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PSA Rising: Stop Letting Them Scare You · Intellectual Medicine

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  We like certainty. We like to know if X happens, I
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  do Y. If the PSA goes up, I treat it.
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  At what level? There is what's known in
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  medicine and life in general as conformity bias.
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  Everybody else does. It must be right.
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  Don't stop thinking. Do not let them force you into
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  making an urgent decision. Do not let them tell you you're
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  going to die unless you do what they say.
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  Well, that is not true. Well, technically it's true.
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  I mean, we're all going to die. But it's not true that jumping
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  onto a treatment pathway will somehow immortalize your future
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  in medicine. When we don't know what to do,
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  we have a consensus committee and we make stuff up.
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  This, in a nutshell, is what's at play with regard to
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  biochemical recurrence. What is it?
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  How does it affect your health? What should you do if you've
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  been labeled with that? And also, what sense can we make
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  out of the PSA number that's increasing?
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  Biochemical recurrence is what is used to define what they
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  believe to be a return of cancer after the prostate gland has
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  been removed or radiation has been rendered.
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  This is what conventional medicine calls a curative
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  attempt. It is not.
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  It is maybe an attempt, but it's not a cure.
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  Radiation and prostatectomy does not cure prostate cancer.
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  The results of the research are in, and that pallacy can no
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  longer be sustained. You should consider it a
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  debulking effort, but it does not eliminate cancer.
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  So we're left with this phenomenon of biochemical
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  recurrence. I told you when they don't know
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  what to do, they're going to make stuff up.
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  And it's not because they're malicious, it's because they're
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  human. We like certainty.
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  We like to know if X happens, I do Y.
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  If the PSA goes up, I treat it. At what level?
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  There is what's known in medicine and life in general as
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  conformity bias. Everybody else does.
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  It must be right. So the American Urological
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  Association has a cut off for biochemical recurrence they
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  share with European Urological association 0.2.
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  Meaning you go from 0 postoperatively in your PSA
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  trickles up to 0.2. Maybe that's a biochemical
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  recurrence. Maybe the cancer is trying to
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  come back, but you feel great. You don't feel symptoms, but
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  it's trying to come back. What you need to know about PSA
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  levels in biochemical recurrence is that there are 50 different
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  thresholds published in the literature to define a
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  biochemical recurrence, 50 of them.
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  Now that tells you nobody really knows and they're just trying to
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  figure it out. Now, I like experts.
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  I consider myself one. But here's what I don't like
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  about the expert dogma. It attempts to lobotomize smart
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  people like you. So yes, you're listening to this
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  podcast. Yes, you're an intelligent
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  person. You've done your own logical
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  discernment of your health, your condition, and how you want to
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  proceed. Good for you.
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  Intuitive logic. Individually based research.
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  Nobody knows their body better than you know your own, and
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  certainly nobody knows philosophy that drives your
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  thoughts better than you know your own.
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  When medicine steps in, when experts step in and say I know
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  what to do, they damn well better be certain of that.
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  If they have an opinion, that's cool, share it with me, but
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  don't portray it as definitive. You must get this or you have a
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  biochemical occurrence. We must put you on androgen
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  deprivation therapy. Not so fast.
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  When the PSA starts to rise, it does present the possibility
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  that the cancer is present and that it's evolving.
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  Few things to bear in mind. 100% of the men with metastatic
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  disease to the bone I've had a significant increase in PSA.
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  That's almost all. There are some situations where
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  that doesn't hold. On the other hand, a rise in the
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  PSA does not mean that you've got metastatic disease.
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  It may never happen. In cases where the PSA level did
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  increase above the threshold, it took about 8 years before
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  clinical manifestations of metastatic disease occurred.
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  That means visible evidence of it, symptomatic evidence of it,
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  some tangible evidence. I don't like biochemical
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  recurrence. I don't like chasing Psas.
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  I do believe following them has merit.
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  We have to be tempered in our assessment.
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  So here's a pattern for your contemplation.
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  Patient of mine. PSA went from over the course of
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  two years, 2 to 4:00 to 6:00 to 2:00 to 3:00.
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  What does it tell you? A little bit of a saw toothing
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  pattern. Now the decrease in numbers
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  occurred after beginning my protocol.
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  Maybe it was a coincidence. We're still happy.
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  Here's another clinical sequence of PSA in a patient with known
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  prostate cancer. Biopsy proven 345.5.
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  Yikes, the numbers going up at 5.5.
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  A lot of doctors would have said hey let's castrate you now when
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  it's creeping up. Instead we do an MRI of the
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  prostate. You know what it showed?
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  No evidence of disease. None.
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  PSA at 5.5 and a man with previously diagnosed prostate
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  cancer by biopsy. Currently no evidence of
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  disease. So a biochemical recurrence is a
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  fallacy. Do not let them sell this to
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  you. It is simply a numeric change.
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  Your PSA went from X to X + 10 percent X + 20% in the absence
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  of symptomatic compelling symptoms.
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  I don't advocate for intervening with anergen deprivation
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  therapy. I never advocate chemotherapy.
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  It's a loser when it comes to prostate Cancer causes harm.
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  I never advocate pelvic irradiation.
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  The idea that you can somehow irradiate the pelvis, thus
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  killing cancer cells, and not damage everything else in its
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  pathway is another fallacy to another comfort.
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  Look, here's where your frontal lobe comes in.
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  Radiation is a carcinogen. Radiation damages tissue.
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  How in the world can the radiation discriminate between
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  cancer and natural cells? It can't.
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  Anybody that tries to sell that to you is making stuff up.
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  So radiation is damaging androgen deprivation.
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  What we know about that, your PSA is rising.
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  You want androgen deprivation 100% of the time it will fail.
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  The PSA level will begin to rise again only now because of the
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  androgen deprivation that the doctor implemented.
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  Because the number went up, you no longer have the opportunity
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  to use it effectively when it matters the most, that's when.
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  And if you develop symptomatic extension, you have to bear in
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  mind only 40% of the men who have biochemical recurrence will
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  ever have any metastatic extension.
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  Ever. And I told you the lag time can
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  be 8 years. So with all this information,
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  what should you do with a rising PSA?
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  The first thing you should do is not panic.
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  The second thing you should consider is analyzing.
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  The PSAI recommend about 3 month intervals if it is doubling in
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  six months. If you go from 5 to 10 in six
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  months, it's worthy of some MRI of the prostate.
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  It's worthy of a consideration of amplifying your lifestyle
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  interventions, of amplifying your non-toxic treatments.
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  It is a consideration certainly to use the protocol that I've
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  developed. I advocate for it because of its
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  safety, its global potential of benefit, the fact that you don't
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  lose erectile power, you don't leak urine, and it doesn't
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  create secondary cancers like radiation does or can.
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  So step one is to just gather information.
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  Do not panic men. PSA induced anxiety is its own
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  pathological event and it can rob you of the joy of the
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  moment. Remember, we are all mortal.
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  The name of the game here is vitality and life extension
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  both. But because we are mortal,
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  something's going to take us out.
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  The majority of men with prostate cancer, the metastatic
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  disease, do not die from it, but some will.
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  So the goal is to take rational steps to diminish the likelihood
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  of dying from prostate cancer and to maintain robust vitality.
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  The idea that you have to sacrifice vitality because your
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  PSA is going up is, well, not worthy of implementing the
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  treatment. So I like Mr. Is of prostate.
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  I especially like them without contrast.
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  And I know the radiologists love contrast.
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  Then the picture looks prettier. But the problem with contrast,
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  it's a heavy metal gadolinium. It accumulates in your body,
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  including your brain. It doesn't belong there.
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  The stuff we need to know we can gather from a non contrast MRI.
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  Are the lymph nodes looking suspicious?
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  Is there evidence of extension beyond the gland?
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  Are the bones involved all that can be extracted?
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  You cannot give it a Pyrad score without contrast.
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  That's hard to do. But the Pyrad score is another
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  one of those subjective judgments by the radiologist.
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  It has its place and it has its potential benefit, but the
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  absence of an ability to get that score does not eliminate
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  the value of an MRI. So rising PSA, step one, take a
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  deep breath. Step 2, repeat the study.
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  Had a gentleman who recently had APSA of 6.
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  Follow up study went down to 1.5.
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  Pretty impressive. Nice drop.
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  Kind of rooting for it, but I didn't quite believe it.
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  When you see something that doesn't make sense, the first
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  thing is to consider was that an aberrant result?
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  So we repeated it and it was 3.5, OK, not a 1.5, but
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  certainly down from six stability.
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  That's what we're looking for. We're not looking for a linear
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  decrease in PSA. That is rare to happen, and
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  we're not panicking because of a gradual increase.
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  Men, you still have a prostate gland.
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  It's still going to get bigger year over year, with or without
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  prostate cancer. With or without prostate cancer,
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  the PSA number is likely to creep upward.
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  So if you go from 4:00 to 5:00 to six over an extended period
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  of time, that's not a recurrence.
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  That's lab variation. Well, it's as clear as mud
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  sometimes, isn't it? Guys, don't stop thinking.
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  Do not let them force you into making an urgent decision.
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  Do not let them tell you you're going to die unless you do what
• 13:00
  they say that is. Well, that is not true.
• 13:06
  Well, technically it's true. I mean, we're all going to die,
• 13:09
  but it's not true that jumping onto a treatment pathway will
• 13:13
  somehow immortalize your future. Hiking PSA, biochemical
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  recurrence. Those are some of my thoughts.
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  Stay well, stay vital, keep fighting, cancel like a man.
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  We'll talk again. Bye.