Latest / Intellectual Medicine / Don’t Biopsy Your Prostate: What They Don’t Tell You About Gleason 7, 8 & 9

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Don’t Biopsy Your Prostate: What They Don’t Tell You About Gleason 7, 8 & 9 · Intellectual Medicine

0:00
Getting old isn't the worst thing.
0:01
Breaking down is worse. Dying isn't the worst thing.
0:05
Withering before death, Becoming infirm, incapable, dependent.
0:10
You can't go upstairs. You can't open jars, You can't
0:13
carry groceries. This is the way to live, man.
0:16
Here's what I want for you. A life of robust vitality.
0:19
Fight cancer like a man. Do not let them take that from
0:23
you. This morning I started my day
0:39
the way I usually do. I often do before I start my
0:43
work. I hit the gym where I lift
0:45
weights. I do some cardiovascular work.
0:48
Prior to that I do my pre workout meal conscientious about
0:51
what I eat. Why do I do all this?
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Because I want to stay vital. Getting old isn't the worst
0:58
thing. Breaking down is worse.
1:02
Dying isn't the worst thing. I mean, it happens.
1:05
Someday it'll happen to me. Withering before death, becoming
1:11
infirm, incapable, dependent. Either through cognitive
1:15
decline, cardiovascular decline, or most commonly,
1:19
musculoskeletal. When your bones, when your
1:22
muscles and joints fade, you'll lose capability.
1:26
You can't go upstairs, you can't open jars, you can't carry
1:29
groceries. This is the way to live, men.
1:32
So you think about it when you're vital, the time to build
1:37
the ark is before it rains. We're all at risk.
1:41
So This is why I emphasize vitality.
1:45
The false trade off in prostate cancer and prostate health in
1:49
general is the artificial belief that you have to go through the
1:53
gauntlet of misery to prevent death from prostate cancer.
1:58
Quite the opposite is true. So why are we still biopsying
2:03
prostates? Because we're stuck.
2:08
The paradigm is stuck. It's reinforced by fear,
2:12
anxiety, financial incentive, time pressure, medical, legal
2:17
concerns. So the docs want to do a biopsy
2:21
because it's quick, it's easy to get paid.
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It caps the conversation. Don't you want to know?
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There are many reasons why a biopsy is a horrible idea.
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But listen, take heart. If you've already had one, the
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next question is OK, now what? Well, stop doing biopsies.
2:40
But doc, I've got a Gleason score.
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What does it mean? What should I do with that?
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Does a Gleason score matter when it comes to choosing a treatment
2:50
pathway? I'm going to explain why it
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doesn't. These things are true, but
2:56
separate. If you have a high Gleason
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score, the Gleason grade 8910, your prognosis, that is the
3:06
likelihood that this cancer will progress is in fact greater.
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It's more likely that'll that'll will progress compared to a
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Gleason score of 6 or 7. That's true, but it doesn't
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necessarily mean that you're going to benefit from more
3:21
aggressive treatment. In fact the evidence of benefit
3:25
is weak to non existent. This is hard to square because
3:30
it doesn't follow logical thought.
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I mean if my cancer is at greater risk to progress, does
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it make sense that I should be more proactive?
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It does, but the next question is in what manner?
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I explain it much more in my book.
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Please buy the book. It helps keep the lights on here
3:50
and most importantly, it explains my theory.
3:54
It explains my recommendation and my approach.
3:58
There are lots you can do on your own, but when it gets into
4:01
the weeds, men, you need to link up with a provider that's
4:05
knowledgeable and capable of delivering my protocol.
4:08
They are out there. We now have the ability to treat
4:12
anybody throughout the nation. I've trained other docs in this
4:16
protocol. So put that as a little side
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note, right? Because you're still faced with
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this dilemma. I have a Gleason score of eight.
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They tell me I'm going to die from prostate cancer unless I do
4:26
something. Well, let's break it down.
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Are you going to die? Yes, that's likely to happen,
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but it's not happening tomorrow, nor is it going to happen in the
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acute near term, and it may never happen regarding prostate
4:41
cancer. So let's break out some studies
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and then we'll go to the big study.
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The protect T this from a study in 2023.
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They looked at men with prostate cancer, early stage isolated to
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the Glen with Gleason scores of 9 or 10.
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Now they chose those people with a high Gleason score because the
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short follow up time it made sense to look at the men with
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the most aggressive form or I should say the most at risk form
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for progression. So they followed these men over
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5 years and they did find that those who had this high Gleason
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score had a significant rate of death, but the rate of death
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from prostate cancer after five years was 79% from prostate
5:36
cancer. They compared different
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treatments in order to determine what the comparative rate would
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be. So 79% was for those who had
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external beam radiation X-ray therapy, 84% in the cohort of
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people who had external beam radiation plus pellets called
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brachytherapy. So they put radioactive pellets
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in the gland and they did external beam two different
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treatments for Gleason grade 9 and 10.
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The third treatment they imposed upon men was a radical
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prostatectomy. They had a 90% survival rate
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from prostate cancer, so 798490 percent radiation.
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Radiation plus pellets, prostatectomy.
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Although there were slight differences when looked at
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statistically, they were all the same.
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In other words, whatever treatment pathway was chosen did
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not have a huge impact on survival at the back end.
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The missing piece here is what about what about other
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treatments? Now we know from the Protect T
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trial that radiation and surgery didn't change the risk of death
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from prostate cancer after 15 years when compared to doing
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nothing. In this study, there was no arm
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within it. That was, if you will, watchful
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waiting. That's a missing piece because
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we don't know if these therapies had any impact at all.
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Based upon the Protectee trial and other studies like it, it's
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possible all three treatments were acts of futility.
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It is guaranteed that they caused harm.
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Guaranteed. You can't do radiation without
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doing harm to your tissue. The risk of cancer goes up.
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Lymphoma, leukemia, all forms of tissue and solid organ cancer,
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heart disease risk goes up. I don't care how much they tell
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you this. Therapy is focal and targeted.
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It isn't. It disseminates and it can harm
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other organs. Prostatectomy is just awful.
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Leaking urine, erectile dysfunction, Not to mention the
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surgery itself. So guaranteed harm uncertain to
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no benefit. This violates a core principle
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within medicine. First, do no harm, especially if
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you can't prove benefit. So it leaves you in this
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horrible space. I've got a Gleason 8 or 9.
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Shouldn't I then get my prostate gland removed?
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You can. It is not unreasonable, but it's
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just never been shown to make you less likely to die from
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prostate cancer. Now, if you choose to keep your
8:15
gland to avoid complication because you believe the studies
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that show ultimately no benefit regarding survival from prostate
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cancer, only you can decide if if that cancer were to progress,
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would you live your life with regret?
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It's impossible to know what'll happen in the future, but we can
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at least survey our own heart and mind.
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Flip it around for a moment, guys.
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Suppose you get the prostate gland removed, or you get
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radiation therapy, and three years later the cancer comes
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back. You suffered all that negative
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consequence and you're in the same place you would have been
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if you had done nothing. It's another form of regret.
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I can't help you get off of this difficult fork in the road, but
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I can reassure you that it's OK to make a decision when you have
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all the information in front of you.
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Some men just can't go to bed at night with the thought that
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there's cancer in their gland and the thought that, oh, my
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God, it's a Gleason 8 or 9. And you'll get your affairs in
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order. Yeah.
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You should always do that, right?
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You should always be ready to die.
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Guys, look, you're a responsible man.
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You have people that count on you.
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Don't wait. Make sure things are in order.
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I'm talking details. Make sure you have a will.
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Make sure all that crap that you have in your house, nobody wants
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it. So be sure do them a favor and
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disseminate, tell them who's going to get what.
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Maybe you've got some like real crazy valuable thing, you know,
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identify who'll get it. It's just I've seen people
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fight. I've had the privilege of
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watching families go through life cycles over 30 years of
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medicine and I've seen what can happen in some families.
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Dysfunction becomes exposed when they're fighting over who gets
10:06
the crystal vase. Anyhow, that's a little bit of a
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little bit of a side reflection, but be prepared to live.
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That's the message here. No difference in these treatment
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outcomes with Gleason 8 or 9. How about studies on watchful
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waiting? Well, here is 1 looking at men
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aged 79 to 84 who had an early stage prostate cancer diagnosis.
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In this group they looked at those who did watchful waiting.
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That's Med speak for doing nothing, which I don't
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recommend. You can always do something.
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I outline a lot of the steps in my book.
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There are things you can do without a doctor involved even.
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I'm not talking about crazy supplements and I'm certainly
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not talking about downloading a non monitored treatment pathway
10:55
including drug therapy. They're out there, I see them.
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You can download them offline. There are there are virtual
11:02
companies that will pump drugs into you.
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Good luck. Fire and forget, that's what I
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call it. Take these drugs and we hope you
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don't die. What is that anyhow?
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Lifestyle changes? There are lots of solid choices
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you can make that'll diminish your risk.
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But what if there's no treatment on other than watchful waiting?
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Watchful waiting is passive neglect.
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I don't recommend that. It's what the doctors will tell
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you when they say you can either have surgery, radiation or or we
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got nothing, but they can't quite say that.
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So they call it active surveillance or watchful
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waiting. We're going to just watch
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things. Really.
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I mean, that's just dumb. Imagine that.
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Yeah, we just found out you have lung cancer.
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But you know, we're just going to kind of watch and see how it
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goes. No, I understand prostate cancer
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is quite different. In many cases it's indolent,
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stagnant. The challenge is you can't tell
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which and you can't tell it by biopsying.
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Just gives you the moment at hand.
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Often times it's even inaccurate.
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So the biopsy, if you've had it done, the information can be
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reflected upon, but don't do any more because ultimately, whether
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you're Gleason 678 or nine, there is no difference regarding
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the treatment chosen. Let me explain.
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In the Protect T trial, this is a trial where they separated men
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in the three groups. All the men had early stage
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prostate cancer. One group had a surgical removal
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of the gland, another group had radiation therapy, and a third
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group did nothing. After 15 years, the death rate
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in all three groups was the same.
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Oh wait, there's more. They did subset analysis and
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they looked at men based upon their Gleason scores, low risk,
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intermediate, and high risk. They found two things that were
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true. The men in the high risk group
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had a were more likely to have progression of their cancer than
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those in the low risk group. But they also find that there is
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no difference in the progression regardless of the treatment
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chosen. It's important to emphasize
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this, men, if you have a Gleason 8 or 9, there is no
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demonstration of benefit between doing nothing, surgical removal
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or radiation therapy when it came to death from prostate
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cancer. That is ultimately the end game.
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So it reinforces your resolve. It reinforces the rational,
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logical basis of your decision. If you choose to defy
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conventional recommendations, they will try to scare you into
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it, because if you die of prostate cancer and you didn't
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do what they said they wanted to do, the Pontius pilot, you know
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I'm not accountable. They need to make you sign a
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disclaimer. Refusal to follow care.
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That's OK because the care they're recommending has not
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been shown to work regardless of the Gleason score.
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So if the Gleason score is not going to really lead us to a
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rational basis of deciding what kind of treatment we should
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pursue, the Gleason score itself becomes of little value.
14:38
Well, don't we need to know what cell type we have?
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Doctor, 99% of prostate cancer is adenocarcinoma.
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You know the cell type. Well, yeah, but don't I need a
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biopsy to tell them that I have cancer?
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You don't. Now we have the PSA with an MRI
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and if needed, a prostate specific membrane antigen test.
15:02
PSMA. Yeah, but isn't the tissue
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better? No, it's worse in many ways.
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It's worse because you can spread cancer cells that way.
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It's worse because you can damage your health.
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Your erections can be altered. Urinary flow can be altered.
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It's not very frequently reported.
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There's no incentive on the part of the docs doing these biopsies
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to report and document negative outcomes.
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They like to kind of diminish it.
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You can get infected. You can end up in the hospital.
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It hurts a lot of negatives here.
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And ultimately, the information gathered doesn't declare the
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path of treatment. I've posed this question to some
15:42
patients. Now, bear this in mind.
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Say you're a man over 60. Your PSA is, let's call it 12,
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and your prostate MRO shows a pyrides of four.
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All indicators are that you got prostate cancer, atypical
15:57
dormant cells isolated within the gland.
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This is level 1 disease as we define it in my protocol.
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Suppose you did a biopsy and it came back negative.
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Does that prove cancer is not there?
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No, the doctor won't believe it. They will say, well, we must
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have missed it, come back later, we'll do another one.
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All right, if you're not going to believe the negative result,
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once again, why get it? The MRI and the PSA are lovely
16:25
because you can repeat them. How do you know if you have an
16:29
aggressive cancer? Your wait three months, repeat
16:31
the studies. If you get an MRI, do it without
16:35
contrast. It's another myth that you have
16:37
to have contrast. You don't.
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It accumulates, it can cause harm.
16:41
So if you have that Gleason score, take heart.
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If you're sitting on a Gleason of eight or nine, it doesn't
16:48
mean you will ultimately die of prostate cancer.
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In almost every case, even if it's progressive, it tends to
16:56
move slowly. Now, that's not a passive
16:59
reassurance that you should do nothing.
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It is a comfort to let you know you've got time to think about
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it, to make plans while you're making your plan for your
17:10
treatment, while you're making a plan for your life and for your
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death. Do not let this cloud follow
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you. Don't wake up every day
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thinking, Oh my God, sand has fallen through the hourglass.
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My days are numbered. Of course they're numbered.
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Mine are numbered. But we derive joy by not really
17:29
dwelling on that, living in the moment, doing what we can do to
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stay vital. Here's what I want for you, a
17:35
life of robust vitality. Fight cancer like a man.
17:38
Do not let them take that from you.
17:41
You'll be O for two. You'll feel like crap and the
17:44
disease will progress ultimately.
17:46
So don't let him do that. Number 2, Arrive at Peace of
17:50
Mind. Live life vitally.
17:53
Expect to live until you're 100. Better prepare yourself to live
17:59
vitally. If you die, that's easy.
18:04
There's no real work you got to do right.
18:06
Everybody else got to do work. But if you live, how you live
18:10
matters. So your Gleason score does not
18:13
dictate the treatment you need. The difference in the treatment
18:18
pathways didn't matter, regardless of the level of the
18:21
Gleason score. All of these are reinforcements
18:26
validating the utility or the lack thereof, of a prostate
18:31
biopsy. Harm, misdirected conclusions,
18:36
amplified anxiety. It's an it's no longer needed.
18:40
I understand I'm coming to this from the outside.
18:43
That's where it needs to come from.
18:46
I was at a a conference recently, very advanced
18:49
conference, very skilled and really a lot of clinicians whom
18:53
I respect in urology, oncology, endocrinology.
18:58
And at one point they had a debate regarding who should
19:01
manage men's testosterone, urologist or endocrinologist.
19:06
I'm sitting there going none of the above should be a primary
19:09
care doctor. Why should your primary care
19:13
doctor be in charge of your prostate cancer?
19:17
If they're trained in my protocol, that is.
19:21
And why do we have do we encourage primary care to get
19:24
involved? Because most men with prostate
19:26
cancer don't die from that disease.
19:28
You've got to look beyond the prostate.
19:31
Urologist have a role. If you have a kidney stone, they
19:34
have a role. If you have kidney cancer, they
19:38
have their role, but in my view their dominance, their pre
19:42
eminence, their exclusivity regarding prostate cancer needs
19:45
to end. We need a broader vision.
19:48
In the Protect T trial, most men with prostate cancer died from
19:52
heart disease. The second leading cause of
19:55
death was cancer of other types. How awful it would be to go
20:01
through the misery of all the prostates, treatment and surgery
20:04
and end up with a cancer elsewhere.
20:07
Maybe the treatment itself amplify that.
20:11
So take heart. If you've had a biopsy, it
20:13
doesn't mean that you have inevitably disseminated those
20:17
cancer cells and that you will inevitably have metastatic
20:19
disease. It is my hypothesis that that
20:23
risk is a little bit greater. But cancer cells, men, cancer
20:28
cells aren't that hard to kill. Your body does it every day.
20:32
Tumors are a different story. So our job is to act when the
20:38
cells are there before they make tumors.
20:41
That requires forethought. It requires action when you feel
20:45
good and it requires action. It's not going to harm you.
20:49
Listen, I really honor your time, so I'm going to make sure
20:52
I don't take too much of it. We want to get this message to
20:57
go through the world. My book is now being translated
21:00
into German and Spanish. The audio book will be out soon.
21:04
This message, I wanted to get out.
21:06
I want men to be made aware of options.
21:09
They have time. I need your help.
21:12
You're already tuned in. By virtue of buying the book and
21:15
also joining the Doctor Pedro de Men's Vitality Group, you can
21:19
help support this endeavor. That's the only way we fund our
21:24
our enterprise. Shannon and I put our money in
21:27
to keep this going. We don't get sponsor money
21:30
anywhere. That's how we like it.
21:32
We love what we do and we do it because it's our mission.
21:36
You can be part of that by joining the community.
21:39
It's not a charitable endeavour, folks.
21:40
We're giving you something in return.
21:41
You're going to get information library interconnection with
21:45
other men in the community. Right now this is a men only
21:49
group. We'll just think about getting a
21:51
woman's auxiliary. But want a place for men to be
21:54
men. You know, I'm of the opinion
21:57
that older men are largely a forgotten class.
22:00
They're all kind of waiting for us to die, right?
22:03
Whether it's an inheritance, whether it's vacating a seat on
22:05
the board, something, right? No, no, let's, let's, let's
22:10
annoy them and just stick around.
22:12
So men's Vitality group is there for you.
22:13
And once a month I do a live question and answer session
22:16
within the group. So join our group, become part
22:19
of the emphasis, the point of change.
22:23
We can make it happen. Well, thanks for your time.
22:25
Look forward to our next time on the podcast.
22:28
Until then, stay vital, stay strong, fight, Cancel like a
22:31
man, live like the leader you are every day.