent. So what was it was? It was I mean he's a problem for me as well. 'cause wasn't Bama's was it. Obama's second term that I was able to vote or was not able to vote for that I can't remember. I don't I don't remember. I know I definitely couldn't vote for the I know but you went with us. Yeah to vote so. You went out of town. Yeah. Yeah. I did go out of town with the good old Chattanooga, Tennessee well, Chattanooga Walk, college do that area now you went before Oh. Yeah. I mean I went a win about two or three weeks ago when I got this four day yeah. When I got my tattoos being mentioned that last episode but it was kind of like you know like the moon you know when we were trying to get to the moon I we we sent. You know the rocket. To the Moon I. went around the Moon. They didn't land. It was like a test run because we've added you up there in the test run. Okay. I ca- Tattoo like of all things. Go up there. Be Masked be social distant I was yeah. Yeah. Oh by the way I'm going to a tattoo power now I mean low key that was the original reason I was going that we that weekend. because. Shout out to my art. My Tattoo Artists Kiddie again at main line. But she was able to share the cancellation so she was able to. Get, in there. But yes so I did go again a week later in stayed for about a week. Or six days. Yeah. Yeah. We Fun and we had protocol in place. Yeah. Because I mean and that was smart. Town. Yeah. So what what what my parents decided to do was they before I got before. I. Got Back to Atlanta. They left home and went to Savannah Forbid. While I was back here by myself. I got tested for covid thankfully came back negative like. We would still been in Savannah third third time charms. You know three tests, three negatives. Then eventually they came back and here we are again and that was the the whole deal, but it was really fun. I. Got to see my friends which I think you know right now I really needed and I also Zach and I got to shoot a music video. So Shelter Zach Bonkowski, and Ryan as well. We shot a music video and that. was to the artist's ooh The artist's name is Saint Cush, right? Thank Kush. Yes. He's a he's a he's he's a rapper. Okay. Yeah interesting interesting music. Okay. Not Not necessarily my cup of tea. But you know. All right. Well, let's something he has an audience, right? So. He has an audience but I will say mom now. So but the video turn out good and it was cool. It was cool or welcome back and thank you know we're we're we're now is act together as he has got to be going to be back. So now you're thinking about going back because you have a big day all I really don't know guys my birthday is coming up I'm not really making it a big deal. This is twenty, four, twenty, four, Kobe year. But Yeah I don't know I. Don't know what I'm GonNa. Do you a trauma linear you like on you know you are a millennial, but you're right the. You know you're a millennial but you'll last. Last year like your mother's last year. And there's also convicting this conflict. Somebody your mom's say's Oh. Careful But there's conflicting dates with like whether I actually am Legno or degeneration after that I don't know I'm GonNa stick with me though I. Hope. So says is boomer animal. Right, that would make more sense. But anyway. Happy Birth soon to be birthday. Yeah. Any any other plans? I mean you? Know you always been a big birthday person have really been. I. Yeah. I guess so much so. That I left from playing easily. You know they played players championship I got invited to play golf at East Lake. For those of you who don't golf, they just had the players championship. This is where tiger has played. To thirty top professionals play this course and you don't even have a car, you know I'm looking around for the car and two guys came out near like our caddies what yes as crazy it was and I'm like I, have a candy I can't believe yes and you feel like a real professional. Yeah. Until until like he gave me like an iron and I was like. One hundred fifty yards away and then I. Give me the three would. Like. Do that don't undermined me. He was easy him because I used three clubs. So yeah, right. I had to leave I left I, left after play nine holes, which I probably should have left anyway and I it was bad. But anyway because your birthday Oh yeah. Thank you so much for. Your birthday was this nine I. Don't remember. No. Well. Yeah. So I had to leave and they they gave me they gave me news. You know they say this I'll say this birthdays for me are a big deal in the sense of just feeling love from people. That's really what I care about like I never really asked for a whole lot of stuff or anything it's just Kinda like, oh, happy birthday here like A Bro Levy brow like happy birthday that type of thing like you know just let me know that you care really about. But you know, hey, as I get older and the years and years go by less people kind of hit you up on your birthday and everything. you start learning just to doesn't really matter if everybody tells you happy birthday as long as it's the people that are most important to you. So that's kind of been happening as you get older I think, right So shoot the kid. Should give some money. If you want to cash my cash dollar sign are Mandi like I don't think he can do that on our break. Why can't why can I not do that come on now? Bless me. Bless me saga Blah somebody else in the future ego like your day. Okay. Yeah. Okay. So this birthday, it'll be a little different in the sense. Why you said. I. Don't try to segue into. Yeah it's going to be a little different especially after last birthday because last year was I mean we don't have one. We don't have to go down that road quite yet. If you've not ready I, mean you know I don't even I don't know exactly how long it's been. and. We're referring to your. Yeah. My break up with my ex girlfriend. Well you break up with the girlfriend who's now ex technically right because you can't break the eggs right? Because that's two negatives than that means you're back to go. Okay. Well. There you go. Yeah. So If. It's difficult. That we can we can talk about it over subsequent episodes. Okay. We'll do I mean what? In in that regard, you WanNa talk about because it's like well, is hard to break up doing covert I. Think it's hard to break up in general. Okay I think it depends I mean. Not Real. Well, we'll look at it this way this this. Okay. You got two options. You have a few options but. Say you break up in person right get you know say the person cries you're crying it's tough breaking up for whatever reason right in person you gotta deal with that face on. It's like this person's in front of me. This person's crying they're upset there's a whole lot going on. With Kobe it's kind of like, oh, it happened over facetime. So but that's still like. Yeah, you know because you. Yes, it is. But it's awesome. Different. person. Okay, but it's also better than like a text. or nothing at all or nothing or nothing you just stop talking to the purchase Mr? Hey if it works, you know. But yeah, talked in months. Oh, shoot I'm yeah. Must have missed something. You just hope that. Fade from I. Don't think that's the right way to do. No, it really is it but that's like if it's worked in the past, you know no, it doesn't work. Guys way of breaking goes we don't we don't. Well, we didn't have a term for it then. I don't I'm not about that. Well, that's good. I'm proud of you for their you you do. Face it and emotional phase. Yeah it's a it's a it's a daily daily. Daily thing I'm still dealing with because it was a serious relationship and I still like I still care about my action. Can we say her name? Is that weird? I, don't WanNa get on it. And I I am in no way bashing her at all like there's no reason to like. I was the one that ended things and it wasn't because of her you of hear the whole cliche thing it's not you. It's me but it really was me and just feeling like. I just I don't know it just wasn't really happy and not necessarily in the relationship with myself and other things going on in my life and. I think I just needed some time to focus on me I think a lot of a lot of my life. I've been in relationships I had been focusing on making other people. Happy. which there's nothing wrong with that like it's It's good to put others before yourself sometimes, but I think I was doing it so often and that's just what I was used to the type of person I am. So I was just I. I was getting to the point where I was feeling like I. I don't know I just I needed some time to to focus on me and to just love myself better. And learn to be alone and be okay with that because I hate being alone. I'll be honest good thing here with us. Right we ease the pain. Well You guys have been very helpful and in everything it's just a it's a daily thing. It's just a lot of emotion was involved and I kind of springing up out of nowhere which didn't help you know I mean it was one of those things where I you know I've been kind of having those feelings for a little bit and. Trying to suppress them just because you don't want to continue to make her happy and and just didn't want there to being issues. I don't like confrontation in general as a person so if I can avoid it. I. Will You know what I mean? So you just get to a point where it's like, can you keep if it's an internal thing and and it keeps weighing on you in the back of your mind and stuff? It's like how long can you keep that up until you feel like you really need to do something about it Watson for guys. I mean we all kind of go through that I. Think. For me in particular, it's Guys you just don't want to deal with the emotional aspect of it I mean if you could say, Hey, were you know this? Is it I think it's time for us to move on and she says, okay cool. No problem. Hey, hit me up. A little. It is easier that would have been great. It is easier. Doesn't particularly when he's you and that her and you've got a that's mark, there's a whole lot of emotions that that comment you. In, got, we like to duck and we don't want to confront that motion. So that's the thing I I've been trying to for for for doing that. Thank you I appreciate because in the long run is going to be better. Yeah. It really is because once you know she goes through the the sadness and the anger and all of that you know that whole cycle. At the end of it, she will appreciate the fact not said you were honest. Yeah. That you were honest about your feelings because that's that's important. Guarantee you. But if you done it the other way, there will always be disdain. Yeah I guess for me like I I try to be cool my ex's. Also depends on the situation I haven't talked to her in a while. So I don't know. You know what I mean. I don't know at what point. will be cool and. It'd be able to you know like I still want to be friends with her and everything. So hopefully, that will happen at some point in time but you know taking the time to kind of be apart from each other is super crusade knows you may come together point. You. Never know you never know. So right now I'm Kinda just focusing on me I'm about to start working again soon hopefully, and I'm just going to be busy just stupid that always helps. Yeah and and that's the thing like I'm trying not to run from the emotion I'm trying to confront it like if I feel something or whatever just to internalize that to deal with it understand why feeling like that instead of trying to distract myself the wrong way but also at the same time. It's very easy for you to have these thoughts and be sad and stuff. So you you kind of need good things to kind of distract you not necessarily to take away from you dealing with the pain, but you know so you're not focusing on at twenty four seven. So that's kind of where I'm at I. Mean I've I've trust me? I'm a lot better than I was a month ago. So it's it takes time it takes time, but it's still it's still thing that I'm dealing with seeing pictures of her and stuff and like if I see her on social media, just kind of like okay. You know it makes it a little bit harder but you know it's it's a it's a process. So I'm not rushing it I'm not trying to rush it because as a as a wise man Gregory right once told me a watched pot never boils gregory, right? Yeah. Okay. Drag. Greg that's last. Yeah. Oh I didn't know that your friend Yep sorry. Put your full government out there Greg if you're listening to this but just not greg didn't like make that up. Yeah He did not make that make that saying I'm sure but he's he's been telling me that. So because you know there's times where I worry like at what point am I going to be good at what point am I no longer feel any of this anymore. And let me just tell you that will happen. I've been on both sides of this thing. So you'd think it won't, but it eventually will and that's why I said the way you did it in the way you confronted it and and honest about your feelings that will help it. Heal better. Than just rip the band aid off and taking off but by by getting in touch emotion and and also like I wish her all the best in everything like I, want to still see her succeed and everything like I. Still Care about her you know what I mean and that's that's something that I don't think will ever change. You know you. You spend so much time with the person you. Love. A person and everything, and it's like those feelings don't just turn off they don't go away I. Hope this. She'll. She's happy and I hope that she's healing and she's doing. All right at the same time I can't be too focused on her. You know I got myself as well and it's hard because I'm not used to being like that and a lot of people say, Oh, maybe that's selfish. But you know that doesn't necessarily mean it's bad thing like you have to take care of yourself I, for you can take care of somebody else. Like how it is on an airplane with the. Thing yeah. Mask right. Right. Well I'm glad we had this therapy session. Right I mean didn't last very long. That wasn't too painful I thought. You know and it helps you know. Yeah. So that's okay I mean do you have any other advice? Certain thing you WANNA I mean maybe Dealing with something similar. The good thing is you didn't take mine. Well, yes. Just the out and cut off right and hide it at least I didn't do that. Yeah. Had until. All the crying and everything is over and she hate your guts and you don't talk anymore and that's not good. So I am proud of you for taking that and and and I'm hoping that people listen they understand. About relationships and how important it is to confront your your feelings. And I kinda went through and speaking of confronting feelings I. Remember you know as we talk about this being prostate cancer month, we talked about in front of the show. A lot of people are talking about cancer particularly with tablet bozeman yeah. and. Yeah. Yeah I. Mean that was they came out what? What type of cancer did you have? Holon Colon cancers? It stays three state for say A. Good because he didn't really heat nobody knew. Years being a cancer survivor I. Think when you find out, there's a lot of emotions that goes through your mind and one of the things I think a lot of people WANNA do when they're diagnosed is to help us i. mean that's one of the first of all you want to be you want to get healthy again that's that's top of mind you you don't WanNa die you know you wanna you want to live and you WanNa, do whatever you can to live The other thing is that you want other people to live. So you just Kinda what can I do and that's something that went through my mind but. I was already doing something right in working on a documentary about a fraternity brother of mine who have prostate cancer only to find out two years into the project that I had prostate cancer and. You know still inexperience but my thing was to do a prostate cancer documentary and outreach project which getting closer to completion. It's been really dedication and just a long journey to kind of get this message out. But I did want to give you guys an opportunity to hear a little bit more about it and I put together sort of a an audio segment if you will. So you can get a feel for the story so. Here it is imagine this a man producing a documentary about his fraternity brothers prostate cancer journey only to find out along the way that he has cancer. Yeah. No, it sounds a lot like the twilight zone and probably not a whole lot like rod sterling. But that actually happened to me and let me tell you when you hear these words from your urologist after a biopsy. So we have a confirmation with a second opinion that he definitely has prostate cancer. Now, what we're going to do briefly now to go over what this shows and what it means. It goes from surreal experience to very scary one in a matter of minutes. Some would say seconds but I hope after listing and subscribing to this podcast at a prostate cancer diagnosis though serious does not mean a death sentence I'm Reggie Hicks producer of the documentary and outreach project if you are brothers and welcome to the I if you are my brothers podcast project started with my fraternity brother. Ralph C T Franklin years ago and Ralph shared his story with me and other members of my fraternity. Alpha Phi Alpha Inc.. And he was diagnosed with a very aggressive former prostate cancer. He wanted the brothers of the fraternity to know what was going on with him, and he pretty much stated to us an email. If you are my brothers, you'll get checked before I go into more of the story. Let's let's hear. Ralph in his own words are saved customary letter from the insurance company I looked at the first line of that letter and it says we reject new application for Life Insurance see enclosed laboratory report the laboratory report says abnormal. PSA A one hundred. Probability. Of Malignancy when I saw probability of malignancy immediately I knew what it meant and it was like what is going on? I had a biopsy, the doctor called me and told me. That the result of the Bob was positive for cancer. Then had to take additional exams. These scans of the body scans of the bones, etc etc. for the specific purpose of seeing a whether or not that cancer had metastasized. Me and my wife went back to the doctor. He told me that the cancer had metastasized and it was in my lymph nodes. My wife asked him say, well, what does that mean in terms of life expectancy? He said perhaps two years after the doctor informing me of my prognosis which was terminal illness. I said that I was not going to go out with that at least inform and my fraternity brothers as to what was happening with me. I was going to be one of these people who would be. And the next thing is that the fraternity gets a call and say, guess, what if Attorney Brother has died? So you heard Ralph story maybe you've just been diagnosed maybe know somebody who has prostate cancer let me say this person foremost that is going to be okay. Good news is if caught early, you have a high chance in a very good chance of being cured but hey, don't take it for me take it from this gentleman. We achieve ninety, nine, percent, five year survival rate I think any cancer could be cure prostate cancer could be one of the first one to be cuter that was teaming chew I had the honor of interviewing him briefly a few years back. The most important thing know about Dr to is that he led the research team in the nineteen seventies that resulted in the discovery of prostate specific antigen or PSA, and also the development of the PSA test A. Lot of you probably familiar with the PSA test and I like to call him the father of PSA doing this podcast. You'll see how PSA played an important part in Ralph and is journey, but you know Ralph and I went through a lot biopsies and seed implants, radiation therapy, surgery, hormone therapy, clinical trials, blood transfusions, but do all of that. We also were connected by Brotherhood. But this podcast is more about your journey and you can expect in future episodes. Over we'll talk a lot about the innovations and research and treatment. Yeah. We'll talk to the docks, but you know one of the main things we really WanNa do this podcast is to talk to you to find out and talk to you about what to expect after treatment from your first day back two years afterwards, we'll interview survivors and partners and family members. Yeah. It'll be the researchers and therapists and docks, but it really is about you. The one thing you are sure to get from this podcast is true transparency people being real about their fears and challenges and triumphs faith courage. We'll talk about what happens when Eddie. And incontinence becomes a side effect of your treatment. How does your partner handle all of these changes? How do you move forward with your life after treatment I, don't get me wrong it's not all doom and gloom I remember and I everyone and I do mean everyone is different but the one thing you will learn from this podcast is that regardless of the outcome, there are ways to cope ways to correct more importantly ways to live a normal life and get this at the end of the day you will hear from me and over again and it's about life about living for your family and what my wife has. Accurately coined is life over Libido. So stay tuned because if you are my brothers, you're gonNA WANNA be a part of this I cast experience. So there you have it. That's my story, and we're working very hard and with the help of a lot of people wanNA give a shout out to. My friend Tom. Loose. Who is the producer in residents at Georgia state also one of the CO executive producers of the walking dead for for many many years and we've I've known him through my public TV Day. So I want to thank him for his help and I really would be remiss if I did not say thank you my dear, friend ran a good water who do all this rainy shot hours and hours of film for little or nothing? I mean of course, rainy was nothing was. Nothing Little. But I mean his dedication to the project. was just tremendous because I didn't have a camera, right? Documentary ad in. TV Radio and you knew you want to tell the story yet you'd never done a documentary. Are So but I think it will definitely make a difference to your son who also yeah. Yeah Abby. have grown up with this thing. Yeah. Yeah. I've gone through all I wanna say all the footage, which is not the easiest thing to do just because you know when you got diagnosed I was what maybe eleven? Ten or eleven twelve, maybe around that age and. I think initially after finding out, there's that that shock and fear Your Dad has cancer right in your you know the first thing you think about is, is he going to die how serious it? These are things that are going through my mind so just I know that it was a tough experience for you something that you have. Come. Out of I think stronger and you know you did what you had to do. In order to get better and to live and to live right. So you know I'm just I'm just happy in that regard you know what I mean but I have seen allowed the footage in I've grown up with the project like you said, and I see how important this is to you. So I WANNA make sure they anyway that I can help you get this project the ground and get it made and everything I'm I'm here. To help. So because I know how important it is what I appreciate it because you know it's it's been a labor of love and dedication, and and also from from this whole experience has taught me a lot about prostate cancer and also the information a lot of information I need to know about getting checked and I mean I'm not doing that anytime soon. But because you had it, I know I I'm going to have to get checked. Probably a little bit earlier than some people. In your forties because men of color tend to get it earlier often times more aggressive. I mean I was blessed. It was very slow growing in caught it early once you if you catch it early, which is which is why it's so important for those of you listening for all men out there that are the listen to this podcast if you've got or if you have an uncle or Granddad home file whomever, you really need to get to know your your PSA and when we get it, we get it. We know that that the test is in or getting checked your PSA check isn't the most comfortable experience well, actually the PSA is just blood work. Okay. Okay. But the Dr Well. The digital rectal exam right heart that part that prevents men from getting checked. Yeah. Basically That's actually a physical. Way of the dot feeling your prostate and seeing if there's any roughness which rivalry say that there's something you know may may have some indication that there's some issues going on. But no in. It's always in your physical probably the last thing that the DOC will do. Afterwards you may not see the doctor for a little. Saying well, doc I'll see in a month. But it is important in even if you know Dr is important but the PSA that number Y-, because I was diagnosed with a very low PSA and so but it had gone up point six from one year to the next and if you need a biopsy, I know there's a lot of things going on. You can watch wait you don't have to do. This is not the kind of cancer you have to really do something about very quickly and Norio but look cancer, and so you know you're going to do something you got to I'm GonNa tell you that right now. So, no, your number is prostate cancer a month get checked and stay alive, and also in honor of Tab with Bozeman get a colonoscopy I'm guilty it's time for me to have one So I've had I've had two or three, but I need to get one. I've been putting it off. So for those of you who know you need to get one or have never had one in your in your fifties particularly for for people of Color make the appointment. Okay. Go ahead and make the appointment you know so it won't take long takes thirty forty minutes and you know it's kind of important like it's your life so. Literally. Nothing nothing too major just your life so Do what you gotTa do I'm saying. So they're being said. On a lighter note. On a much lighter, much lighter. No NBA playoffs going on. Yeah you know. What one does this going to be over I? Mean because they're playing every other night yet it's going by fast. So probably about the end of the month, we're talking the finals. October or or maybe finals in October maybe the end of Saddam I would say finals in either into September early maybe maybe like Tober right because they're playing like I said every other every other day because they don't have to travel right which is I mean it's convenient for people that watch it. You know what? I mean the fact that it's going by. Fast that's the only only probably but then they gotta turn around I guess and in a normal year, they would be getting rid. This would be like preseason because they they. They would actually start to season in October so I mean in a normal Basque right. Oh. No when season will begin right also got the NFL season back. That's right and I'm going to be honest. Here we go again with the Falcons and now. Here we go again. I I don't know what I have. I have really looked at this covert season as I'm not as vested in it as I. Yeah. Now now I say that but. When it comes on, you're going to be watching. I watch but. Even. Like the college by College football, you know Georgia's starts on the twenty six yard. He had one big development in that. The quarterback Jamie Newman transferred from way for who was going to probably be the starting quarterback. Not to play because of covert. Yeah. I mean I get it and and and this was my this was my concern from the beginning now he opted out. Prior to playing because of covert. But again, what happens when you think you're you're on a championship run in your top players test positive. Then what I mean. You know you go into a big game against Alabama or somebody, and you can't play your best players because they're testing positive over I just think it's a big it's going to be a big mess. Yeah. But maybe colleges already started. So it's different than basketball. Now they're they're in a bubble, but you know they're on a college campus. Already thousands of students that have tested positive I. Don't know I'm just a little little concern and actually speaking speaking of football. I saw something that I thought was very interesting I wanted to get your perspective on. Sure. So you know how Colin Kaepernick hasn't been playing because of the whole controversy with him kneeling during the national anthem and everything and how before. Maybe months ago he was trying out because it seemed like some teams really had some tried out here. Yeah. But but they were saying recently that that was all just a farce and like they're really not nobody's really trying to sign Colin Kaepernick right what's crazy is madden twenty-one. He's in the game a while as a free agent. So you can play as Colin Kaepernick, and this is the first time he's been in mad and since two thousand sixteen. Wow, right. So well, a statement, right I think. So this is that that everybody now it's like everybody's trying to do whatever they can to make a statement, but that's interesting I. think it's crazy that they put him in madden but he's nobody's cry sign you know what I mean. I didn't think that they would something like that. Well, I can see I can see why I mean because it's a business and what what we're seeing now is a lot of corporations trying to make inroads and to show that they are sensitive to black lives matter this sensitive to and even even the League which is you know it's just so crazy that the thing that Colin capper nick did and how he protested now is like this being embraced it's like Yeah. Right. I mean since since George Floyd and everything going on now I mean, you look at the basketball near the bubble and black lives matter everywhere even even I just saw something else since you're talking about else. Interesting. Because we got the the US Open tennis is back and shallow to Serena I got to watch her play a little bit but also Naomi Asaka right? You know who is on the come up she's a young rising star in the world of tennis. She's been wearing masks with names on them like George Floyd. Brianna Taylor, a different mask day. Right and so I think I love how athletes are using their platform, and of course, what they're doing in the NBA that's what they canceled games. The protests and everything in in with the not playing and stuff. So I love that athletes are using their platform to speak on racial injustice and in that sort of thing but I think it's just crazy that Colin, kaepernick still hasn't gotten sign and from the video that I saw when he was trying out, he was he looks good like he's been working out. Better than some of these backup quarterbacks hoover shirt and who knows at once the season gets started and people get the ranks get a little thin that maybe they will call him up because I think that that conversation will happen again wants to season star. What about Colin. Kaepernick times when when people take stances on things, they are looked upon as being villains and but you know Colin Kaepernick really started a movement in sports. Now, what Colin Kaepernick did doesn't seem to it never seemed to be an issue with me of course not but I think now is definitely more mainstream and so hopefully, this will continue you. Okay. Yeah I'm okay. Now, I just had to clear maestro. Real quick. Sure go yeah. I'm okay. Question Mark I'm good. Don't. Okay I'm just checking yeah. No, it's okay. We six. You get a ruler. Almost, I trust me if I gotta you you definitely got I. Know What s that's really reassuring inside. If. You're a symptomatic. You know it's OK. Three negatives. So that's all that matters all that matters. Yeah. But yeah. So so that's that's interesting. Almost as interesting as what I've been watching, what have you been watching honey even waiting To this. Yeah. See Looking at our time yapping waiting. To really talk about things I. Don't know why watch so much because like I haven't had time to watch a whole lot of things but anyway, you know all the Sapphire stuff's coming out now trying to get Mars, I don't know what it is about like Mars I mean. Every the Moon and Mars, the Moon and Mars. It's been a lot easier. y'All can't pick a different planet. Well, it's the closest planet. You know that's the next one that without space force and trump we're going to the moon again, and then from the moon, we're going to Mars, but you know what happens a Lotta Times right and you know fiction is close to reality. Over these yeah. You know they're saying there could be life on Mars and in water I mean Jonah. Other planets in our solar systems I, get it but you know what I'm watching away with. Hilary Swank and that's on Netflix. I. Just came out. So I watched in your mom even started watching with me which I thought was really interesting. Yeah. Because you know she's not the biggest. But but you know what? It's really thirty percent Safin's seventy percent soap opera drama. Yeah. I was GONNA take every one of these. You have like the the rebel teenager and and then you've got the commander and you know it's it's just the interaction of the family and the hustling and all of that but I will say it was it was pretty well done and made it to Mars. I'm sorry. Didn't mean to give away the ending. It is it is a, it is a good way to spoil that but burnings but here's the thing. This is kind of like two degrees of motion picture kind of connect like people like three, six degrees of separation and I thought about it. So marching away with Hillary swing. She was on one of my favorite movies called the core right? She was going to the. Core of the planet. I don't I don't know the movie ever seen a movie no anywhere. But anyway, destroy Lindo who plays in a movie I just watched is a scientist in this particular movie with Hilary. Swank. Del. Roy He plays in the five bloods. Spike Lee joint with tear Bozeman I think management is less his last film. And it was eerie. It was eerie to see him in there because you know he's playing someone who has died in in war. and. It's a flashback, right? And at first scene was was really you know as well they talk about it. You know it's like four guys going back to find this goal that they buried and also to find the remains of you know their fellow comrade, who was Chadwick Bozeman the character in the movie and as they come together in Vietnam they reminisce about him and that was just because he's actually gone. Yeah and and they said it was and people said, it's very hard to watch it I. Just that one scene really brought home. The fact that you know this great actor was no longer with us, but it was a good movie. Shoutout Spike Lee who I see from now every now, and then over at Clark Atlanta University. where he learned. Filmmaking from your mentor Yeah Dodgy. But then? Yeah. Okay. So you've been you've been watching that the only thing I've been watching recently is. STILL RE watching game of thrones. I'm once he's seven it's a it's a long journey again to rewatch shelf. But now the boys on Amazon prime is back season two and it's crazy because show the trail axiom it's a lot going on. It's it's very heavy in some instances. But it's really good. So I'm glad that there's a new show out that can finally watch I've been waiting because I've been re watching things. And I started watching thanks to you. Hbo Max are raised by Wolves. Let me tell you something guys. You know. Let me tell you when you know things have changed when you are an adult is when you are no longer on your parents streaming services, it's when they ask you you hey, what's the password and username for the streaming service that you have that you pay for yourself? So my father is now in my Hbo Max and for those of you who know how much hbo cost I think I think for him being my father for twenty four years this is a fair trade I think in my is here. The NFL that you're on net flicks Amazon prime and listen you don't gotta do all that. Okay. You Ain't got you. Qaeda. That out there. Okay. Hi I'm ever say okay final that's fair enough. Yes. I still use the family Netflix and Amazon prime is there another one that you're Disney? No I don't have anymore I was never on your Disney I was on my own be on Disney because busy comes with the cable. Well. So I mean like I've seen in it. Pamela ten enough times. So if I really want to see something, you know I'm a firm believer in only having again only having the streaming service for when you WanNa Watch particular show because it just keeps you from having to pay for, and then when something comes up okay, I'll get this like power the spinoff not spin off but you know the Next part of power because it's been a yeah. Okay. True. Stars came out on Sunday. So I'm thinking about maybe getting that to to watch it but I think we'll wait a little bit because I don't know how well it's going to carry with not having all of the main cast back. We'll speaking of the main cash out Omari Hardwick homeboy and Alpha. Yeah. Also pledged that at my chapter. Yeah University. Shot to Joseph. Sikora. Plays Tommy who I've met met. Yeah. Working on yeah. He tweeted listen when when he responded to my tweet after meeting him that was way too cool. Oh so does ours act season three yeah. See again degrees of separation. Yeah. Yeah for for power. Wait a way to bring a full circle I. Know I know Mari's mother and I grew up with the family and we just know people guys like don't get him on he and his mom because every school this sort of well yeah. If he's not too Lazy Selenium, I think maybe a little. I don't know how it doesn't matter. We'd love to have. Yeah I like who wouldn't listen to that. So you pull some strings give us give some time folks, right? Yeah. We're working on it and. He'd been reading some mouse to write. GAIA. Well, yeah. If you normally talk about shows but also if Your books and Yeah. PICKED UP A book. Your mom had in school. It's a little old, but it really is relevant. Not. Your mom for the book. I understand. No, and you can't take it out because it's fine. The I'm leaving in there. Oh, good. Yeah, and maybe she won't be okay. Yes you'll be put. Yeah. I'm reading a book called hidden costs of being African American by Thomas, Shapiro sounds like a good book. Well you know it is. Well. It's it's a little dated. You Know Bassim years but the message is still the same is written a textbook kind. Of case studies and stuff, but the bottom line is and i. just read this the other day that when you look at what he calls transformative assets thank you inherit and stuff like that. Okay. Okay. Being long story short is that because of all the things that keep us from? From being equal in in housing and stuff like that they're being black cost about one hundred and thirty something thousand dollars All right. The class would cost you being black. And I'm sure that cost has gone up I'm. Probably, crease over the last ten years because books about ten years old. And that's not too old I'm thinking. No, it's not like thirty four. No, no, no, no. Okay. But again, I just picked it up say you know I mean because of all the things that are going on it really is relevant for us to kind of look at well I would say that you have a more appropriate read for the Times that we're in s what I'm saying it but. Tells having. It's hard to to read some time. Well is disappointing. No you work and you work and you work and you try to achieve what they call the American. Dream and you WANNA pass stuff on to you, and in the you WanNa pass up on your children. And it just it's just difficult. Are As your mom would say we're on first base and everybody else you know they're sliding into home and there are things that are systematic to racism that keep us from. Being on equal ground s just as disappointing frustrating part of it. But also I I haven't been reading reading I. Guess You could say, but I have been listening to. Listening, to the Audio Book. For Midnight Sun. Okay. Still I don't know if I mentioned that last episode or not did I know you didn't mention the episode but you mentioned how you got it. Oh. No No. I. So I had to end up. Getting it because it just kept taking it on and off. Youtube. Infringement Brian Exact flavored word. That's why but yeah, I'm man I. Well, that's a long book. It's like twenty nine chapters but like listening, it's like twenty four hours. So if you could finish it in the day, but you literally for twenty hours straight be listening to yeah. Because most audio books like seven hours. Yeah. So this one's apparently the the unabridged version. Oh Yeah. Well. So but I'm I'm down to. Like six hours left maybe six and a half or so. Okay. So I'm one chapter like twenty, one, twenty, nine chapters. So it's it's heating up. It's pretty good. It's pretty good. I love audiobooks. We you know when you were in in school up in Philadelphia you know we would drive. Yeah. We had such a long distance to you might as well listen to an argument about. James Patterson we did all of the the murder club. Yeah. American history. Remember that. So we would you know it was one through? School we went through one through twelve or fifteen. Yeah not since. You took that Mickey trips so I understand so but I like James Patterson because he has like one hundred one chapters but he's Super, short like to. A you feel mad accomplishment. Chapter Seventy two I was like, Oh man I'm really getting throwing staying right Forty more chapters to go right exactly. So you know yeah, that's pretty cool. So I would say that law going on breeding. That's a good thing means fundamental. It's a little different than like actually reading the physical book, but it's cool because I can do other things while while listening at the same time. Right you know if I if I'm driving somewhere washing the dishes or whatever. I can listen to it all at the same time. But yeah, we talked about a lot today. Yeah. Yeah. I really you know I I got a lot from talking about you know relationships and stuff like that have to. Do More of that not. Necessarily mice in yours. But down the road as we continue our podcast and we just thank everybody got a text from somebody the other day. I've been putting more people on to the pocket. So we got some some more subscribers or more listeners out to all you guys out there I like people say you know ride their bike or while cleaning up and they listen and so we would like to hear yeah we really doing again I continue to work on the website. So just bear with me we are on social media as facts. So, and you can get us wherever you enjoy your podcast We're everywhere apple podcasts gone google play spotify tune in even Alexa. You can ask for a Alexa play she just she just lit up a while. Yeah you gotta be careful. They're always listening and know you can ask her to play boomer in the millennial and but you just say Reggie and Monday here but I think it's kind of cool that like our names and they're like, yeah, we'll. We'll. Yeah. So that's Over. Here glancing sure she doesn't lie to write. Stories about about her like listening to certain things you'd be saying in your house. So be careful saying. So please please listen subscribe, and give us show facebook twitter instagram. That and that's all like in the decision as well. So we want to hear from you want your feedback to help us to make the show better that you'd WanNa. Continue to listen right. That's what it's all about. We enjoy doing it and we kinda bond you know a little bit fun. This is fun. Sit Down and we map out where we're going to talk about. So we're getting better at it, you know. Or more consistent and stuff and our mighty getting good at editing. So a lot of stuff you don't hear is because, yeah, I'm taking it out guys. Hey. Now, we don't want to waste your time sometimes you gotTa. Do you know sometimes you gotta do it being a boom in this? I can go on and on and on. Can I talk a lot of people who know me legations gas? No but they don't see you when I go and you're like, make your face and trying to hurry along. Okay boomer. They're probably doing it like all the millennials listening doing it in their heads. Yeah probably so Because we liked to but you know what? He makes me sound good because he'll cut a lot of stuff out where I rambled. But So it's good and also again guys like we said before earlier in the episode go out and vote Yes we we're gonNA keep telling you guys like to the elections that are going on over so because it's it's so important. Yeah, you're right? Yeah. I remember you got a I got a dentist appointment tomorrow. Fun. I hate the Dennis Gus. Are Dentists so gentle. So gentle. You feel nothing. You know it was over not still no pain whatsoever at all. No roughness. We did that subscribe to the I'm just saying how gentle. Well I'll be there with you guys now. That just makes me feel so much. Your Mambo. But anyway, reach out to please vote and register the vote. If you have not registered I think there's still time to register. from not mistaken, and then make sure you check on the ways to vote mail in early voting whatever gotta get out. GotTa vote because I gotTa do we gotta get Agent Orange is? Into every episode. We gotta let you guys know and also guys out there though ups say, yeah you don't get tested I'll make sure. Get a colonoscopy. And all that jazz and remember still pandemic going on. So where your mask, where man sixty, two part. And say. Well. That's it for really upset saying. I'm Richard the boom and I'm on. We're out of. These guys. I always say peace high well we out.

the Times cancer prostate cancer Bozeman Georgia Colin Kaepernick NBA Spike Lee basketball Reggie Hicks Savannah NFL Netflix Ralph C T Franklin Dangerfield Obama Kobe Atlanta
EPISODE 2B WEB RADIO TODAY

WEB RADIO TODAY

20:31 min | 7 months ago

EPISODE 2B WEB RADIO TODAY

"I'm GonNa Start My cancer story on December twenty four twenty nine teen. It begins on Christmas Eve. In Columbus Ohio was in Columbus to celebrate Christmas with my daughter and her family and my wife's family. What a wonderful evening. Everybody together view. These people only see him once a year. But I love them all. And we're all thinking what a great year twenty twenty going to be all of us looking forward to exciting things in the New Year especially because my daughter Diana is going to have another baby in May a new grandchild wonderful. You know everybody thinking about that night looking back on it now. It's funny. I was thinking that you know you really know nothing about the future. No way that you can predict. What's ahead you really only can say. Hey today's pretty good tomorrow's looking okay but beyond that we know nothing about our future Little did I. On December twenty four th twenty nineteen that there was a pretty good chance that I wouldn't be around on Christmas Eve. Twenty twenty during the last few months of twenty nine thousand nine. I was having some what I'm gonNA call old man problems needing to get up too many times at night to use the restroom. Their Christmas Eve and I was looking forward to January sixteenth. Twenty twenty hours scheduled to to have an appointment with a urologist and to get this problem which had been annoying me for a few months fixed full disclosure and I think it might be helpful to other guys. Listening out there I hadn't had a digital prostate exam or PSA test for several years. I don't know why I don't know why my primary care doctor didn't do those test. But I knew that that on this January Sixteenth Appointment. I was going to have to have the digital exam. But Hey if it got me fixed. I'm all it's funny because in the past I was actually slash foolishly happy at the end of of every physical exam getting them every six months that I didn't have to go through the digital exam process thought it was Yawkey. Well everybody I can summarize my January sixteenth. Twenty Twenty. Visit with my urologist. I can summarize that in one sins. It did not go well. Exclamation point. Urologist was very concerned about the size size. And about the feel of my prostate. And no I needed to be scheduled for a prostate biopsy immediately like the very next week that biopsy the next week was it was a pretty simple procedure. Not Painful at all and I was actually kind of proud. When I was told that I had a really big prostate then. I got the news by phone. Two days later. Stage three prostate cancer gleason score of Eight. That gleason score means that there was already a chance that it was spreading. Or this is worse or it could have already spread to other organs. I was immediately referred to a surgeon and a radiologist and scheduled for scans to to see what the next steps would be. Oh Endo just a side note. Large prostate bad. Not good options on the table at that time based on whatever. The scan results were surgery. Radiation Difficult Chemo. Maybe a painful death. The scans would give us more information you know. I've been a Christian. My entire life raised in a somewhat fundamentalist church baptized on a beautiful summer. Evening at age. Twelve in a lake near Lakeville Ohio. I accepted Jesus then as as my personal savior even during my time in the air force. I decided that I wanted to go back to school and and studied to be a Lutheran Pastor. Well for a number of reasons that didn't happen. Perhaps it's story for another time at the time of this cancer diagnosis. Of course I believe in Jesus and I guess I can describe the way I practice my Christian faith. I guess you could describe. It is casual less casual sometimes more casual at others. At the time of his diagnosis. I was a member of a church occasionally attended services parade once in a while when I needed something so there. You have it my spiritual diagnosis. Going into twenty twenty as well as my cancer diagnosis. After getting the results of of the prostate biopsy. This sounds cliche. Hope it isn't but in terms of my spiritual diagnosis. All that changed after that cancer diagnosis. The Bible says God will use the very thing that's meant to destroy you to deliver you that everybody is so true. Of course I started praying several times a day. Don't let this be cancer. Police helped me keep this cancer from spreading. Let the scans be clear. Make it possible for me to have the surgery. Assist me to have a good recovery. As the days and nights went on my prayers became deeper more analytical. They became well a profound examination of how I was living my life. I talked with God about things on needed. The change no matter the end result of this cancer God was going to be more deeply involved with my life talks with God well. They helped me to to realize that I needed time to shine my light and make a positive difference in the lives of my family friends. People that I don't even know. Is this newfound deep faith just a cliche because I happen to need God? Right now are the things. I'm saying just latitudes to get me through this fight from a life. No everybody. This isn't a cliche. These are not platitudes. I'm all in if I fail if back backslide if I'm really full of crap if I'm just using God right now telling everybody it's all going to be out there for everyone to see especially with the web radio today podcast. I thanked this cancer though for challenging me to learn change and grow when I tell this cancer these things. Thanks for teaching me to. Stop and listen. Thank you for reminding me what is truly important. You can go now my more intense relationship with God. My wife my family. My new found a positive attitude and my high level at least for my age of a physical fitness have been and and will continue to to be very important and fighting this cancer battle four shore. Yes this cancer can go now. I wanted the surgery so bad. I want this cancer out. No radiation I want the surgery. Want this cancer GAW. In order to be able to have the surgery my scans needed to be clear on February thirteenth. Scans were were done at Vanderbilt Medical Center. Prayers have been answered the scans indicated that the cancer had not spread and it appears it appears to be contained within my prostate now to convince the surgeon to allow this seventy three year old man to undergo robotic prostate cancer surgery Terry and I met with the surgeon at Vanderbilt Medical Center in addition to well in addition to being a world class surgeon. She's a professor at Vanderbilt Medical School. And she's the head of the residency program at Vanderbilt Hospital. Needless to say I was very confident in her. Tomasz surprise and maybe disappointment. She spent the first part of our meeting explaining that radiation was just effective surgery and then went through a long list of possible negative things that could happen with the surgery especially because of my age stroke. Daf multitude of of really bad other things. I didn't want to know this but I found out that seventy-three is is kind of old for this type of surgery however because of my overall physical fitness my good body mass index off. Felt that that I'm on. Have some advantages that maybe other seventy three year olds didn't have but asks. She pointed out even with my ideal weight and fitness still had seventy three year old parts. It was clear if I was going to get this surgery. I needed to make my case I wanted I wanted. Everybody wanted the surgery so bad so I told her about my life and my plans and then I I finally said to her. So Hey let. Let's pretend that that I'm your seventy three year old father as your father. What would you suggest my treatment should be her? Answer with a smile. Well Dad I think we should do the surgery as you say you are in really good condition for seventy three year old. She said that that I'm briefly observing my personality. Mas ZEST FOR LIFE. More positive attitude. She really felt that the radiation coupled with the hormone treatment which has to be part of that radiation treatment would change me in a way that that might cause a profound negative effect on my positive attitude. My Zest for life my desire to stay physically active and then these words lutts scheduled the surgery. So I- underwent a robotic prostatectomy robotic prostate. Surgery was performed on me on on March fifth. I was wheeled into the operating room and I got a quick glimpse of that huge spider robot. Believe me it is so much bigger and scarier than it looks at any picture. Then short blink. My eyes and I woke up in the recovery room. Six hours later. Terry's beautiful face smiling down at me with Mark Cancer Ridden prostate gone. Now I have to tell you everybody. I cannot imagine how this recovery would have gone without. Terry's help almost daily twenty four hours a day. There were things that that I had to do for myself or someone do for me. Would I had no idea how to terry learn them all and perform them all? What a trooper. What unbelievable sacrifices she made so with her help. The recovery process went by quickly and really without any problems. I started walking to and then three miles a day beginning within a few days after the surgery this is important everybody to other members of my family. Both nurses were so much help. Terry's sister Laurie was on the phone. Almost nightly with instructions. And and help for Terry and I and then early in the process and then through the recovery process talking with my sister. Marcia was an unbelievable comfort for me. Marshes recommendation of the book getting well again was Talisman that got me out of my initial depression and then on the road to my new relationship with God and trust me everybody a much needed and effective positive attitude and by the way. I'll be talking about that book on Episode Three. The the May third episode of the Web Radio Today podcast So to to bring this long rant about my cancer story to a close I want to let you know that tomorrow again recording this on April seventeenth tomorrow. I'm adding running back into my workout six weeks. After the surgery I follow up. Appointment is next week and at that time we will find out what next steps will be. Hopefully I'll be able to provide you with an update on Web radio today episode. Three whatever happens as I've been saying since January sixteenth. It's in God's hands everybody. Not all men will die of prostate cancer but all men will die with prostate cancer. That statement may not be totally true. But but it's close to true if you look at the ages in the numbers and every man. I know every guy out there that I can reach with this web radio today. Podcast needs to know killer out there and it could be living in your body right now. Lease have that digital exam each year it's Yucky. It's uncomfortable but it's a lifesaver. Also please have your doctor do that. Blood draw and test your PSA every year. If you know that you haven't had the digital camera or a PSA test over a year make a special appointment. Here's the thing the earlier you start getting. Psa test the more effective they can be because your numbers they can be tracked over time prostate cancer. It's now hitting man at at a younger younger age also seems to have black man at a higher rate. And if you're having any kind of urinary issues it's your doctor right now I urge every guy and every gal get an stay in shape being in good. Physical shape helped me to ensure that I can get tolerate and recover from the surgery at my Vance to age of seventy three the goal and why. I'm starting the web radio today. Podcast is all about getting you healthy and in shape guys and gals. It's about fighting cancer. It's about fighting all life threatening diseases and even more important than that. We're going to spend time on the PODCAST. Spend time on our faith and our positive attitude become somewhat of an expert in dealing with life threatening diseases lease Rumba perspective of the patient or the person who's WHO's trying to avoid serious life threatening disease. I'm going to continue to research that information and share it on web radio today so it goes without saying I want you to be part of this podcast and I'll be here every Friday to spend twenty or thirty minutes with you.

cancer Twenty twenty prostate cancer Terry Columbus Mark Cancer Yawkey Columbus Ohio I Diana Vanderbilt Medical Center younger age gleason Vanderbilt Hospital Ohio Vance
EPISODE 3B WEB RADIO TODAY

WEB RADIO TODAY

06:30 min | 7 months ago

EPISODE 3B WEB RADIO TODAY

"Hey everybody thank you so much for pushing that play button because I have. I have some really good news that I wanNA share with you today about this battle that I've been waging this year with prostate cancer. A good news. Today these verses from the the Ninth Chapter of of Matthew so clearly focused everything for me versus twenty three twenty two again the ninth chapter of Matthew just then a woman who had been suffering from bleeding for twelve years. She came up behind him talking about Jesus and and touched the edge of his cloak. She said to herself if only I can touch his cloak I will be healed. Jesus turned and saw her and and he said these important words to her but they're also for all of us take heart. Your faith has healed you and she was healed at that moment. Everybody Mafi has healed me for those of you. Who Don't know my cancer story. If you're interested you can listen to it or read it on my website web radio today Tom. Just Click on the genesis link mine counter and my confrontation with prostate cancer. These past months exactly ninety four days as record this so many changes have occurred in my life over this ninety four day period. The number one change the most important one of all being that this battle with cancer. It's brought me home to Jesus in my Christian faith that which has sent to destroy you will deliver you. Another of the changes and the outcomes from my experience with cancer is that it became the genesis for for a new faith based fitness and health. Podcast that I've created. It's called Web radio today okay. I've kind of buried the lead but here is my good news. I had my first ever medical tele visit on April twenty third the Vanderbilt Hospital and the Vanderbilt Medical Center with they're doing tele visits in lieu of appointments for for most of their patients because of the covert nineteen situation the Tele visit last Thursday was with the surgeon who who did my prostate surgery and who is essentially managing my prostate cancer. Care Right now. She is a superstar. It was also her first. Tell of visit and on the technical end we did pretty well. No glitches or anything like that. But the big news. She is so pleased with my recovery from the surgery. And the fact that I'm experiencing only minimal side effects. She also made this comment. That I'm kind of proud of considering that Emma on a fitness Geek. She said that she has never had anyone. At my age recover so quickly and so easily from robotic prostate cancer surgery but but but the big news my psa was undetectable that means no evidence of prostate cancer. I asked her. I said well watching. Tell my kids my grandkids and my close friends. Do I say it's in remission? She said tell them you no longer have prostate cancer. There is no prostate cancer in your body. The surgery to remove it was a success those words the answer to so many prayers that have been parade by me and for me over the past. Several months told me say one more time I no longer have prostate cancer. Oh Yeah God is good. Everybody God is wonderful thank you Jesus. Thanks to everyone who has been praying for me and sending me good thoughts over the past several months now of course like all cancer survivors like all cancer survivors. That's pretty cool to say like all cancer survivors. There is the worry the the very real chance you could come back. It's going to require constant monitoring and well also looking at other treatments that could could help ensure that that doesn't come back. Maybe more about that at a much later. Date the big news for me and for those that have been Parang for me. With God's help my nightmare is over for now

prostate cancer cancer Jesus Matthew Vanderbilt Hospital Tom Emma Vanderbilt Medical Center ninety four days ninety four day twelve years
Shyam Natarajan, CEO and Founder of Avenda Health, Explains How the Start-Up is Gaining Momentum  Natarajan

MedTech Talk Podcast

31:40 min | 1 year ago

Shyam Natarajan, CEO and Founder of Avenda Health, Explains How the Start-Up is Gaining Momentum Natarajan

"Hey, welcome back. This is Tom Salama. You're listening to episode one. Thirty three of the med tech talk podcast lately, we spend a great deal of time talking with experience med tech exacts like Dennis Warren, Scott heinekens conversations invaluable so valley, you can so can so much from their years of experience. But I wanted to take a different approach with this podcast in this episode. We're going to talk with Sean maharaja and the CEO of an interesting startup called Venda health. It's a really early stage companies developing a system to use focal laser ablation to kill prostate cancer. The company's original founders not erosion in Dr Leonard marks started working on it in earnest, maybe five years ago, or so, but recently, they've started get some real traction. But the FDA and they're making some big moves on the financing side as well. So in this interview, I'll talk with Shaam about the company's origins. It's unusual fundraising path and it's relatively short path to potential FDA approval. I thought this focus on early stage company would benefit those of you out there who were really entertaining thoughts to create your. So I hope you learned something from this experience. Before we get into a vendor story, though, I want to remind you that the meta conferences coming up on may twenty ninth and may thirtieth in Minneapolis again. If you look in started med tech is a great place to network and meet people you've got the day planned out on may thirty that's going to be our usual, usual agenda, but work really begins. I may twenty ninth. We'll be offering breakout sessions to start and then we'll have a very first opening reception for the entire attendee list at the conference. So everyone's invited to the lows Minneapolis hotel to get an early start on networking. So if you haven't registered yet, go to meant tech conference dot com, and please don't forget to use your med taco. You'll save yourself two hundred dollars and do it quickly because our discount rate will be expiring very soon. Now, let's get into the story about of into health. We'll start off with the company's origins. Can you give us a little bit about your your background? And and how did you get to the point where you are? Sure. I'm first of all thank you for having me here. So event health really started out of a academic exercise before this. I used to be a professor at UCLA in violence during in urology, really working on image guided surgery for detecting and diagnosing, and the now treating prostate gets so been an academic for pretty much my whole career worked a little bit on the startup side, you know, for internships, etc. I have a computer science background and from the bay area. So you know, I've been exposed to of the startup community. So I always had a passion for entrepreneurship and medical devices is kind of an interesting field because we you know, in in the academic side. Learn about prototyping building up device and then testing it out in clinical studies. Or in vitro studies. But really we don't get exposed to all of the great challenges involved with reimbursement regulatory at cetera in so it this has been a really fun journey for me taking this project from the very early stages when we had a napkin sketch against new early prototype at the university testing it out in a clinical trial at the university. And then finally launching the company about two years ago. So I think this has been pretty fun journey for me. So where did that where was that? Napkin sketched on where did this develop from? Yeah. This is great question. So my research is primarily been focused on image guided prostate biopsy, so using MRI and ultra sound to be able to find in diagnose prostate cancer. So I have had a great collaboration with a urologist at UCLA who's now my co-founder. Dr Leonard Mark's been him, and I in working for about a decade working on the targeted biopsy. Upside of things taking this technology, this concept of being able to image prostate cancer for the first time bringing it to the bedside and being able to specifically diagnose it with increased sensitivity increased specificity and being able to track these cancers over a period of time. So after about thousand patients are so of doing this very sophisticated diagnostic procedure, we realized that it was possible to go back to the same spot six months or a year later in the same tumor fo- Cy and be able to characterize it. So we thought well if we can find it target track it characterize it why not treat it where it lies, and that's how the Venda health started. This whole concept of folklore treating prostate cancer rather than removing the entire prostate and causing all the quality of life problems associated with Sean says the goal. Standard for diagnosing prostate cancer. We used to be biopsy needles. They were randomly inserted guided by an MRI looking for the prostate cancer. But MRI technology has made such great leaps in the last decade or so that we can now use imaging to diagnose it as well. And in the case of a vendor we can use that same MRI technology to create a targeting system for a very powerful new weapon. Let's listen, then to health is focused on focal prostate cancer treatment while preserving home of life. We're making the whole exercise of being able to treat prostate cancer in a clinic while preserving quality of life, so simple for the average urologist, and we're doing this by enabling the urologist to predict where the cancer is through our software form using artificial intelligence, and then being able to treat in at the bedside in the same manner that they perform the biopsy that instead of inserting a biopsy needle there. Inserting a laser fiber in our sensor. Be able to monitor treatments real time. So this is really taking the whole concept of you know, in and out of the doctor's office for clinic. Visit by applying that to cancer of is making a lot of progress. The company is relatively new we'll get into its founding in a few minutes. But if the work started at UCLA four or five years ago, the company developed its early concept, it got an ID from the FDA to begin a small trial on ten patients with intermediate risk prostate cancer, and the showing some promising results so that trial, which now we have about two years follow up and beyond has shown that this concept of treating prostate cancer folklore preserves quality of life. We had not seen any incidents of sexual or urinary dysfunction. That's typical with some of these radical treatments as well. As able to be performed in a doctor's office under local anesthesia based on those results event secured. A national academic industrial partnership grant from the National Cancer Institute. This is an accomplishment that not erosion says he's really quite proud of company. Also got a boost in some help. From an unlikely source more on that after this message. The one thing we cover and almost every midtech talk podcast is just how difficult it is to run a med tech company to start a midtech company to run the meta company. I hope these podcasts provide some comfort solutions, but I'd like to offer up another resource attendees at the midtech conference will have access to some real problem. Solvers in metric through our breakout. Discussions going to cover a lot of different topics from precept meetings to GDP are IPO's to building toward a digital future. Securing successful coverage. It's all there so much to learn. So these discussions will be held in smaller rooms conversations will intimate and ask the questions you need to ask. What you need to do if you'd like to have access to this kind of resources, go to midtech conference dot com. Register for the event you can pick your breakout. Russians. We'll have some on Wednesday may twenty ninth at some on Thursday may thirtieth. You can pick one for each you can actually choose up to and let us know also if you're tending the reception, which is happening on may twenty ninth. That's first time we're having a conference wide reception prior to the the midtech compensate, you really get an early start on your networking and finally, of course, registered before April thirtieth. So you get the discount rate and use your midtech talk code. So you save even more money be able to show your support for the podcast and keep couple of hundred bucks in your pocket. So why not do that? So go to med tech conference dot com. Register sign up for your breaker discussions, and we'll see you in Minneapolis. And now, let's get back to a vendor story event is making great progress in the clinical side, but something has to pay the bills. So I asked them how they set out to raise money if they established a financing roadmap. And if so how closely did that roadmap match reality. Let's listen. So I'm chuckling a little bit. Because certainly I thought this could get done for a million dollars in six months and everything would be great. But, you know, reality sets in and so really when we started this project. I thought that we hadn't good clinical data out of this university ninety sponsored trial. We thought that. Okay. We just need to go through the design for manufacturing gets through the FDA. We thought ok maybe a million dollars might be enough, but turns out that manufacturing and design controls and all of the other fun stuff that you have to do to get approval is definitely a lot more intensive than on the university side. So for me that was definitely a learning experience over the last several years, and with this grant, I think it was kind of interesting because we got the grant without having started the company and even with Mantech innovator. We actually didn't have a company at the at the time that we initially got accepted to the Laredo program. They actually told us you have to start the company if you want to get into the program. So I think that was really the forcing function to start the company to start seriously looking at you know, what what sort of capitals involved, how many employees, you know. What what should be the the step wise approach that we get really this product to know not just the clearance, but really some some level of robust reimbursement than Newmarket success. Because at the end of the day. That's what we really care about is making a product that invented especially for prostate cancer, you know, Medicare population. So what was the procedure the process like rather for the grant application, how difficult was that? And did you did not need to be accompanying to to apply for those grants? Correct. We went through something called the academic industrial partnership prevent so this is what's typically known as an RO one. So it's a research grant, not a small business grant, and you have to have an industry PI or principal investigator as well as a university principal investigator, and we ended up getting the grant and actually scored the highest nurse study section. Despite not having an industry partner. So originally we had to we we started working on, you know, getting third parties to build various components for us. And then eventually realized that well in order to submit this to the FDA, it can't be, you know, UCLA submitting this this device it has to be. Real company. I think for me it kind of satisfied the. My goals lie dual goals of being able to make an impact on patient lives. While also satisfying the curiosity and interest. I had an entrepreneurship Sean says of into locked up three point one million dollars from that grant program and the capital is gonna go to pay the cost of the company's clinical trials, but the company shot way past his initial cost estimates of a million dollars. So they needed capital to pay for bills as well event. It was able to round up another three point three million dollars from angel investors. Sean to walk us through the angel. Investing raise was that process easier than he had anticipated or more difficult. So I would say both I would plant angels in two separate buckets. There's the evangelical angels who are so excited and so motivated by either in the success or the the team where the technology. That you know, the process is a lot more simple. It's just explaining what you've done showing them your clinical data and showing them the path forward in terms of what's capital raises. You need what sort of dilution in what's potential outcomes they could have enjoy from. But the other sort of angels, I would put into like a more seasoned or knowledgeable angel in the field, and this sort of angel. You know, does the standard due diligence? They look at your legal documents one of the. He. Benchmarks that we had to pass before we were able to raise capital is we had to have a free and clear license from the university for intellectual property and working with universities. Sure. Many of your listeners have done this as well. It would be a process, and it can take a long time. The Timothy almost the license. Outer IP at the end of the day. Even from an institution like UCLA that I imagine. What would do this frequently still in process? I think so, you know, we love UCLA, you know, they've been really good to us. But at the end of the day, it is still a process. No matter where you one process that Shaam found, very helpful. And very productive was the med tech. Innovator program of end ahead applied to be one of the companies, and for those who aren't familiar with the program started out as med tech. Idle. It was a pitch contest held at industry. Conferences. Startups would get up on stage pitch their programs and judges EVS's would give their commentary which use a winner and someone would walk home with a giant check. But Paul grant who you may know, formerly from our CTO technologies has really evolved the program. He's added regional elements presents investments to the winner. So I asked Shaam what the process was like, and what have been the long term benefits of being part? Mantech innovative program. Let's listen when we started out there were about six hundred companies that had liked the program and the way that it's structured is that there, I know that they've changed in recent years, but it was a number of regional competitions. And in each within each region. The winner of each competition would move onto of the finalist round were get invited to the accelerator program, if they necess- find some benchmarks, you had to be seed series B, you have to not, you know, have significant amounts of revenue, etc. So I think midtech innovator their focus in their aim is to really make companies in the early stage or get them to prevent making mistakes that kills deals later on and to really start thinking about like the important things in med tech like the value proposition reimbursement. You know, what does it mean for all stakeholders, not just the physician or the provider, but you know, the patient payer. Government industry cetera. So that process was interesting because we were definitely the earliest company in the whole program when we onto the accelerator program after winning the LA competition, we realized that we were think we were about three weeks old as a company, and it was I think the network provided by men taking of air was probably as important or more important than the program itself because through this program been able to meet some fantastic people in the industry. Other entrepreneurs other folks on the venture side that have really allowed us to step up our game and and start at that point. Look like, a real company do the right things get a nother co founder so actually based on feedback in the program. We've got another co founder with one of my friends from UCLA who actually. Ended up going to the medical device industry in worked in pharma digital health printing, very busy, so her and I have been working since then since mentality innovator about eighteen months ago, we every day, and I think having a really strong co-founder is probably one of the best things. Best pieces of advice that the medic innovator provided so Venda actually did pretty well out of six hundred applications at one the southern California district contest, it was one of twenty companies that made it to the accelerated class. It wasn't one of the final four finalist rather. And it didn't win the grand prize. But Sean says he walked away with a great deal of insights. And a lot of great advice and a really strong alumni network. One of the more interesting suggestions was bring in a third co founder, which ultimately ended up being Brittany berry. Pusey who is now serving as co founder and chief operating officer of event, I ask. Shaam why that change was necessary. You know, when we started it was myself, and my other co founder, Dr marks immunize have been working together for about a decade. We were at the time we were both on the academic side. I had worked at a program called the business of science center at UCLA. So I had some exposure to entrepreneurship and had some great mentors at the university that have been successful in other businesses, like pharma, etc. But. I think one thing that we sort of lacked in in the team is being able to have that industry perspective of seeing you know, how how does like a big player think about you know, technology. How what are they care about? What are some of the things that you no matter in terms of? You know management of people skills etcetera that it would be really great. If we could find somebody like that to round out or team. So Brit was actually my first choice her, and I have been had been talking for for years. You know, we we were working on the business side center together. She actually started that program and every six months we check in with each other saying, oh have you left the university? Oh, have you left? Your job. Like, you know, what what are we going to start something? And we actually had started something in the past. We actually ran the first healthcare hack on in southern California. It's about three hundred call students, you know, this is about two thousand thirteen but I think we enjoy working together. And you know, she was my first call, and I'm very grateful for her coming on board. Because I think that's since then we've really been a real company so has the team in place. It's got a strong network from the school from its angels from the medic innovator in his closing in on FDA approval. Using the six million dollars. It has raised from grants and from angel investors. So what is the company's next big goal setting out to raise ten million dollars. I series. There was a time. I think one of a company was raising money when when they intentionally would avoid talking to people like me in want to have the publicity because I wanted to limit their. Sations to investors. In by people like me. Of course, I mean reporters in in the media is is do you find that the getting the word out of Enda? And in telling of the story more Bodley is something that you imagine you expect it will enhance your chances to to raise that series. Well, I think the way that we think about you know, fundraising and also our path forward is that the prostate cancer space. There's a lot of activity in on the side of benign prostate hyperplasia. But on the cancer side while there is a lot of activity. It's really hasn't changed in several decades. So I think the able to tell the story that we're transforming the treatment of prostate cancer. We're taking a morbid inpatient procedure that has a fifty percent chance of ruining your sexual or urinary function and taking that to a simple personalized outpatient Trine treatment that you can do in under an hour. And then go home mmediately afterwards. I think that story of thing that we're we're changing the game for these patients with prostate cancer about three million men in the US are partly living with disease, but I think in terms of fundraising in getting the word out. We really see this as we really need to get the word out about what we're doing. Because there's not been historically a lot of attention on the answer side compared to save breast cancer or some other cancers, but aren't they cancer? I think is undergoing a whole industry transformation, you know, with better imaging better targeting better accuracy and now with event health better therapy. So what has your your fundraising process? Look like so far have you been meeting with with venture firms? Yeah. So we've contacted a few venture firms. I think we're just at the beginning stages of our fundraising process. Had been having a lot of great conversations with the venture folks in med tech. I think the perspective that we've been getting is that for VC for this traditional med tech BC's, the sweet spot is really post approval. And you know, starting that commercialization we're kind of an interesting period where we're pretty close to submitting, and we have a pretty short path towards approval, but I think the med tech industry. Yes, uniquely is pretty mission driven. So even with funds that maybe aren't interested in our particular technology have still been helpful in connecting us to other folks. And really giving us feedback on our on our process. So I'm pretty grateful to the industry as a whole going through this process because it's while challenging it's been been getting a lot of great. Feedback in making a lot of good connections. Are you surprised by the collegiality of the of the industry? It seems like you're getting a lot of support from a lot of different people. Yeah. I it. It was kind of surprising because you know, have a lot of friends in technology, you know, working at large -nology companies in the bay area and the perspective that I get from them. You know, even if they're on the startup side is that everybody's trying to be secret stealth at centra where whereas with med tech innovator, you know, even beyond meant taking with the with abdomen and some of the other groups out there like I oh com. It's been phenomenal firms of the kind of support that we've been getting from not only the VC community and the the investor class, but also other men tech companies that some of them in urology that have been very helpful in helping us navigate through the process because I think at the end of the day as an industry, we all want to see no patient's lives getting improved. We all wanna see projects getting. Successful assuming you're not a direct competitor. But now it's been it's been a great process. But at the same time, it's it's a challenging process because. In terms of capital for men TEK versus capital for tech. It seems to be a lot less in terms of the deal flow Farley. I wanted to get a sense of what it looks like today when I talk with Shaam he was in one of those phone booths inside of a we work set-up. So they're gonna co working spot in Santa Monica, the running lean they've got staff with with heavy software intact backgrounds. I just want to understand what the company looks like today. Let's hear what he had to say. So we're six employees right now, we have you know, the five core. Members of our team will see software engineers, and then we have a whole host of. Interns that are either in software engineering, a UI design or we actually have a fourth year medical student taking a year off who has an engineering background who's working on some of our clinical aspects. So I think we've been fortunate in that we've been able to be very lean. But at the same time our team is pretty phenomenal. You know are two software engineers have built our product in less than a few months of, you know, we're starting to build our our next Soffer product, which is a cloud based platform for prostate cancer treatment planning, and yeah, we I think we work suits us because our personalities to be this, you know, lean scrappy technology for this disrupting healthcare. So I think it it really suits their personality in terms of you know, where the companies do. Do you see yourself as a as a pure med tech company or a hybrid of mentality intact? Yeah. I see ourselves really as a kind of a hybrid were, you know, this new era of men tech where we have a great, you know, contract manufacturer that working with or building our product. I think this field has a lot of greats service providers. But at the core of our business or the core of our team in our core. Competency is really software is really building out. Great software to be able to. Foreign predictive margin, planning for prostate cancer patients to be able to risk stratification vehicle to use artificial intelligence and use cloud services, etc. To be able to. Rapidly transform both the device side of things and also be able to scale more broadly. Just let me give example on that for our actual treatment device are laser ablation device for prostate cancer. We are giving it the ability to be able to monitor all of the inputs and all of the usability with the procedure. So that we can be able to monitor in real time. You know, how the system is being used and how if any errors happened if any challenges occur we can actually feed that back into the whole process. So that's been very helpful even on the validation side of things getting tiff DA. We're able to use the device as you would normally use it. But at the same time, we're collecting all this data that we can then feed back into the process to be able to improve you final question. And this is one that maybe could have could have prepared you for but fewer to talk to someone starting a company today. And you're conveying your story looking back are there one or two things that you perhaps would have done differently would've would've you corporated earlier and started the company earlier you brought into co-founder earlier any any obvious things that you would like to change from this terrific founding story. I think I would have started a little earlier, I think definitely in external force led midtech innovator to get us going. However, I don't have any regrets in how he started and how he developed her company. I think we've been able to surround ourselves with some great seasoned serial entrepreneurs some great advisors vote on both on the medical side and the business side. And it's almost nice not having kind of the baggage of knowing how how things are typically done to be able to build your company because I think some of the decisions that we've made early on say with how we're doing our design controls that cetera. Are getting are enabling us to be able to be lean and scrappy, you know, I think just an example is just how we're doing verification validation and being able to do our data collection. I think coming from a, you know, some of our advisers is telling us that maybe you should do this like the the way there's always been done first, and then an iterative from there. But I think the way that we're doing it now is allowing us to rapidly iterating skill quick here. That's great. Well, it's a fascinating story. And I wanted to follow up with you after you sure, you will do this closed on your your series. I because I think it's a really interesting space. Thanks for being so generous with your your thoughts and insights. Well, thank you so much for having me here. I really appreciate it. I will have to wrap. Thanks so much for joining us on this episode of the midtech talk podcast. Hope you enjoyed hearing a of story. We'll try to track their progress going forward if you enjoy this podcast, please subscribe, please tell your friends, please share this podcast future podcasts on Twitter, Lincoln and other social media. You can also share with friends directly via text or whatnot. If you do share in some of the social media, please do tag me. I'm on Twitter reach me at midtech, Tom. And of course, reach out to me on Lincoln to hear from you. And we'll hear any questions thoughts. You had about the podcast. Finally, you can also reach me the Email. My Email address is Tom at health g dot com. That's the word health, followed by letters EEG y dot com. Health is the producer of this podcast. And of course of the med tech conference happening on may twenty ninth and thirtieth in Minneapolis, go to midtech conference dot com. For more information. Check the Genda to look at our breakout. Discussions, and of course to register using your med tech talk code use that code you'll save yourself a couple of hundred bucks. That's folks. Tune in next week. We'll have another great tale of innovation for you on the midtech talk.

prostate cancer UCLA FDA Sean maharaja Minneapolis Shaam co-founder Tom Salama California co founder Dr Leonard National Cancer Institute Twitter professor Mantech Dennis Warren
91 - The Penis with Mindy and Bruce Mylrea

Switch4Good

46:50 min | 3 months ago

91 - The Penis with Mindy and Bruce Mylrea

"My husband my dear, sweet husband almost forty years. He got diagnosed with prostate cancer about nine years ago and all the doctors through all of the. Removal of the prostate hormone treatment. Radiation Chemotherapy they all said that. He would not have any erectile function at all and I should be prepared for no sex life well as we went through. All, the treatments, his his erectile function just kept getting better and better and better and better. Hello out there everyone. We are so so pumped to welcome you to the switch for good podcast I am Olympic, silver medalist and switch for good nonprofit founder, doc-, wash an IM, Alexandra Paul, a certified health coach and a long-time actress years ago. My life was radically transformed when I made the switch for good away from eating animals and animal based products. My athletic performance was greatly enhanced much to my surprise actually by the power of plant based eating dropping all animal products for my life has finally aligns my values with my diet. And now I feel more balanced and war peace with food and with my body. Alexandra and I started this podcast with in mind. We are here to take you on a transformative journey to learn the power of eating plants and help you redevelop a healthy relationship with food and a more whole relationship with yourself. Each week we bring you doctors, Dietitians, psychologists, prominent athletes, and other interesting guests who have rich information and inspiration to share. We welcome you every week. Join US on the journey to switch for good. This is the future. Good afternoon good morning, good night wherever you are everyone and welcome to the switch for good podcasts, dot C. Bausch and I am right here across the table from Alexandra Paul the Alexandra Paul. Now. EITHER DOTS how? How are you? I'm good and So you know we do talk a lot about poop on the show and we've mentioned that over and over again But today we're GonNa talk about that same area but a little bit more about penises. Yes and I have to say him so I'm really excited to talk to our gas because they don't shy away I mean we've had doctors on this show who say things like down their Private Parts I remember one show I start talking about penis because I was not happy with us sort of. Right, in the penises amazing thing why dance around sell it girl Right. So we're going to be talking about penises today and prostate cancer because unfortunately they do go together We're interviewing Mindy and Bruce, Mill Ray, and they're the founders of one day to wellness, which is a nonprofit and they're also. They're married and they're the. Of two new books that are just out one is called the plant powered penis written by Mindy and Bruce Because of his personal experience Gently wrote the plant powered approach to prostate cancer which released yesterday. Yes. Exactly. Exactly. So This is these are two topics that one might make you giggle and the other one serious. But we're GONNA talk about them both very honestly, and they're here to educate us about the prevent the preventative. Benefits of plant based. Diet because they travel all around the country in their RV which they're in. There are Vit right now as they're speaking to us parked in Santa Cruz because covert has For the moment stopped their their their traveling, but they're going to talk about these very. Things in our lives that are very common. Prostate, cancer and penises. So let's get on the wellness wagon of Mindy and Bruce Mill Ray. Hi Welcome to the switch for good podcast. It's courageous be with you. Goodness Gracious. Well I definitely. have learned that not only as an athlete but someone who appreciates one specific penis in my life that good blood flow is good. Blood flow is good blood flow and what I mean by that is. You need to get oxygen to the working muscles organs we need to get oxygen right through complete and fluid blood flow to our brains, right so that it doesn't the. The neurons don't die off. So we may be don't get Alzheimer's, and we also need to get blood and oxygen to the working muscles so that I could produce what I did in the Olympic. Games and for our down there part. Sorry. Both women and men it's all about the open breathing arteries and and being able to get the blood flow moving and the oxygen to. The penis so that it can do its job and I I have learned through the the journey of making the game changers film and everybody knows that scene in the game changers film right where they basically see the plant based Diet affects the peanuts and I think it was you know most guys you know what? The what the reason that they thought the film was legit was because okay that's really mattered. You said the film they only need to show that really that two minute I think so and everybody would have been like, okay, we're sold we right. But that I learned that really if you have erectile dysfunction and you go to the doctor and your doctor gives you Viagra. And he doesn't mentioned to you or she hears she sorry thank you. I'm just thinking penis something is, but it's probably could be a woman. That if he prescribes Viagra but does not suggest that you go see your cardiologists that's basically malpractice because you have not only erectile dysfunction you have a blood flow is which means your arteries are starting to be clogged, which means you are susceptible to a heart attack. Can you talk about that and kind of fill in the blanks that I've left there? was first of thank you so much for. Having us on we are we are thrilled to be here and you are absolutely right. It the blood flow to the arteries into the veins. It goes up the bane chain. So if you have erectile dysfunction, you are much more likely to have A. Athlete grosses and a heart attack Alzheimer's all of that. So the arteries that feed the penis. In the Groin area are so much smaller that that's going to show up I. so anyone that has erectile dysfunction it's like a canary in the coal mine you are. You're that's a little red flag saying you know what he d is a sign of an early death possibly, and we need to be really conscientious that the reason I wrote this book is that my husband my dear sweet husband almost forty years he got diagnosed with prostate cancer about nine years ago and all the doctors through all of the. Removal of the Prostate Hormone Treatment Radiation Chemotherapy, they all said that. He would not have any erectile function it all and I should be prepared for no sex life well as we went through. All of the treatments, his his erectile function just kept getting better and better and better and better, and and I thought I gotTA write a book about this 'cause everybody that I talked to was wrong and this guy is thriving and it all is because of the foods that he eats it. Because I have a hot Y. See that. Producing nitric oxide into your body really allows for the blood flow to to flow all the way through the arteries and the veins, and he's got great woody's and I had to write about it. I had to write about the woody. We're happy that you did and I know a lot of people will be helped by this book because you write about it honestly but also in an entertaining manner. So but with a lot of science and personal experience to let's go back to Mindy and Bruce, you've been the fitting you were in the fitness industry you well, let's start with you met in Santa, Cruz Bruce was surfing and Mindy was acting and you fell in love you you raised a family mindy you were. A champion aerobics instructor and you also won that world, National Aerobics Championships in the national aerobics championships chips in the early nineties. So everyone would have looked of you and thought you were super healthy couple. But Bruce, you've said that you've really eight a bad a junk food diet and that the. Fitness industry doesn't necessarily mean you're healthy. That's exactly right and put emphasis on the last. I just because you're into fitness industry does not mean you're healthy or the industry healthy and. I've been a very active person my whole life I grew up in Atlanta Georgia. fried chicken is a food group in Atlanta Georgia and I ate a standard American Diet. I would say a deary heavy. Standard American. For my entire life and I never gave it much thought I started wearing about nutrition as my cholesterol sorted decline in my late forties and early fifties my class raw got about. Two hundred, seventy six when I was white in my. In my what I still had a career in Silicon Valley this work together I was in a sales marketing executive for about twenty years in Silicon, valley on sixty two now and. Mike Cholesterol's very high, and we just started working together. We're flying across the country and I didn't bring. I love to read I. Didn't bring a book to read and refine to a conference of fitness conference in Mindy had the book China. Study and I said. What the heck is that. I'd never seen a buck and heard anything I read the book. I got on the plane a half century standard American Jerry Laden neater. I got off the plane a Vegan. With I was so furious that I did not understand why you know I thought it was really smart. I thought I knew it was going on the world nutrition and it just floored H I just was determined to try to. Solve a lab rat, which I still do to this day and experiment with base nutrition I dove in it was not a clean. Transition at first I thought I'd eat the grass the airport I didn't know what else to do I flew to South Carolina Barbecue places and that we changed our decision last minute to go to whole foods against sal because I became a Vegan on a plane. But the I dropped my cholesterol by one hundred points and six weeks might total cholesterol and a lot of my ldl and it just it just amazes me and I took all took my blood test and went back in to see my doctor never said anything about Diet just about drugs and I said, look I dropped my cholesterol and I did three diet by reading this book. And he goes yeah, that's great. But your PSA is high. And I said what's PSA. And that was my journey PSA as prostate specific antigen, which was high because I had prostate cancer and I know through all the research I've done in writing my book. But all over the last twelve years, it's all done is research into evidence-based nutrition. I know I gave myself cancer. In this is a, this is really the message trying this is the most important message I'm trying to get to other people's blame myself. It's not my fault it's not my family's fault. We didn't know. We didn't know like when you went to the Doctors Nineteen fifties and they recommended chesterfield cigarettes. If you had heart disease, don't wait for that diagnosis and that is our mission. I? Mean we live in a fruit and vegetable covered. RV traveling all over the world speaking on evidence-based nutrition fitness and wellness. So let's go back. To the book, first of all, your fast reader because I could not get through the China study on a flight. No matter how long it was pretty thick book but do you remember the the pieces of science in there? I'm assuming because I have read the book that it was probably Science that really loud you that made you make a change when you stepped off the plane. While specifics for me was cholesterol saturate the link between cholesterol and saturated. Because I hurt so much and Dr Campbell does drill into the connection between saturated fat and consumption saturated fat ankles, animal-based cholesterol and increase cholesterol levels and insulin level physicians follow up study with. A big wanted determined. What was the first one to indicate? It. Was randomized controlled trial, but it was a cohort study large cohort study show that net increase. Significantly increase your risk of developing prostate cancer specifically I. If you work house now as a directly their European prospective investigation into cancer another large one of the largest epidemiological studies on cancer and food down the same length. So yeah, and that's one of the main things. The first thing we say when a wellness we have three. Challenges for all the people come and take our program. The first one is ditch dairy ditch dairy. It's so interesting because as Dotson I have spoken about most people who want to improve their health or be kind to animals and the environment a ditch meet I. But most people everybody except for Dr. Gregor actually who I know is a friend of yours. So he he's the only one who said no, no, no, no I would ditch meet I. Dr Has said ditch dairy if you're going to start slowly and not do this is true. Bruce, I have a My my dad's dearest friend has been fighting prostate cancer for a really long time and hasn't gotten a dairy completely out of his his diet yet. If you were to speak to him and share with him part science and just part personal experience. what would you? What would you say to him if I brought him on the on the line right now? Well the sides seeds there. It's clear route. It, you look at the hierarchy scientific. Bottom. You've got large epidemiological studies, large cohort studies of hundreds of thousands of people. Looking at the consumption goes consumed the most dairy. Have the most Mr prostate cancer. I don't know what cohort means an epidemiologist at redeem logical either. Oh. Sorry. So A lar- epidemiological just needs. Looking at global trends at what's going on as opposed to like the gold standard for the pharmaceutical industry is randomized controlled clinical trial. So Doctor Dean. randomized controlled clinical trial with a hundred men show he split them into two groups. He said, you're just eat a straight vegan diet with a couple supplements the other groups that keep doing what you want. We're going to monitor your PSA which is. The measure you use the best market for the progression of prostate cancer. He was able to show a decrease in the PSA with the people that switched off of all dairy and I'll meet an increase in PSA in his control group observational studies. Cohort studies are much larger so you can't you can't show proof necessarily, but you can show trends that will then show give you a good indication of we need to randomized controlled clinical trials to look and and and clarify what we're seeing these trend Dan we got even randomized controlled clinical trials several which line in my book I've interviewed all the researchers that did this work. That show that even not only can you slow the growth of early stage prostate cancer through a transition of eliminating dairy in all animal foods from your diet but you can actually slow and in some cases reverse the growth of advanced prostate cancer, which is what I have because they've got all the treatments failed. I still have cancer we can't find my body, but my PSA is located. I. Have a biopsy in about a month. See if we can find it again So so so the evidence tiles up, you've got observational research though that's important. Then we randomized controlled trials that show that same thing and then on top of that pyramid, you've got people like us to live the standard American diet dairy laid guide their whole life when. Off of it and got immediate experiential results, I would ask can like, what do you love? What can you not give up right and then when I would do is I would bring my Handy Dandy recipes from my book and I would make him some beautiful cashew cheese or banana ice cream or something that was a substitute I mean your friend. Vincent in about thirty seconds I, if you look at. The prostate cancer, the foods. The number one to entertain animal foods jen animal process who is in its largest prostate cancer it's cancer, right? I mean my stories prostate cancer but the most cancer surly hormonal cancers in her mouth kisses celebrities. As Dr John McDougall told me personally it is. The cause is the rich western Gary Laden dying. Have An. Ice. And so if you look at specifically the foods, they're most associated. When you look at these observational studies, it's chicken it red meat chicken and dairy and eggs. And the for prostate cancer incidence in prostate cancer recurrence, those of the most dangerous food. So if you're interested. In trying to improve your odds Jerry's the first one that go get her taste buds backed where they they were normal tastebuds from when we were born and we are feeding ourselves glorious beautiful delicious living food. It's GonNa. Make you feel better if you it long enough to experience. But most importantly like in my situation if you're going through cancer treatments. Radiation Chemotherapy or therapy. I've done surgery I've done all these. You want to have the most powerful the most scientifically evidence based Diet you possibly can in order to recover into continue to battle that disease if your doctor declares cancer-free. Shovel side you're never cancer after you've had been diagnosed with cancer your battery you're battling cancer for the rest of your life you start switching on all the genetic singling with what you did. Before with those foods, the disease will come back just like diabetes you can eliminate diabetes through diet in elimination dairy in most cases however. As. Soon, as you put those foods back in your diet, it comes back while I wanted to. I want to know before we. Go to the next question how common prostate cancer is what's the survival rate? WHO's the most susceptible to it and I don't think I mean I don't think we have enough information really out there about about those things and forty seven men Is the leading cause of cancer death worldwide. In the United States, the third I believe is the third most diagnosed with cancer. the age. The risk factors are ages number one most people that are nandor diagnosed with prostate cancer are older than I am. which puts me in higher risk on dynasty young at hd two because our diet. I just watered genetic seeds. My prostate cancer had to have the genetics to develop the cancer, but I watered the seeds every day. For fifty years and then African-amer African. Americans are much more susceptible to prostate cancer an aggressive prostate cancer after that obesity. Is a the highest. Only one, four, seven, nine diagnosed actually die of prostate cancer so that that is good news it's generally slow growing cancer, but not always I have personal friends who were diagnosed when I was and it was on slower stage than I was that are no longer with us. and so it just depends. I'm right at the intermediate, but my cancer had already grown enough that it had grown outside of my prostate bed. That's why it's advanced and had grown into might what's called seminal vesicles and it would have gone to spread. So my surgery head didn't have the margins to remove all to cancer, and unfortunately that's why for the last nine years the good news is that there long survival odds generally. As I write about in my book but however, the difficult thing is you've got to be prepared psychologically because this can be a long term situation that you're GONNA have to deal with and you have to have a great partner at or if you don't, you've got to have great purpose if the giant randomized control trial came out, said e need Rusty Nail Sin Defeat Prostate, cancer I'll be the first one at home depot. Nails and put them in salt water to figure out how to do it. So. and. But a lot of men have trouble changing their die because as we talked about, these habits are very hard to change, and because only one out of forty seven men might die from it. that's. A reason that people might not take it so seriously, but the quality of life in terms of sexual health can be devastating. Can you tell us how what percentage of men after having either Chemo radiation or the surgery where you remove either part or all of your prostate one happens to their erectile function what percentage? What what what should they expect and I guess what's going on with you and your penis we can hear from other mindy or Bruce Abell all start, and then I'll let him finish. It's well that's that's a hard question because there are a lot of men that won't tell you one way or the other because it's it's a very sensitive. So that's you don't really know the stats all the way. However, Bruce is probably in say the five percentile that is thriving from a sexual perspective. I mean, really it's we've Bruce I had his prostate removed. He was put on Viagra right away by the doctor to get his everything. An and very quickly we learned that we didn't need that at all and it was on the doctors blown away with the doctors ask him all the time we'll how you doing. Great and I look at him. I'm great to work. Right? It's it. It's it's worthy of a book to be written about it. I'll tell you this good. The you did so so you say it's the nitrous nitric oxide in the vegetables would what makes Bruce? And a wide why does diet make such a difference? Well. When you are eating foods that help produce that nitric oxide that that blood flow the veins and arteries open up so that you can have more vascular health down there. So it's not getting clogged up and then of course, then as as you were talking about earlier than, of course, up the vein chain for Astro Service and heart disease, all of that. So it's it's all off the the from the vegetable kingdom and I talk about some superfoods, but it really is fueling yourself with plant. Traits vegetables really critical writings. Cardiovascular health and nitrate rich vegetables are metabolize to create. We all have a single cell lining into it's called. They're not aligning all of our arteries and veins, and the job of that endothelial lining is to keep blood flow happening unimpeded through our bodies. The way you do that if that's where nitric oxide is created right there in the endothelial lining in the best way to prime that pump is eating nitrate rich vegetables and eliminate the foods but are going to have the negative effects of clogging up your arteries and veins, Gary animal foods, cholesterol saturated fat, and accessible oils. But did you know that watermelon rind is sort of a super food for the Pinas? His ate that though. That's terrible. I was it. Is it the white part insiders at the outside the green part on the outside? Y Heart. Oh. What how do you eat that? You just bruce just do either. Accident. Read it, but that's a superfood. What are the top five nitrate rich vegetables? Well. Let me take lock in my book. And Evening Green Anything Green Okay. Dark Leafy Green Vegetables and beats And beat each beat up e juice juice eat leaves all cruciferous vegetables or nitrate rich Avocados are great to citrus fruits are wonderful. Berries are wonderful. So it really isn't anything that will that will create nitric oxide rich quality inside your are reason veins. I'm Olympic cyclist DOC- bash and I'm here to tell you if you've got milk then you've got a lot more than acute white moustache. There's a good chance. You've also got indigestion a hormone imbalance excess fat poor circulation and less energy when I learned the truth about how milk does a body bad I totally ditch dairy, and if you've been thinking about doing the same thing, then switch for good dot org is a great place. To start at switch for good, you'll learn the real science on dairy not the stuff you were fed in grade school, and you'll hear from people who've changed their lives by going dairy free including elite athletes like me who improve their energy performance skin complexion even their conscience. If you've got milk, it's time to get rid of it. Start Your dairy free life today by going to switch for good dot org, you'll find awesome recipes learn how to give your fridge dairy free makeover and discover all the benefits of living dairy free that switch for good switch the number four good dot org how? How can those who work in the fitness industry start to really kind of flip the script right on what what? General Public think is healthy in the fitness world. If for me back in the day in in my career as a cyclist, there was a lot of protein powders. It was like it was like you know you couldn't do anything unless you put powder in your shake and there was there was an ease of use about it sometimes, and then also just you know my my teammates and I used to just get tired of consuming. So many calories I literally get tired of chewing we would call it force-feeding when we were doing long distance stage races. So it was helpful for that too just to get something down but the now. As, just a regular active fit person not trained for anything specific I. DON'T I don't find any need at all for powders like why would I put a scoop of powder and I could just eat food? How can we change that whole entire thinking it? You know from from thinking that they need processed powder the fitness industry is I think you know on top of on top of the pyramid on that in terms of of thinking that's a need and obviously a lot of it is based in you know the the companies wanting to profit. So the company's telling you that you need this right to to be well unhealthy but. Your Martin Right. There is the reason for all all the. Related you WANNA why? Why we have these horrible chronic conditions in our country? It's marketing of. Disease Voting Food. It's. Doctored regulatory is very simple. I date a walnut and a shot beat us a date for a shot glucose in your system. That's what you need before you work out maybe a little safety for the walnut but that shot beach use that is going to increase your athletic performance by to twenty percent increasing nitric oxide production right in your. So, what's your food philosophy now because bruce here you love nut butter which has got a lot of fat in it but you you prefer to eat a lower fat diet. So tell us about your we've heard the whole food and plant based but. Low Fat to we found a solution to Russa's nut butter fetish our plant based Diet over the last ten years. Probably like most people's has been an evolution we started out we didn't know what the Hell we're doing. It'd be developed our own tools probably the most important thing we do is we just continue to stay engaged with the evidence space utrition community, but we do low fat low fat primarily because Dr John McDougall has beaten at into me up for. Cancer Treatment and. What do we do? I am addicted to nut butters the knee bought peanut butter last week. I can't stop eating it but this gals is the solution that we have found to enjoy nut butter. We made this this just nut butter sauce nut butter. We were Portugal winter at under there have been Portugal but you go to like Porto and they're roasting chestnuts right on the street and he's all bought and put them in a value. Evil and then we bought him every day we thought oh my gosh there's so high in fat or does or nuts turns out it's your touch. Chestnuts are less than ten percent fat is opposed to. Any other nut right nothing nuts nuts are generally healthy. If you eat the very small quantities, you know trying to lose weight. But I, could control it just. So delicious because we make our own nut butter sticks. So we started making nut butter sophomore with chest zillow. We've developed a low fat and we're GONNA put it on our website. We've got a thirty plus a recipes on our website. We're going to put this. So I make a my my black bean brownies and my chick cookies and anything that requires a nut butter I use this not butter is it as good? It's an acquired taste. So. As not. On Amazon they're already roasted I wrote him a little bit more. I put him in the food processor was a little bit of water and then they they make this wonderful chestnut butter and we put on our toast and as I said, I make recipes. So we are now very low fat and we say with nuts Roy's best dry roasted be second but you have to be very careful with roasted nuts because that's roasted oil and we do not eat any added oils at all just naturally occurring occurring, fat so we'll have. By the way is another evolution are dying. We gave up all added oils what three or four years ago after he went to McDougal Retreat and we heard DR Congo. Talk about all the research is done with Robert Vogel at the University of Maryland on oil olive oil slowing down your endothelial lining ability to create nitric I`ts. So you ask our philosophy of eating it really is a whole foods plant based diet with no added salt oil or sugar that was that's been added to the food. So we often have a trainings online where we train people had a cook and eat well and loves eating. That's one of the problems in our country especially is we have this focus on I'm eating something I feel guilty about eating, and so I'll either Russia or I'll be standing or I won't just sit in saver and be satisfied. Foods addictive I know is addicted to it for fifty years dairies addictive. And you both were athletes and yet mindy is now saying that you know diet is eighty percent of your health and fitness fit for life. You know if you want to be fit for life, you have to eat well to you just can't have strong muscles while Mindy. Which? When she won the World Aerobic Championship in the National Robot Championship like a hundred years ago. You she ready. She weighs now and we now both workout less than we ever have. We're better. We're better physically flexibility. Anywhere both we both feel better redoing our twenties and thirties I. Just I created a couple of years ago program called fluids strength because I noticed that my flexibility was so much more profound than ever in my whole career and I'm fifty nine. And if if I can squat low and extend and reaching twist and pull without any any feelings of fatigue or or angst or anything, it's just it's it's all it's diet. It really is food I, and the other thing too is, I want people to work out because they enjoy moving and moving throughout the day. So we follow of attendance of the balloons people that live the longest pockets around the world, and they're not going to a gym and working out for now or and feeling like they have to. They're just moving throughout the day and Brazil I travel a lot speaking and we noticed different Pockets of of old people like Italy walking the streets and they never go to a twenty four hour fitness or a gold's gym. They just move and they move beautifully and there there over one hundred. So that's what we advocate. We advocate this balance of wellness this love food and purpose. A, passion for partner. In. Life but people are so just like mini or you're just afraid you're like to give up the foods that I love the part of be giving up cheese was dislike. Could do Dow's lasting tribute ago. I still sneak over to whole foods in sample in Grad cheese. Relieved Me Thorough Dr. Bruce. Sampling cheese. House mccaskey's. Delicious. Now. But. which is just letting people know that it really if you can do it long enough to experience how much better you're going to see. That's that's the power. Well, we know that a plant powered dyke gives energy because this is a very energetic couple. They do not seem to be a couple that are nine and sixty two or that have dealt with cancer at all not one. So what? Cancer. Dealing with cancer right, right. About in your book, Mindy the plant powered. Penis. what what are some of the? How do you? What's the book about I wanted the book to be to come from a very personal perspective but I also wanted to lace all the science and the research in it as well. So it starts out with my personal story I. Have Three sons I have three brothers I have a father and a husband. I I'm the loan vagina in a sea of penises. So I have many many Pena stories so laced. Laced in the research, the science of what is erectile dysfunction, what how to curb erectile dysfunction with the foods that we eat in the purpose and the partnerships I have a whole section on on partnerships. I do have a whole section gutsy on working out and working in a creating that aspect I have a whole recipe section, really four substitutions so I have lasagna and pizza and. A breakfast Burrito and the things that we normally would eat a standard American. Diet that is now a whole new plant based Diet. I also in every chapter, I have a penis tip from my perspective, and then I have a tip about the tip. So I have a whole section on a Viagra and my story about Viagra host section of of masturbation. It's very fun. It's lighthearted, but it's also it. It tugs at your heartstrings as well and a lot of it is Bruce's. Relationship along the way and there were many stories that I read early on when Bruce was diagnosed with prostate cancer about relationships changing and changing not for the better. But for the worse because men retreated or their sexual functions within eliminator one of the main treatments for especially advanced prostate cancer, it is worth therapy. which is androgen deprivation therapy, which is a drug you take the shuts off the gene that. Tells you to get an erection? So you just loo- you don't have any it's not like you want to have sex can't sound. This is like you don't care. For years at been. Wise so that Donald shut down your sex drive a lot of work done during that time. But you can over conduct, but it takes effort you have to work at net. If you're on intermittent hormone therapy that will allow you to come back and your testosterone will come back and return, and if you've been practicing out trying to little, keep it up you're going gonNA help in the long run. But food is critical how you deal I have something called partner pointers on. I. Have I think twelve tips from my perspective from living with this man for forty years and having three sons as well. I think that it is a powerful book for relationships whatever that you are in. So I talk about I. Don't talk about just the male female relationship I talk about whoever your partner happens to be, and if it happens to be two women or two men or whatever it is, it's it's it. All is beneficial for whatever relationship that you are in. I WANNA, ask a technical question That came into my mind when you were talking is that the prostate when the process? What is the reason that? People men cannot get an erection after prostate removal. Is it because there are nerves affected or is the prostate will end even know what the prostate does well, thanks Rasa question the prostate creates. It creates the semen. Opposites, it it's. It's your. Pump semen. Optimal. You. That's what it does and it's located right at the base of its located basically the bottom between your bladder in Iraq de sitting right there. It's right in between you and your wreath against right small and it's awesome should be about size of a walnut. Now. So your question is if you have surgery, you're moving it and yes, you can get nerve damage and you can have. With robotic surgery, they're much more accurate and being able to. Limit. The nerve damage associated with the prostatectomy H, which is still considered the gold standard for prostate cancer just to have it removed if the cancer is. Contained within the prostate bed. was already outside of the prostate. We didn't find that out after I had my prostate removed. So yes, you can cut the nerves you can actually. Do severe enough nerve damage. There's nothing you can do right. So that does happen occasionally and those type those men I certainly feel for them. So that's number one. So did I have nerve damage probably but not overly extensive. After that radiation has has a tremendous efficacy a decreasing. erectile. Function over the years like the. Years as why radiologists said, you probably won't have interaction within five years ago the aside nine years, and this is after surgery now going into radiation. So the radiation. Also has is the issue and then engine deprivation therapy just shuts down the desire you have dr saying you're not GonNa have erectile dysfunction you're just erectile function is going to be minimal. Or non in Moose men. WanNa most men many men. Take that as okay. All right that's the way it's going to be and many doctors do not talk to their clients about diets. This is the this is why I wrote the book. Both real starbucks just might. Hyper extreme frustration going from the best supposedly, the best medical experts in the world don't assume the your doctor knows anymore about nutrition than the check the guy at the checkout counter bagging groceries. I would say and they don't unless they. The only way that they've gone out of their way personally to their own education very few. Have the wanted have go find him. I WANNA ask a couple other technical questions for men who might be about to deal with this or something you said that the prostate. The is the pomp. Does that mean that after you don't have a prostate if you're prostates removed that when you Jackie late then there's no Exactly. Up Okay. A dry. Oregon. And are your. Are Your orgasms affected by the surgery or is it just an erection issue? It's never know men. It's not an orgasm issue. Well, I can't speak for all men because certainly some men had made everybody's GonNa have varying amounts of nerve damage. So I can't you know if yesterday or nerve damage, you're not going to be. It's going to be difficult to come erectile attention, but it's All all this is just going to help. you Wanna do everything you can. Yeah. All these everybody said you're done and nobody said anything to me about diet and I said look at all of this research on Diet. Approved. Nine Years Lurk your share, our insure your books are really going to help a lot of people and we really appreciate that you've written them and that you've given us an opportunity to share with our audience that they can learn more about this issue. Because as you said, mindy there, we all have penises in our lives whether or not we have one ourselves. So we can help just one person, one man or one wife of one man deal with prostate cancer. If we can if I can help one penis, get a woody. I'll. Be Happy. And that's all we need to hear. Thank you so much. Thank you. Thank you guys. Hello, out there it's dot C. here and I just have a favor to ask if this podcast is helping you in any way or helping your friends or your family or peeps out there in the world. Would you favor? Would you write a review on either I tunes or your favorite podcast or Youtube depending on how you are listening to this podcast? It would be amazing. Would help so much because it helps us move up in the ranking on Youtube and on itunes so that more people can find the switch for good podcast and more people can be helped and revolutionized their health. So thank you. So. Thank you so much for tuning in today if we helped you in any way, then click the subscribe button and let's keep hanging out together. We have so much more to share with you. And if you need more information on actually making the switch for good, please visit us at switch for good dot org for loads of Info and you can subscribe to our mailing list. You will receive all sorts of super bowl gifts. Discount codes to are very Fav- dairy, free product and a lifetime a powerful health tips. So join us on the journey to switch for. Good. This is the future.

prostate cancer cancer Cruz Bruce mindy Viagra Mindy partner US Alexandra Paul Jerry Laden Dr John McDougall China Santa Cruz Alzheimer dot C. Bausch founder Vit Youtube
Prostate-Specific Antigen (PSA) Testing: A Urologist's Perspective

Mayo Clinic Talks

21:26 min | 1 year ago

Prostate-Specific Antigen (PSA) Testing: A Urologist's Perspective

"This is male clinic. Talk say curated weekly podcast for physicians and healthcare providers. I'm your host Daryl Cheka, a general internist. At mayo clinic in Rochester, Minnesota. Prostate cancer is a very common malignancy in men second only skin cancer, despite the fact that it's one of our more treatable malignancies. It remains the second leading cause of cancer deaths in men when diagnosed early it has an excellent prognosis the five year survival rate approaches one hundred percent in those with local regional disease, although screening for prostate cancer is available. The use of these screening tests has been somewhat controversial and recommendations regarding its use confusing to help us sort out prostate cancer screening, we have as our guest today. Dr Mitchell Humphries chair of the department of urology at mayo clinic Arizona and dean of the male clinic school of continuous professional development. Thanks for joining us today. Mitch thanks so much for having me. It's my pleasure. Well, let's start out by talking about PSA that's been on. Everybody's radar screen. Because it's still difficult to know how we're supposed to use that test. What is PSA? And where does it come from? So it's a great question. So PSA is essentially Therion protease of Calkins family. It's produced by both normal in neoplastic prostate epithelial cell, but it's also founded minimum amounts and other organs such as the liver pancreas salary grants and the breast even female the whole purpose of PS day is the cleave portions of the semen to liquefy, which is important in fertilization or reproduction. We think about PSA the half life is anywhere from two point two to three and a half days. And it does not bury during the day cover when we talk about PS day. It is Andhra Anderson dependent the confusing part about PS day is that it's not just one in Zaire when we talk about prostate specific antigen. It includes a whole family of it. So to really understand. It. It's really produced as a pro enzyme called pro PSA by the secretary cells of the prostate where then put into the Lumine of prostate where peptide is subsequently removed to create what we consider active PSA, and that's the functional PSA this ins, I'm undergoes pretty allies this, and it generates an inactive form of PSA which can enter the bloodstream and circulate in unbound state, which is typically referred to as three PSA alternatively active. PSA can also enter the circulation where tend to be bound by protein such as awful one anti KEMA trips in which is the most common one. But it can also be complex alpha to micro gobbling. And I go down this pathway, not to confuse the issue. But to explain a little bit more about PSA and its biggest ice forms and how they could be. So what? Mean is when we think of prostate cancer? What happens is because that sell your proliferation. The prostate those prostate gland tend to lose their basil cells with disruption of basement membrane. So what happened is more pro PSA and truncated forms have direct access to the circulation and more PSA has leaked into the blood. This kind of principle behind the free to total bound PSA ratios that we can talk talk about a little bit later, but essentially the higher the free PSA ratio. Remember when I say free, that's kind of the inactive form of PS day. Then that's the more mature deactivation. It's more reflective of normal BPH and prostate tissue versus a low free PSA. So you're getting more of the active the pro the truncated forms of PSA, which is more reflective of cancer overproduction of PSA. So that's one of the. Tests that you can use to provide clarity to PS day getting a PSA free PSA ratio that ratio is low higher risk that elevated PSA due to cancer that ratio is high the chance that that PSA is elevated due to benign caused. Women's when was the PSA introduced as a screening test for prostate cancer. And then what happened as a result of its introduction. In terms of how many prostate cancers we found? Piece actually has quite an interesting history. Social, I it was first discovered in cement in nineteen sixty six and it actually started life as they forensic tests by law enforcement in the cases of suspected sexual assault. It was first discovered in the blood and approximately nineteen seventy nine, and it was I used a screen for prostate cancer, not until nineteen eighty seven and since then FDA approved it as a screening tool in nineteen ninety four it's been used as a screening tool what we've seen is detecting prostate cancer, an earlier stage cancer detected by PSA or more likely to be organ confined and treatable in PSA detects prostate cancer, an average of six to thirteen years before otherwise be clinically apparent. So from what you're saying. It sounds like PSA's a pretty effective screening test. Well, it is but. There's a complex answer to that. And it depends on how you use it. Are you looking at it from an individual standpoint or you looking at it from a healthcare back economic standpoint. And I think any time we talk about a screen test. We really have to talk about what is our goal, and that's to detect disease before it becomes clinically relevant evident that we have the ability to intervene before can have an impact on somebody like in to meet the demand of screening test that has to have high sensitivity or a high chance of detecting disease, while missing very few cases, it needs to have high specificity or not falsely diagnosing these when it's not present. It has to be reproducible, reliable safe can bean inexpensive. And it must lead to a treatment that improves the patient's quality of life or extend their life. So we think about PSA it is very convenient and expensive generally relies on just a blood sample. And Jen there's. The general belief that if you find cancer early you can treat it early. And so there is advantage where the controversy really this is around sensitively specificity, and what happened PSA not detect cancer. But it basically stratifies and tells us which patient the biopsy biopsies are not as benign as detecting blood test that requires by seeing the prostate or even imaging there's idea socio with that there's complications associated with that. And so that's where a lot of the controversy. And I think when we talk about PSA screening, we have to really look and see what the government has done in regard. You know, there's an organization United States, preventive services task force US P SPF, and they tell us what we should do all screening calling screening breast cancer screening prostate cancer screening and a couple years ago, they came out with a recommendation that you should not do PSA screening. And the reason they came up with this is because there's been two randomized trial regarding PSA screening, the first of which was a US trial called the PL CO trial the prostate lung, colorectal ovarian cancer screening trial, this US trial. There was a property. Seventy six thousand men aged fifty five seventy five and they were randomized either routine screening PSA once a year, or what's called usual care. So patients could have BSA screening if they wanted it in what they showed is that in. Screened group and that group a only approximately eighty five percent of them underwent screening. And unfortunately, fifty two percent of the usual care group had PSA screening. And at the end of their study period. What they showed that the PSA screening group had twenty two percent more cases of prostate cancer detected. But this did not reach statistical significance. Really if you think about this study it compared a screened population mostly to an opportunistic screened population. So it didn't really answer that question. And the fact that the study group was contaminated because forty four percent of men had their PSA test of prior to even entering the study shows that there was a methodological problems with that particular study. But that is what the United Services or the United States, preventive services task force base. The recommendations on when they gave it a great deal. Recommendation. There's been other studies actually larger study there was the ER SDP study, which was the European randomize study for screening of prostate cancer. It was one hundred eighty thousand men, and what they did is they routinely screened patients with PSA every four years versus no PSA screening all and in their nine year data they found a reduced risk of death from prostate cancer by twenty percent that's significant and their recent publication where they just released their thirteen year data. They increase the cancer death rate reduction twenty seven percent. So in other words, seven hundred eighty win men had to be screened to prevent one death and twenty seven men had to be diagnosed with prostate cancer to prevent one those are pretty profound numbers where really shows the value of screening and the impact of the there's been other studies such as Goldenberg trial, which screen. And for PS day and they reduce prostate cancer death by forty percent. And there's several other trials that should be maturing in the next couple years, that's the pivot trial. There's also a protect trial coming out of Britain. And a Japanese prostate cancer screening trial that should add further light to the conversation. But when you look at all this data together, there was a prostate cancer world, congress consensus in two thousand thirteen just that for men aged fifty sixty nine level one evidence demonstrating PSA testing reduces prostate cancer specific mortality, and the instance of metastatic disease, and if anybody has ever treated somebody with metastatic prostate cancer, if not a not a nice way to go. And if anybody remembers any patients prior to the PSA era when we had asked that foster taste and we've found late days. The we've completely changed the disease course, I do. Call those patients, and they were not a pretty sight. They they had a great deal of bone pain, spinal stenosis, all kinds of problems. Attend. The mayo clinic health care leader intensive offered. Three times in two thousand nineteen March June and November gain insights into the operations of an integrated healthcare practice. Learn leadership and administrative skills that can be used at your organization and discover the best practices that have established male clinic as a trusted healthcare provider registration is open for more details. Visit C E dot mayo dot EDU. Join us here weekly at mayo clinic docs, we discuss best practices and burning questions. Subscribe today, using itunes or your favorite podcasting app. Let's talk a little bit about the problems with the PSA specificity. I had a patient last summer who's who had had several PSA's done in the past usually been around one point zero in this year's came back over twenty and I suspected there was something unusual nut specifically prostate cancer. But on further questioning turns on just went on a five day bike trip, and when we checked him after voiding his bicycle it went right back down to normal. What are some other reasons? PSA can go up unrelated prostate cancer. You're exactly right PS day does have its limitations. Then there's other reasons that the PSA can be elevated one thing BPH can cause Novick PSA bigger prostates produce more PSA, inflammation infections such as prostitites it and causing increased PSA urinate tract infection can cause increased PSA prostate biopsies or any prostate surgery. Or if the urinary tract has been instrumented either with a fully catheter anything else will cause an increase in PSA, generally as we age PSA increases as well and not to get too far into the weeds. But there's certain imaging they can cause both elevations the PSA such as with the process and Gan other thing, and you can see temporary small rises the PSA with recent Jackie Latian rigorous digital rectal exam by clean hepatitis. And 'cause increase in PSA, and there's also factors that can. Reduce PSA artificially e- crease value which should be considered such as by Alfred duct tape hitter medications that can do the PSA by fifty percent energy. Deprivation therapy can reduce the PS day. Various assets can vary. The PSA by twenty five percent depending on win. Their PSA was drawn. How often equipment normalized how old the agents are in? You can also the small decreases in PSA with debt drug use in the OB city, and even dial hemodialysis peritoneal, dialysis don't alter total PSA, but hemodialysis can't alter free PSA. So you have to think about that in contact for hemodialysis patients. It seems like ten them has swung a little bit more towards the middle. Now in terms of when we should be using PSA from we should not be using it to using it under certain circumstances. How should we be using this screening test in I think the most important part of PSA? And I think what it done it a highlight of the problem of over treatment and over diagnosed, but I think with any test. The most important part is really have that conversation with your patient the risk benefit limitation of PSA. And from my opinion. I believe the most important PSA person can get in their forty because there's been some great long-term natural history. Studies that show the medium PSA and your forty should be zero point zero point. And if you're higher than that, your lifetime risk of developing prostate cancer is very high and if it's lower than that your lifetime risk is very low. So I think the ques-. That we struggle with today. How often should we get you should be once a year every five years, and I think using some of the natural history. Data can help us stratified that the other thing is when do we stop checking? If that patient has so many Comber bidders that their lifespan is less than ten years because of the late nature in the slow growing nature of most prostate cancers the benefit of PSA probably fades away, and those men are seventy five and have a PSA of less than three their lifetime risk of dying from prostate cancer. So love it screening, probably isn't appropriate. So we have all kinds of things to help us with PSA the old age corrected norms. I think have kind of gone out of style. I think the most important thing is really to start thinking about Connecticut, how we use PS day in some of those different things for doing terp. Let's spend just a couple minutes talking about the other screening tests for prostate cancer, the digital rectal exam. Is this affective is should be continued doing it. So there's controversy with this as well. But from my opinion from urology standpoint, I think there's no substitute for good physical. Bam, and there's been data that has been shown that combining PSA with digital record them more effective than either PSA alone or a digital rectal damn alone. I think can real reveal a lot of things about the prostate, including integration d'alerte as well as any potential boss round, the ph. And if you just look at digital damn prostate cancer detecting approximately thirty percent of individuals admirable digital, but just because they have a digital abnormally direct with them doesn't mean they have prostate. I think part of the controversy with direct them this because there's no large university agreement about what constitutes an abnormal digital rectal. A lot of people say, I know what normal is until I don't. Feel it. And so you can think the same thing when it comes to the different. Finally, what about prostate cancer prevention? I've gotten some patients who come in saying, you know, my dad prostate cancer, his father had prostate cancer is anything I can do to prevent me from developing prostate cancer. Yeah, if the rape, and there's been double recent studies, the literature data about prostate cancer prevention, probably the most publicized one is the prostate cancer prevention trial, where they treated eighteen thousand bent over fifty five who had a normal digital rectal exam and a PS three and they were randomized either to benefit five milligrams a day or placebo in their five years because remember what we know about prostate cancer is that with energy deprivation therapy. Prostate cancer will shrink die and go way going revision, but it won't be a total cure. So potentially the thought behind this trial was if you manipulate that hormonal act of locally on the prostate with minimal. Defect. Can you prevent prostate? And what they showed in that first trials they were able to decrease the risk of prostate cancer by twenty five percent. Some of the initial reports came back those thing. Well, you're decreasing prostate cancer by twenty five percent, but you're increasing bad prostate cancer high-grade prostate cancer to another degree. So you're selecting out a worse malignancy, and maybe preventing lower grade malignancy that don't really need treatment. Anyway. However further analysis showed this really not to be true, the absurd affect they noted in that follow paper was really due to a detection bias, but the USA finished drive for the provincial prostate cancer still controversial there was another study called the reduced trial, which is which was the truce ride and prostate cancer events trial, which was only eight thousand men, but what they found there. They've found less Gleason thick prostate cancer by. Twenty seven percent in didn't change the risk of developing high-grade prostate cancer, however with both of these trials they commented that the use of by Alfred hitter for prostate cancer prevention did increase the risk of erected, erectile dysfunction and decreased libido those Ben. So it should be considered. There's been some other trials in this base. The trial looked at St. versus might be Linea or both of these. There's been the hope trial that looked at some of these other medications was vision health study into when you look at these alternative medications like bite him the Baleno them bite Amin's. The there's been no affect or influence on the detection or prevention of prostate cancer with those other trial. So at the end of the day. There's something to this prostate cancer prevention theory, but at this current time, there's still a lot of controversy that goes. Around the issue. So I wouldn't say that it is really recommended at the current day with our correct data that exact pathways has been defined. We've been talking about prostate cancer screening with Dr Mitchell Humphries chair of the department of urology at mayo clinic, Arizona, Mitch thank you so much for your time. Great discussion. If you've enjoyed mayo clinic trucks podcasts, please subscribe, stay healthy and CNN last week.

Prostate cancer PSA PSA cancer mayo clinic United States mayo clinic Dr Mitchell Humphries mayo clinic Arizona Daryl Cheka Mitch Rochester Minnesota Calkins family BSA metastatic disease Andhra Anderson Piece Jen