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Prostate Cancer Alert: What to Ask Your Doctor When Your PSA Is High · Intellectual Medicine

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  Preparation is the foundation for success in any endeavor.
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  Now, I'm talking about you being prepared when you see the doctor
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  and you're told that you have an elevated PSA or that your biopsy
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  came back positive and you have prostate cancer.
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  In the next few minutes, I'm going to share with you some
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  questions you should already have in your mind.
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  Things you need to ask when you have an elevated PSA.
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  An important question, very fundamental.
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  Do I need to see a urologist? It's not a requirement, it's an
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  option. We'll explain why I am a little
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  skeptical of the movement vigorously toward a urological
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  consultation. Just because you have an
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  elevated PSA does not mean that you need to go to a specialist.
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  Your primary care doctor can manage this.
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  However, you're going to need to be assertive.
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  The primary care doctor is almost obliged to make the
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  referral. It's a medical legal thing,
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  right? It's a peer pressure thing.
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  But if you say to him or her, you know, I don't want to see
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  the urologist doc, can you manage this for me?
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  That will liberate them to make that recommendation for you.
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  How about this question? Do I need a biopsy?
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  An elevated PSA, folks, is never a trigger to an automatic
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  biopsy. You never need a biopsy.
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  It is an option. We'll explain the limits of
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  that. Well, let's talk about it right
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  now. Biopsies have been around since
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  the 1980s. Now just just freeze frame for a
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  minute. The 19 freaking 80s, folks, that
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  was 50 years ago. The 1980s.
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  We had gas lines. I was wearing bell bottoms.
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  They're talking like ancient history.
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  Do you mean to tell me that in 50 years we're still Japanese in
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  prostate Glens? That's as good as it gets.
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  How about an alternative to that?
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  How about can I just do an MRI of the prostate?
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  The Mris came in a vogue in the 2012, 2015 era.
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  Between Mris and and biometric monitoring, Psas and others, we
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  have the ability to assess the health of your prostate gland
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  without a biopsy. There for a lot of reasons
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  urologist are not enthusiastic about the non biopsy approach.
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  You'll have better luck working with your primary care doc if
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  you empower them to do it in a manner that is not biopsy
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  centric. Here's another question folks.
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  So we talk about asking them. Do you need to see a urologist
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  Asking them can we monitor this without a biopsy?
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  Perhaps with an MRI? Suppose insurance doesn't pay
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  for that MRI. This is ridiculous.
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  But some insurance companies that actually require a biopsy
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  first, that's just stupid. Now, just because the insurance
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  company is stupid doesn't mean you have to embrace their
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  stupidity. The average cost for an MRI and
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  the neighborhood of 800 bucks. You could probably negotiate it
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  lower. Get a cash discount.
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  It's worth the money if it avoids A biopsy, which it can
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  do. Here's another question a little
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  bit off the trail but very relevant.
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  What's my calcium score? A calcium score has nothing to
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  do with your prostate. It has everything to do with
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  your lifespan and death and your heart.
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  What are most men die from who have prostate cancer?
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  Answer heart attacks. So before we start chasing the
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  Psas, before we start scrambling to look at Gleason scores, let's
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  get a a full spectrum view of health.
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  A calcium score greater than 100 and a man over 60 correlates
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  with an 18% ten year risk of death from all causes, including
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  heart disease, whereas early stage prostate cancer, presuming
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  it's there, has a 10 year mortality rate of about 1%.
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  So we want to be able to risk assess.
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  I hate to break the news to you folks, but nobody's getting out
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  alive. Our goal is to extend life with
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  the greatest vitality. There's nothing about getting a
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  biopsy that enhances your health, right?
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  It just scratches an itch. Another question to the doctor,
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  the urologist, or your primary care doc.
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  When you have an elevated PSA, what lifestyle changes can make
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  a difference? If this question stumps them,
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  you need better consultative information because they're a
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  host of lifestyle changes that can alter your risk profile for
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  prostate disease, including cancer.
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  So you want to know the answer to that question, and if your
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  doctor can't provide it, you want to find someone who can.
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  Now, the Internet can be very helpful, but don't lean heavily
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  on it. You'll go crazy.
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  There are about 1000 different pathways from apricot seeds to
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  water fasting that are absurd, so be be warned.
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  Use your intelligence, use your instincts.
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  What role of MRI we talked about that?
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  Do I have to then acquire biopsies to monitor this
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  condition? What interval of PSA testing
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  would you recommend, and what would you expect my PSA to do
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  over the next several years? These questions are worth asking
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  so you can frame out a plan with your family doctor.
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  I'm I'm advocating for you to avoid urology consultations, at
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  least at the early stages of evaluating this condition.
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  Avoid them. However, if you choose to get
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  one, be prepared. Be prepared with your own
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  knowledge. Be prepared with your own
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  resolve because they are oftentimes quick to recommend
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  biopsy now should you do one. In my opinion, a biopsy is an
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  antiquated intervention that causes harm and does not provide
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  information of value that can't otherwise be acquired through
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  non invasive testing. In addition, based upon common
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  sense and supported by research articles, it can cause
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  metastatic spread if cancer's there.
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  And finally, the biopsy is horribly inaccurate.
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  The idea that you can somehow take an MRI, target a nodule and
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  stick a needle in it and that is superior and more accurate is
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  absurd. It defies biology.
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  When somebody has skin cancer, I like to draw these analogies.
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  There's a procedure called a Moe's surgery where they take
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  little slices around the skin cancer and they look at it on
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  the microscope. Why?
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  Because they can't tell just by looking at it with a naked eye
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  whether or not the cancer is present.
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  Why? Because the cancer spreads in
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  tentacles and they have to look at each slice to find out where
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  the edge is. So too, with prostate cancer.
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  You cannot target it with a needle.
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  You cannot target it with radiation.
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  That is a false hope. It has tentacles, so to the
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  extent it's in the gland, we're going to let it sleep.
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  Now, we talked about some questions.
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  If you have an elevated PSA, suppose you already had a biopsy
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  and you've been diagnosed with prostate cancer.
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  What then? Well, there's some important
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  questions to ask. Chief among them, can we monitor
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  this cancer without further biopsies?
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  The biopsy, if it's been performed and if it shows
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  prostate cancer, you have what you need to know.
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  You have prostate cancer cells in the gland.
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  These are what I call atypical dormant cells.
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  In most cases, Adcs, so long as they stay in the gland, they
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  will never harm you. Now they'll say, but we have to
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  know if it's changing. Remember, folks, the biopsy is a
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  1980s technology. We have better methods.
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  You can look at the MRI. If it's changing, the MRI is
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  going to pick it up. If it's changing, the biomarkers
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  are going to pick it up. You do not need to do biopsies.
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  They're harmful. So just stop.
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  Doctors like them, they get reimbursed.
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  There's a lot of reinforcement psychologically, financially and
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  medical legally to doing these biopsies.
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  The standard of care of doing sequential biopsies is simply
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  not proven to protect you. It's just there because it's
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  there because So there's that old saying in medicine, how do
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  you convince a doctor that what he's doing is wrong and he
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  should change his approach? Answer.
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  You wait for the doctor to die. Doctors, once they adopt A
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  pattern of care, are very slow to shift.
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  They like what they do. Ask the doctor which biomarker
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  are you going to use and why. There are a host of them out
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  there. None of them are distinctly
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  superior. They all have their pros and
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  cons. In my opinion, you want to have
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  consistency so you can compare apples to apples.
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  Whatever biomarker your doctor is using should be tracked
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  periodically so that you can see any variances that are relevant.
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  You want to know the calcium score?
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  Now your urologist probably doesn't know much about a
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  calcium score. In fact most doctors don't know
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  much about it. For those of you that are
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  curious, you can find my paper go to pub Med doctor pederuti
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  calcium score. The research that we have done
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  on this shows an ability to reverse it, but more importantly
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  for your purposes it puts risk in perspective.
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  Am IA heart disease guy. How much you know lifespan do I
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  have? Where should I put the focus of
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  my energy? My dad was a family doc and he
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  used to say, if you're destined to die by the knife, you don't
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  fear the gun. Look, none of us want to die.
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  We all want vitality. Let's put the vitality first and
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  foremost and not subject you to traumatic treatments.
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  Another question for your urologist.
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  We talked about the MRI, about the calcium score, about the
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  biomarkers. Can we test for circulating
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  tumor cells? CTCS.
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  This technology is breathtakingly new, and it has
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  merit. There's a test called The
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  Gallery, which is put out by a company called Grail.
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  They're one of others. It's not perfect.
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  It's a blood test. It can pick up cancer cells.
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  Cells, not tumors, floating around in your blood.
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  Well, guess what, folks? If it picks up cancer cells in
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  the blood, that is objective evidence that the cancer has
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  left the gland, which means that to the extent any surgery, any
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  radiation ever had any sense, and that's a highly dubious
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  statement, it is now totally evaporated.
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  You never screw with local treatment when you have cells
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  floating around the body. Now that test is not perfect
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  early stage prostate cancer, it's frequently negative, but it
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  has some value. If your surgeons are
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  contemplating radiation or surgery before they touch your
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  prostate gland, in my view, this test should be done.
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  The other test you should absolutely consider getting
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  before anything aggressive any of these conventional treatments
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  that are sometimes advocated for you.
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  Can I get a PSMA PET scan? Prostate specific membrane
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  antigen PET scan that will target prostate cancer outside
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  of the gland and it can help you determine if there's disease
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  beyond the gland itself. If there is, you're in a
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  different category of treatment. Eliminating radiation and
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  surgery completely. Not that I ever advocate it, but
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  even conventional doctors would have a tough time justifying
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  such an intervention. If the cancer has left the
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  gland, you're in a different category.
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  Find this out before they screw with your prostate.
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  All right, so we talked about that.
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  Here's a question. Now, this question may be a
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  little bit uncomfortable for the doc, but it's worth asking.
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  Doctor, do you own an interest in the Da Vinci Surgical Center
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  that you are contemplating referring me to?
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  It is legal for doctors to make profit from and own an interest
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  in surgery centers of that type. It's not to say that it is
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  patently unethical, but holy cow is a bit of an incentive there
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  that you have a right to know about.
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  Here's another question equally uncomfortable and equally worth
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  asking Doctor In the past year, have you received any financial
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  consideration from pharmaceutical companies in
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  regard to prostate cancer treatment?
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  Yikes. A study from 2021 revealed that
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  87% of urologists received some form of compensation from
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  pharmaceutical companies on the average amount of $650.
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  Now that is not a Stop the Press dollar amount.
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  However, we know why the companies buy doctors free
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  lunch. It's not because doctors would
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  otherwise go hungry. It's because of the
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  psychological effect of reciprocity. 87% and that's an
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  average amount. The money comes in several
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  forms. It can be a speaker fee.
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  Doctor, we're going to give you 1000 bucks to go to this
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  restaurant and talk to your colleagues about whatever it can
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  be in the form of of free lunches.
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  It could be in the form of some nominal fee or consideration for
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  clinical research. It's not to imply that the
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  urologists are unethical. In my opinion, medicine doctors
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  in general are highly ethical people, but they're people.
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  They're influenced by things. You want to know where those
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  influences lie? That's my only point.
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  In a perfect world, you want your family doctor to lead the
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  charge. But folks, your family doctor
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  has been knee buckled. They have had their power taken
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  from them in large measure. You can restore it by virtue of
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  empowering your doc to lead the charge.
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  Doctor, I want you to monitor my prostate.
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  I understand that you're recommending neurology referral.
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  Perhaps I'll go to talk to them. Right, That's fair, that's
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  reasonable. But be prepared to resist the
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  urgency. If they look at you and say you
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  have to get a biopsy, time out. You don't have to get a biopsy.
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  They should talk to you about the risks.
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  A question you should ask, could a biopsy potentially spread
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  cancer? If they say, well, that's a good
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  question, It hasn't been fully studied, but theoretically that
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  possibility does exist. If they answer like that, that's
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  a rational answer. If they say no, that didn't
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  happen, that can. That is comforting you in the
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  face of illogical conclusions that are not research supported.
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  So be prepared, even write this stuff down.
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  Remember, you're going to an environment where you are
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  historically disadvantaged. The doctors have a lot of power,
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  they have a lot of knowledge. In some cases, they have rather
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  rather vigorous opinions. This is no time for you to be
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  meek. This is your body, it's your
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  life. It's your prostate gland, it's
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  your erection, it's your urinary control, it's your muscle, it's
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  your masculinity, it's your quality of life.
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  It's yours. Own it.
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  Do the research, Take your time. If nothing else, this is never
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  an emergency. When you hear the big C word,
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  I'm sorry Sir, your popsy came back positive for cancer.
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  The first thing you do, take a deep breath, go on a vacation,
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  go to Aruba, hang out. There's no emergency.
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  This is a slow moving train. And by all means, continue to
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  watch my podcast. Well, that's all I got for now
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  folks. I I hope this information is
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  helpful. I hope you share it with others.
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  It's our mission to get information out, to educate men
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  SO and the people who love them so that you can have a balanced
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  view of this most compelling issue that is really critical to
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  your quality of life throughout the span.
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  I'll talk to you next time. Bye.