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His PSA Was 16. But That Wasn’t the Number That Worried Me · Intellectual Medicine

• 0:00
  In the world of prostate cancer treatment, how do we define
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  success? What is considered an effective
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  treatment? What is considered a good
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  outcome? The only way you can be
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  reassured that the treatment is working is when you actually die
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  from something else. Well, that's a weird way to
• 0:19
  define success, isn't it? Here's a big question.
• 0:29
  In the world of prostate cancer treatment, how do we define
• 0:33
  success? What is considered an effective
• 0:37
  treatment? What is considered a good
• 0:39
  outcome? Well, I'm going to share with
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  you how we define it within my protocol, compare and contrast
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  it to the institutional medicine approach.
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  Certainly one metric is death. We don't want to die from
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  prostate cancer. The problem with using that as a
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  criteria is the lag time. It can take 10 or 15 years to
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  determine if the treatment you're doing now is going to
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  prevent you from dying of prostate cancer.
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  In fact, the only way you can be reassured that the treatment is
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  working is when you actually die from something else.
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  Well, that's a weird way to define success, isn't it?
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  I mean, I don't want my patients to die at a premature age.
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  So in my protocol, in our approach, I challenge the
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  conventional definitions. In the absence of death, they
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  have to look at disease progression.
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  And this is where it gets a little bit hypothetical.
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  They define disease progression as your PSA going up.
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  In some cases, that becomes the only criteria that they're
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  judging treatments based upon. I'm going to share with you a
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  case of a patient who came to see me.
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  He didn't want to get a biopsy. Listen to my podcast, read my
• 2:00
  book. Good for him.
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  And he decided he wants to consider an alternative.
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  Why do they want to biopsy my patient?
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  He's in his mid 60s. He feels great.
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  This is perhaps the most common presentation of men with
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  prostate cancer. They feel great.
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  But his PSA was over 16. Stop the presses.
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  We must do a biopsy. But first, he cautioned, I want
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  an MRIMRI is done. Here's a pyrides of five.
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  Now, remember, the pyrides score is a judgement about whether or
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  not the images look like cancer, and they're rated anywhere from
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  1:00 to 5:00. One means this is not cancer.
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  A5 means yeah, this looks like cancer.
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  A4 means it's probably cancer. A three is a coin flip.
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  So you get the picture here, PSA above 16 pyrides of five and a
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  male greater than 60. That spells prostate cancer
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  gang. So why do a biopsy?
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  Why do a biopsy when you're not going to believe it if it's
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  negative, right? This is the lack of intellectual
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  reflection. This is reflexive, dogmatic
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  institutional medicine. You know me say biopsy.
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  Why? Because it's what we do.
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  We biopsy. Yeah, but but the dude's got
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  prostate cancer. By every reasonable criteria, it
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  is so evident that if you biopsy him and if the biopsy comes back
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  negative, you're not going to believe it.
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  The biopsy, folks, it's not benign.
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  People land in the hospital with sepsis.
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  It can damage erectile function. It can damage urinary flow, so
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  it's not a trivial procedure. Don't let them fool you.
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  Should not be done ever. But fortunately my guy dodged
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  that bullet. Came to see me, now we're
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  talking about what to do next. To a reasonable degree of
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  medical certainty, the cancer exists.
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  What treatment is then available with APSA above 16?
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  Take out the gland radiation castration.
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  How about none of the above? His MRI demonstrated that the
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  cancer looked as if it had gone outside the capsule.
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  Now the capsule. Think of it like the rind of an
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  orange containing the material within it, including the cancer.
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  If your cancer is within that capsule, it's not going to kill
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  you. If it goes outside, the capsule
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  encroaches upon it. Now it can become more
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  problematic. It is still eminently treatable.
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  It is not a cause for doing destructive therapies with some
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  false hope that it's going to avoid death, right?
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  That's not going to happen. So my guy's seeing me.
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  He has what I call level 2 prostate cancer already
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  extending outside the capsule. No biopsy, no surgery, no
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  castration, no radiation. We put him in the protocol.
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  What's the goal? The goal is to have it, not
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  progress. The goal is not to cure cancer
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  and have all the all the nodules disappear.
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  Yes, that has happened with men. In my protocol it can't occur.
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  But that is not the gold standard for for treatment
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  success. As long as this cancer doesn't
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  progress, my guy is going to take it to his grave, feeling
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  great, dying of something else. So what happened after a cycle
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  of treatment, his PSA went from 16 to 16, didn't go up.
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  It had been trending up 10121416 stop the trend.
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  That's one success. The other success, no anatomical
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  progression. So we repeat the MRI.
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  This is why I like to do it without contrast.
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  Guys, that gateolinium accumulation in your brain,
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  that's not good. I don't care what they try to
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  tell you, it doesn't belong there.
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  So we avoid the contrast. We don't need it.
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  Those who think it's essential are simply not knowledgeable
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  about the latest trends and evidence.
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  Right, so no contrast then We can use it sequentially.
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  It's fast, about a 15 minute study.
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  It's pretty cheap, about 400 bucks in the world of medicine.
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  Not a Backbreaker. Usually insurance covered when
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  you compare one MRI to the next MRI.
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  Yes you gauge each individual study with a bi rad score, but
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  you compare 1 to the other with a precise score.
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  That's all capitals. It's an acronym and it's a means
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  of judging. Has it gotten worse, better, or
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  stayed the same? A precise score is rated one to
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  five. One means wow this really
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  improved. 5 means Yikes it's getting a lot worse.
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  A3 means no change. Success is defined in my
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  protocol by a stable PSA. Even if it's inching up, it's
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  stable and by a precise score of three or less.
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  On occasion A precise score of four can be acceptable depending
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  on detail, but you get the picture.
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  No progression, no harm being done.
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  Urinary flow is good, erections are great, energy is great.
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  The protocol includes a focus on global health, not just the
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  prostate. We got to remember there's a man
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  attached to that prostate gland and his global health is
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  relevant and his vitality is critical.
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  The idea that we should do damage to a man who feels well
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  with this false hope of preventing death is foolishness.
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  Now back up the camera a little bit, right?
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  What in men with prostate cancer die from answer heart attacks.
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  Number one killer of men with prostate cancer.
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  I believe it is in part because many of the treatments are
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  damaging to the heart, right? The heart's a muscle gang.
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  You whack testosterone, it's losing some of its merit.
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  The radiation therapy damaging to the heart, hormone blocking
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  therapy damaging to the heart. If you die of a heart attack,
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  some of the people that are advocating this type of
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  treatment for prostate cancer consider it a relative success.
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  I mean, you didn't die of prostate cancer.
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  That's nonsense as well. Premature death from any cause
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  is to be analyzed and avoided. What is premature death?
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  Anybody that dies before the age of 90, I consider premature.
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  My goal for my patients is to get to 100.
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  Now. The goal's important, folks.
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  You're all familiar with the concept of a predetermined
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  outcomes. Expectations become reality,
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  right? And if I presume my patients are
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  going to be happy making it to 80, I may be a little bit
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  passive as they get into the mid late 70s Nonsense.
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  We need to be proactive. So what do we do for our guy?
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  Well, I know the number one killer is heart.
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  Heart attacks and cholesterol has some merit, but the great
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  test is the calcium score. A calcium score is a CAT scan of
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  the heart and it can determine if there's hardening of the
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  arteries. It can see calcium build up on
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  the artery. So now we don't want to die from
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  prostate cancer. Job well done.
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  Things are stable. Precisely 3.
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  The PSA is stable. He's happy.
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  Life is grand. What about the heart?
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  The calcium score, if it's zero, that's like a 10 year free pass.
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  Likelihood of death from heart attack is really hardly present
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  at all. That's fantastic.
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  By the way, this is for men over 50.
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  If the calcium scores above 100, that indicates a significant
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  amount of calcium buildup on the coronary arteries, considered an
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  increased risk of cardiac events.
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  Well, what was my guy's calcium score?
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  It was over 900. Now that doesn't mean he's going
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  to drop dead tomorrow. It does not mean you need to go
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  to the emergency room. But it does mean we uncovered a
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  critical risk that would have been missed if they were so
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  ambitious to jab needles in his prostate.
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  On top of that, the hazard is amplified because of the
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  pre-existing cardiac risk. Look at the big picture.
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  Don't let them fool you into thinking that they have a cure.
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  They don't we know that prostatectomy is removing the
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  gland, that amputation doesn't prevent death from prostate
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  cancer, nor does radiation, nor does hormone blocking therapy.
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  So protocol approach. Check out the heart.
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  Now we can do things to focus on his global vitality and
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  well-being, maintaining strength, maintaining energy,
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  maintaining vitality. If you chase the number, well,
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  your PSA is above 16, Mr. Smith, we got to get it down.
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  Getting your PSA down doesn't make you feel better, doesn't
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  heal you, does not necessarily correlate with the status of the
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  cancer itself. I've had men in my practice with
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  PSA's that didn't budget. They're like 567.
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  But the MRI evaporated the nodules.
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  So you got to analyze the proper detail and you have to make the
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  right judgement about how to define success.
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  In a conventional world, they would have done something to
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  this guy now at a point in time where he feels great.
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  You know, I had a patient once, his PSA was in his 60s, known
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  prostate cancer, and he was told by his other docs, you must go
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  on home. And blocking this PSA is way too
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  high. Calls me up in a panic.
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  What am I going to do? I said nothing.
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  How do you feel? I feel great.
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  Goes to work everyday. Makes love to his wife.
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  Your inflow is good. What are we doing, folks?
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  We're treating a number. We're treating a number.
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  They like treating numbers. Those are Thunder for a dramatic
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  effect. In medicine, we like treating
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  numbers. Right.
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  It's concrete. Yeah.
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  Your PSA used to be 16. Now it's four.
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  Aren't I great? Aren't you happy?
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  I know you feel kind of lousy from the treatment I'm giving
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  you, but boy, it's preventing you from dying.
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  It is not so, my guy, at 60, we wait.
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  His PSA went up to 90. He felt great.
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  We wait. PSA went up to 160.
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  At this point, five years later, started to have some urinary
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  flow issues. Then you take the action.
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  Then you can do hormone mitigation.
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  You never, ever, ever get castrated.
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  That's no way to live. No way to live, guys.
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  They try to tell you it's essential to save your life.
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  It is not guaranteed harm, no tangible benefit.
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  Why are we stuck in this? I'll tell you why.
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  It's because the voices have been stifled.
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  My voice is out there. Not many.
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  I actively treat patients. Most don't.
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  I'm a board certified osteopathic family doctor.
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  What am I doing in this space? I'm being bringing a fresh
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  perspective. Got to look at it differently.
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  If we want a different outcome. The institutional docs, they got
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  that monolithic path they've developed over decades and it's
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  great because you just follow the bread crumbs.
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  You high PSA, I'm going to do this, I'm going to do this and
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  biopsy. I'm going to do this to what
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  benefit, right? There's enormous financial
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  incentive in maintaining the status quo.
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  Enormous. These focal therapies are coming
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  out with all of them brag about their success rate nonsense.
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  They're not going to work. Why do I know that without
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  waiting 15 years? If you take the entire gland out
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  and it doesn't affect the death rate from prostate cancer, what
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  logic supports the thought that taking a portion of the gland
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  out is then going to work? There's no logic.
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  It's just a false hope with enormous financial backing,
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  right? Stuff that is inexpensive, stuff
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  that is generic, stuff that supports your health does not
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  make the cash registers ring at your friendly neighborhood
• 15:05
  hospital medical treatment center.
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  I mean, we all know that in America we pay caviar prices and
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  we get oatmeal results, right? Our cost is nuts.
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  Look, I don't mind folks spending money, but I want some
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  value here, right? So it indicts the current
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  treatment pathway. Let me rephrase.
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  It invites reasonable consideration of alternative
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  approaches so that men so that you have a choice.
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  You don't have a choice if you're going to follow the
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  frozen footsteps of institutional medicine.
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  You don't have as much choice if you're going to allow yourself
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  to be handcuffed by what the insurance says is right for you.
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  This is not breaking the bank's stuff, folks.
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  Where do we ever start to defer our judgement about our own
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  health to an insurance company? Well, you know, I, I, I, I, I
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  would do another treatment, but my insurance won't pay for it.
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  That's dumb. Insurance doesn't pay for your
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  health. They don't pay for your
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  well-being. They don't pay for vitality.
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  This is a new age, folks. Vitality can be restored,
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  maintained unto your death, not through conventional treatment.
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  So think about how you want to live.
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  I'll continue to share this information with you.
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  This is cutting edge. This is a potential to alter the
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  way that prostate cancer, especially those early stages,
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  are managed. Robbing a man of his vitality
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  with false hope is no longer necessary.
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  Probably never was. The growing evidence makes
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  current treatments less tenable. It gets harder and harder for
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  them, The conventional institutional docs, to impose
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  these treatments upon a public that is getting more and more
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  knowledgeable. Thank goodness for the Internet,
• 17:08
  for AI, for your ability to search and validate what I'm
• 17:12
  saying with your own supportive data.
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  Well, listen, I, I hope you stay with me.
• 17:18
  This is important. We're going to be grassroots
• 17:19
  changing medicine. It's not happening from the top
• 17:22
  down. It's happening from us demanding
• 17:25
  better. So comment, leave messages.
• 17:28
  We love to hear from you, ask questions, suggest topics.
• 17:32
  This is your formal forum as much as mine.
• 17:36
  Well, thanks for being part of this podcast.
• 17:37
  I look forward to connecting online in the future.
• 17:41
  Keep watching. Bye.