Latest / Intellectual Medicine / Prostate Cancer Didn’t Kill Testosterone. Doctors Did. | Dr. Stephen Petteruti #prostatecancer

Transcript

Prostate Cancer Didn’t Kill Testosterone. Doctors Did. | Dr. Stephen Petteruti #prostatecancer · Intellectual Medicine

• 0:00
  So don't put up the white flag, but keep living, keep aspiring
• 0:05
  to extend that life and absolutely grab vitality.
• 0:10
  Should you consider going on testosterone therapy if you have
• 0:14
  prostate cancer or if you have an elevated PSA, an abnormal
• 0:19
  prostate MRI? We're going to talk about it.
• 0:21
  Even though there's research supporting the potential
• 0:25
  benefit, studies are not definitive.
• 0:28
  If it progresses, you have to look in the mirror and know in
• 0:30
  your heart you made the right choice.
• 0:33
  This is where philosophy, science, proof all merge you and
• 0:42
  only you can decide how you want to live.
• 0:46
  Can testosterone therapy treat prostate cancer?
• 0:52
  Is it possible that by taking testosterone you can actually
• 0:57
  interfere with the progression of prostate cancer?
• 1:00
  There is evidence pointing in that direction.
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  We're going to talk about it now.
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  Forever we've been led to believe, we've been told that
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  giving a man with prostate cancer, testosterone is pouring
• 1:15
  gas on the fire. It feeds the cancer and it
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  propagates it. Well, this has been postulated
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  and it's been actually shown that there is some correlation
• 1:25
  here. I mean, we know that men who
• 1:28
  have metastatic prostate cancer and they're having bone pain or
• 1:34
  urinary obstruction, we know that some of those symptoms can
• 1:38
  be reversed by blocking testosterone by lowering the
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  levels. How then is it possible that
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  giving testosterone is therapeutic?
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  It's an absolute paradox. And that's why it has been
• 1:55
  difficult to move off of this perception, because there's some
• 2:00
  truth to it. Both things are true.
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  How can that be simplicity? So much nicer.
• 2:08
  But it doesn't fit here, man. You know, I talk about the
• 2:12
  hermitic principle and this applies to pharmacology where
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  the different dose of the drug has different effects,
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  completely different effects. It appears a similar dynamic is
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  at play with regard to testosterone.
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  So we became suspicious about this connection when we started
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  to realize that having a low testosterone level is a risk
• 2:37
  factor for developing prostate cancer.
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  Well, if high testosterone causes cancer, why would a low
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  level be a risk factor? It's because high testosterone
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  does not 'cause prostate cancer going on.
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  Testosterone therapy is not a risk factor for prostate cancer.
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  None. That's pretty well established.
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  What about if you have prostate cancer or you have an elevated
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  PSA? Can you safely use prostate?
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  I'm sorry, testosterone therapy? It appears that the answer's
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  affirmative, but we're going to explain the nuances here.
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  So a low testosterone level correlates with increased
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  prostate cancer risk. In a setting where there's
• 3:24
  advance of prostate cancer blocking testosterone, lowering
• 3:29
  the level can have an initial beneficial effect clinically.
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  It turns out some of those prostate cancer cells are
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  androgen sensitive and when you lower the level, you can
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  adversely affect their well-being in a way that will
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  lower your PSA level and will also in some cases reverse the
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  progression of the cancer. But there are also cancer cells
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  in there that are not androgen sensitive, and when you affect
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  those that are, the others that are not androgen sensitive take
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  over. The other thing that happens is
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  the cancer cells adapt to a low testosterone environment and a
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  low testosterone environment that they adapt to they
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  eventually overcome. So when testosterone therapy is
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  blocked, when you lower it, your androgen deprivation treatment,
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  it's going to progress all the time eventually.
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  So we know that that approach is inadequate.
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  How is it then that giving testosterone can be helpful?
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  Well, one theory is that those low levels of testosterone cause
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  the engine receptors to become, if you will, a bit thirsty.
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  And when they get hit with a tidal wave of testosterone, it
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  kind of blows their little cancer minds and they blow up.
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  That's kind of cool. There's also evidence that going
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  from high to low testosterone levels, now called bipolar
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  androgen therapy, that that disrupts the DNA of cancer
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  cells, causing them to be destroyed.
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  The suspicion that testosterone might be helpful actually
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  started. The theory was postulated based
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  upon some rogue patients who are doing their own thing.
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  You know the standard of care for a long time.
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  If you had APSA that was rising or you had prostate cancer that
• 5:36
  was progressing, the standard of care for a long time still is
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  Knockout the testosterone. Get that PSA down and then pound
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  it and pound it as low as you can, as long as you can.
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  And when it starts to come back up, pounded again, a failed
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  approach, gentleman, it always comes back.
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  And oh, by the way, you feel rotten.
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  Take a totally healthy man feeling great.
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  The PSA starting to go up and they whack him by taking away
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  his testosterone. It's awful.
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  Now it turns out that the PSA, yeah, it's helpful marking
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  cancer, but it is also a testosterone dependent protein.
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  You need testosterone to make PSA.
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  So when you take away testosterone naturally the PSA
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  level goes down. Sometimes it's because it's
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  affecting the cancer, but often it's just because there's no
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  testosterone to make the PSA. So it can be a little bit of a
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  false objective, lowering the PSA.
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  Conversely, if you give a man with a low PSA, or let's say the
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  PSA is elevating and you decide, you know what Doc Petery saying
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  makes sense to me. I want to go on androgen
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  therapy. I want to go on testosterone
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  therapy. There are studies correlating
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  super high levels of testosterone with a reduction in
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  the rate of cancer progression. That's kind of bold.
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  It's kind of exciting as well because now men, we have the
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  opportunity to combine quality of life without amplifying
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  cancer progression risk. That part I feel pretty
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  confident with that is if a man has an elevated PSA, even biopsy
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  proven cancer, it's level 1. Level 1 means it's in the gland.
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  It's isolated within the capsule.
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  The bulk of evidence does not support risk by putting on
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  testosterone therapy, by taking testosterone treatment.
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  It's fascinating. There may be actual benefit to
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  that. Clearly there's benefits to
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  quality of life. If you're that man that is
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  suffering fatigue, erectile difficulty, muscle loss,
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  weakness, irritability, all the classic symptoms of low T,
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  there's not much benefit in depriving yourself of the
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  treatment. The DHT, dihydrotestosterone, is
• 8:17
  a metabolite of testosterone that stimulates the prostate
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  gland more directly. Now, when you go on testosterone
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  therapy, the DHT levels in your blood are going to rise, and
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  that's because some of the testosterone gets converted into
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  DHT, but is a different level in the gland versus in the blood.
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  The prostate gland makes its own DHT and has very high levels
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  such that even if the blood levels are going up, they don't
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  transfer into the gland. There's not an osmotic gradient.
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  The levels are too high in the gland and the DHT, Think about
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  it. It can't go uphill, so to speak,
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  so it doesn't go into the gland. Ironically, when your
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  testosterone levels are low, the androgen receptors in the gland
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  connect to more DHT instead of testosterone.
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  Hypothetically, that may not be such a good thing.
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  That may be one of the mechanisms behind the potential
• 9:26
  benefit of going on testosterone therapy.
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  Where's the proof? Well, I told you there's some
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  rogue patients out there that were interfering with the
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  traditional approach of blocking testosterone.
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  They would stop taking their androgen deprivation therapy.
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  Why? Because they felt awful.
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  So they'd stop it and they'd start it and they'd stop it.
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  And some of the docs are noticing these guys doing pretty
• 9:54
  well. They're living longer than their
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  other patients. Cancer is not progressing as
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  fast and that led to the theory the bipolar antigen therapy.
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  Now we know when cancer progresses and becomes
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  castration resistant. What an awful term, isn't it?
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  They castrate you, that is block your testosterone.
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  It's a temporary reprieve because the cancer always comes
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  back when it comes back, when you have the PSA level beginning
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  to rise, and this happens after prostatectomies, radiation
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  therapy, it happens with great frequency.
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  One of the many reasons I advise men not to do those traditional
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  treatments, high failure rates, high morbidity rates, but that's
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  what they call biochemical recurrence levels are starting
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  to go up and they whack it. Castrate levels go down for a
• 10:52
  while, then they go back up again.
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  That is what they mean as castration resistance.
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  Prostate cancer is no longer responding to blocking
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  testosterone. It's a bad place to be because
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  there is no treatment for that. Well, Johns Hopkins, they noted
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  this phenomenon of some of the men that were skipping the
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  androgen deprivation doing pretty well.
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  And then they developed the theory, Gee, if we give men high
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  testosterone levels by virtue of giving them injectable
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  testosterone, and then we whack the level down low, we're going
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  to go from high to low. I wonder what would happen.
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  Well, since these men were beyond any known treatment and
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  since castration resistant prostate cancer ends poorly, if
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  you don't die of something else first, you will die from
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  prostate cancer. Now it's beyond the level of
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  being controlled. So they put them on this bipolar
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  approach and guess what happened?
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  They did pretty well compared to the traditional androgen
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  deprivation therapy. There appear to be no
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  deleterious effect and in fact a beneficial effect noted by a
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  decrease in PSA levels in many of the men and in those men who
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  were on the testosterone therapy and later were reintroduced to
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  androgen deprivation, There was an enhancement of the benefit,
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  if you will, sort of a revitalization of the benefit of
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  the androgen deprivation. That's exciting stuff,
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  especially when we're comparing it to the current standard of
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  care which imposes horrible adverse effect.
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  But do you have to wait to be castration resistance?
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  What happens if you start it sooner?
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  Testosterone therapy, begin it sooner.
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  There are no definitive studies, and I don't think they're going
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  to be men in our lifetime. Testosterone is generic.
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  The drugs that I use in my modified bipolar therapy
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  approach, the protocol that I've developed, are generic.
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  Nobody's spending money to research this stuff.
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  Nobody is moving off of conventional treatment very
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  quickly. Too renumerative.
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  Too much money invested in advanced therapies.
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  See my floating quotes. Advanced therapy for prostate
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  cancer. How about if giving a man
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  testosterone was better than any other drugs out there?
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  That would be very upsetting to a multibillion dollar industry
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  from a financial perspective. It's not that they are an evil
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  cabal looking to harm men, it's simply a lack of incentive
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  correlating with the financial effect.
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  That is no money to be made, no money to finance studies.
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  Nobody's that interested except for you and I and a few other
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  people. And Doctor Morgan Teller, the
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  urologist out of Harvard, recommend his book Testosterone
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  for Life. He has case studies in the
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  literature showing circumstances where men were placed on his
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  form of modified bipolar therapy.
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  Two months of high testosterone, one month of testosterone
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  blocking. These were men with metastatic
• 14:20
  disease to the bone. And guess what?
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  They did pretty well. Quality of life goes up.
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  That's almost a given. Energy, muscle mass, vitality,
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  all the horrible parts of castration go away.
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  In addition, they had better than expected longevity.
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  Now, note my language here, folks.
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  Better than expected longevity. It means, yeah, that someone's
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  still going to die. And that's the problem for
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  doctors. The standard of care is to block
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  testosterone. You give testosterone, a man
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  dies of prostate cancer, Doc's worried he didn't follow
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  standard of care. Unless that patient is very
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  affirmative, willing to accept the possibility that going on
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  testosterone could lead to death from prostate cancer, even if
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  the testosterone didn't 'cause it, even if they lived longer
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  because of the testosterone, these are impossible things to
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  prove. So far in doctor Morgan Taylor's
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  case reports, two of the men have lived for four and eight
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  years, respectively, with cancer in the bone.
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  That's right in the bone. So don't put up the white flag.
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  Don't go into a corner and make funeral.
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  No, we can make funeral plans. I mean, after all, you're going
• 15:47
  to die someday. But keep living, keep aspiring
• 15:54
  to extend that life and absolutely grab vitality.
• 15:58
  Should you consider going on testosterone therapy if you have
• 16:03
  prostate cancer or if you have an elevated PSA, an abnormal
• 16:07
  prostate MRI? My advocacy is generally in
• 16:12
  favor of it. But men, you have to go in with
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  eyes wide open. You will have to sign an
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  informed consent that says you accept the possibility that you
• 16:21
  could be accelerating your cancer.
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  Even though there's research supporting the potential
• 16:28
  benefit, studies are not definitive.
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  There are no guarantees and if that cancer progresses, only you
• 16:38
  have to live with a consequence. If it progresses, you have to
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  look in the mirror and know in your heart you made the right
• 16:45
  choice. You gain quality of life and
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  there is no evidence going into this treatment pathway that you
• 16:51
  would inevitably increase your risk of dying from prostate
• 16:55
  cancer. Might you enjoy a better quality
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  of life? I would expect so.
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  Might you prevent castration resistance by doing a modified
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  bipolar treatment? I think so.
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  There are case reports supporting that outcome, but
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  there's no proof, nor will there be in our lifetime.
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  And this is where philosophy, science, proof all merge you and
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  only you can decide how you want to live now.
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  That's true if you're given rational options.
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  My protocol exists, this podcast exists, my practice exists, so
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  we can create that rational alternative that right now it's
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  really hard to find, really hard.
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  If I'm an insurance based standard of care urologist,
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  providing testosterone therapy to my patients is a significant
• 17:56
  risk. Doctor Morgan Taylor should be
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  applauded as other urologists should be, who have the
• 18:03
  knowledge, the patients and the courage to administer therapy
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  way off standard of care. Now.
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  It helps that you know Doctor Morgantails from Harvard.
• 18:16
  I'm a humble family doc living here in Fort Lauderdale, but the
• 18:20
  science is still the same. The advocacy on your behalf
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  should be put forth. This should be a choice and
• 18:30
  option, well informed, well educated.
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  The studies are out there. The TRAVERSE trial was one
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  looking at men on this bipolar therapy versus traditional
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  androgen deprivation. They were showing potential
• 18:48
  benefit. So you got a lot to think about.
• 18:51
  How do you want to live, right? Number one, I advocate you grab
• 18:56
  vitality. We're not guaranteed next week,
• 19:00
  next month or next year. What we have the most control
• 19:03
  over is how we're living in this moment.
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  And how do I want to live? Strong, vital, confident,
• 19:12
  positive, energized? How do I want my patients to
• 19:17
  live? All the above the same.
• 19:21
  But in your heart, you have to know the path you're taking.
• 19:25
  It's not wrong to do a conventional treatment.
• 19:29
  It really isn't. Men, only you can make these
• 19:32
  choices. Conventional treatment, in my
• 19:36
  opinion, prostatectomy, radiation, androgen deprivation,
• 19:42
  more harm than benefit, my opinion, supported by research,
• 19:47
  but you're the one that makes the call.
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  Take your time, do your due diligence, challenge what I say.
• 19:55
  You can do your own research nowadays, and that's pretty
• 19:57
  fantastic. So testosterone for prostate
• 20:02
  cancer, I believe it's day has come.
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  I believe the research supports that.
• 20:07
  I believe that the benefits far outweigh the risks.
• 20:10
  But I also believe that you've got to be willing to live with
• 20:15
  whatever consequence comes next, even if that prostate cancer
• 20:19
  progresses. All right, I wish that we had a
• 20:22
  simple cure. We don't, but by golly.
• 20:25
  We keep at it, we're finding new pathways of care, things that
• 20:29
  can help, and we're going to get there men by us working
• 20:34
  together, by you being bold enough to challenge convention,
• 20:39
  by asking tough questions and by being willing to consider
• 20:44
  alternative approaches. So come join me.
• 20:47
  We have the community that's up and running the prostate
• 20:51
  competitive vitality. It's on a Facebook group, it's a
• 20:55
  source of information and ideas to be exchanged.
• 20:58
  And we have a course happening here in Fort Lauderdale in April
• 21:02
  for other doctors, nurse practitioners and providers.
• 21:06
  Why am I sharing it with you? Well, maybe you're one of them.
• 21:08
  Maybe you're listening in your provider.
• 21:11
  Come join me. You'll become certified in the
• 21:13
  protocol that I've developed. It's a 2 day course.
• 21:17
  You'll become part of a registry or referral network.
• 21:20
  I want this protocol to be available to every man
• 21:23
  throughout the country and if you know a doctor that is an
• 21:26
  open minded progressive thinking person or nurse practitioner of
• 21:31
  the same attributes, refer them to this course coming up in
• 21:35
  April in Fort Lauderdale. Beautiful place to visit.
• 21:38
  We're going to spread this out folks.
• 21:40
  Together we can actually change the arc of treatment of prostate
• 21:44
  cancer. That would be beautiful thing.
• 21:46
  All right, in the meantime, have a vital week, a vital day.
• 21:50
  Stay positive and let's let's keep living.
• 21:53
  I'll talk to you soon.