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PSA Rising? Ask These 3 Questions · Intellectual Medicine

• 0:00
  You don't rush off and get expensive screening test alleged
• 0:05
  to be more sensitive, more specific.
• 0:08
  There are a number of them. There are blood tests or urine
• 0:10
  tests, genetic testing. The problem, all the testing,
• 0:15
  Shades of Grey. All you're going to get out of
• 0:18
  that is a percentage of likelihood that you have an
• 0:22
  aggressive cancer. It's not much more information
• 0:25
  than you have before you do the test, and all the tests are
• 0:28
  going to funnel you into the decision about getting a biopsy.
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  Don't let them scare you into doing something you made ready
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  to grab. I call it PSA, paranoia.
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  So many men are focused on that number and I get it.
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  It makes sense. It's a tangible number and it
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  has some relevance. So what is PSA?
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  The prostate specific antigen is produced primarily in the
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  prostate gland. It's normal for it to be in the
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  bloodstream. As we get older and as a
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  prostate gets bigger, we make more of it.
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  So the PSA number correlates with the size of a gland.
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  It's an important detail. The number can vary depending on
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  the condition you're in and it's been utilized.
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  Many feel inappropriately to channel men into a fear
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  stimulated pathway of biopsy and aggressive interventions.
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  PSA elevation does not mean you have cancer and APSA elevation
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  does not mean that the cancer is necessarily progressing.
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  But it could be. And that's the conundrum.
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  So I'm going to talk you through a rational intellectual medicine
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  pedrity protocol approach to rising PSA.
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  Here's what I do for my patients and what I recommend you do for
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  yourselves. The first thing if your PSA is
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  trending upward is to take a breath.
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  Do not do anything interventional.
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  Do not allow a biopsy to take place just because that number
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  went up. Whenever there's a lab test that
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  is skewed, abnormal, or otherwise questionable, first
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  thing you do is you repeat it. So your PSA was stable and now
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  it just jumped up. Now what does a jump up mean
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  anyhow? It can trend upwards slowly.
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  Nobody knows exactly how much of A change should draw our concern
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  with regard to cancer, so they've estimated it.
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  These are all speculative guesses.
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  The total number of four is a complete guess.
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  That is in a lot of things you guys read about.
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  It'll say, well if your PSA is above 4, that's abnormal.
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  That's a fallacy #1 it goes up as you get older.
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  The average PSA for a man over 70 is around 6 #2.
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  The bigger your prostate, the higher the PSA, so getting this
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  equilibrated based upon the size of your gland is important.
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  For APSA, the average size is about 30 milliliter for men 60
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  and above. How do you know how big the
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  prostate gland is? Usually it's estimated with an
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  MRI, sometimes an ultrasound, not a CAT scan.
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  CAT scans are radiation guys. Radiation causes cancer, so
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  avoid it. But if there's a question about
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  your PSA, step one, repeat the study.
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  And if it's a consistent steady elevation, if it increases by
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  two points or more in a short interval, say 3 month interval,
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  maybe worth attention. If it double s in a year, went
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  from 5 in November of 24 to 10 in November of 25 to worthy of
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  some attention. So now you've made sure that the
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  number's real. I've seen cases where one number
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  spiked for reasons we couldn't discern.
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  You get another number a week or two later, and it's down three
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  points. It's reassuring.
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  So get the number validated. That's one step.
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  Suppose no fooling this number is elevated.
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  The next thing that you want to do is get a prostate MRII
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  recommend it without contrast. The contrast they put in you
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  makes the picture easier for the radiologist to read, but it's
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  not critical for the purposes we have in mind.
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  One of how big is your gland? And we want to know, are lymph
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  nodes involved or is there evidence of cancer percolating
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  within it? And most importantly, is there
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  evidence of cancer pushing beyond that gland?
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  It is uncommon in my experience to have a man with APSA level
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  greater than four with a prostate gland that is stone
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  cold normal. Nothing going on here at all.
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  So the prostate MRI worth getting, but once again, be
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  careful how it gets interpreted and do not overreact to it.
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  So you get a prostate MRI. Now you know how big the gland
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  is, You know what your PSA number is.
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  The average PSA level does correlate with the size of the
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  gland, and you get that. It's a formula to multiply the
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  size in milliliters by .15, and that gives you a corrected PSA
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  level for the size of your prostate gland.
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  Size of the gland times .15 equals APSA number.
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  That should be approximating it for benign prostatic
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  hypertrophy. BPH.
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  Now, if you're in a pathway of increasing PSA levels, in my
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  protocol, we do not castrate you, we do not put androgen
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  deprivation therapy into play. So when we talk about what you
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  do with your PSA number rising, it's equally important to talk
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  about what not to do because the conventional approach with a
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  rising PSA with a diagnosis of prostate cancer is to interpret
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  that as a biochemical progression or a biochemical
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  recurrence. I believe this is a fear
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  inducing fallacy. The fact the numbers going up is
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  self-evident, but does that mean that the cancer is now marching
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  forward? And more importantly, does it
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  mean that you should allow aggressive treatment to take
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  place? Not when you're feeling good.
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  Not when you're having no symptom.
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  Doc, I feel great. My urinary flow is good.
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  I'm not having any bone pain. I'm feeling pretty good here.
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  Oh, but, Mr. Smith, your PSA went from 4:00 to 8:00, went
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  from three to five. We must treat you with androgen
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  deprivation therapy. We have to do this otherwise
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  you're going to die from right. This sound familiar to some of
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  you guys? It is fear mongering.
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  Instituting drug therapy that absolutely causes harm.
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  Androgen deprivation castration therapy 100% will cause some
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  harm. To introduce that therapy in a
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  setting where you feel good and the PSA is going up is to put
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  speculation ahead of tangible evidence.
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  The only time that I support the use of androgen mitigation, not
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  castration, it's a different thing.
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  We do it with the Petri protocol.
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  We mitigate. We don't castrate.
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  Remember the focus. Fight cancer like a man.
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  You cannot be fully masculine guys with your testosterone
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  being squashed to nothing. That's not what men are made of.
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  We need testosterone and if we don't have it, we're not fully
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  ourselves. Not just sexually, mentally,
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  physically, emotionally. It is a critical hormone and we
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  are deprived of it at great risk.
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  So never would I recommend it just because the number went up.
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  Now we're treating a lab. Now we're not treating a person,
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  are we? We're treating a lab study.
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  Wait. Not only do you delay, possibly
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  fully avoid all the negative consequences, but when you
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  introduce castration therapy, when it's introduced into your
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  treatment, the clock starts ticking.
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  Within one to two years, the cancer will become resistant to
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  castration and will progress despite the castration being
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  present. That is ominous.
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  The term for that castration resistant prostate cancer.
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  And at that point, Katie, bar the door, it's now going to
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  progress. So you hold off.
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  You hold off. You hold off if the cancer
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  creates symptoms, you can't pee because of prostate is now
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  encroached upon by a tumor. You're having bone pain because
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  of prostate cancer is now somewhere in your skeleton.
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  Then you treat it and then it's going to work.
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  So you don't start treating it today because your PSA number
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  went up and your doctor's telling you we want to prevent
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  it going to your bone. It's never been shown to do
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  that. That is a pure speculative hope.
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  You do not implement speculative hope at the price of castration,
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  guys. It's not worth the price of
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  admission. Yeah, I get it.
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  The notion of cancer going to the bone is terrifying, but
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  doing something with a hope that it'll make it less likely to
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  occur? Conventional medicine?
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  That's crazy. Furthermore, we know that if
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  it's in the bone, that introducing castration
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  mitigation therapy at that time is highly effective.
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  So this idea that you're going to go to your bone and then
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  you're going to burn up like a house on fire, Even with
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  minimalist therapies, when the prostate cancer hits your bone,
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  you're still median survivals are outward of four years and
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  above. Now, I don't consider four years
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  to be adequate. I'm on board with you guys.
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  We're looking for outlier results.
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  So your PSA is going up. Step one, take a deep breath,
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  get it retested. And remember guys, when you get
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  your PSA done, your condition at the time of the test is
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  relevant. If you're sick, you have a head
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  cold, don't get the PSA done. It's going to be elevated.
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  Inflammation makes it go up. Don't go on a bike ride the day
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  before. Don't have sex the day before.
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  Don't have alcohol the day before.
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  Be well hydrated as best you can while rested.
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  These conditions matter. And if possible, try to use the
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  same lab. There are at least four
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  different companies that make APSA test and they each have
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  their own proprietary reagents that they use for the purpose of
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  the test. That means you could take the
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  same blood sample and get 4 different numbers depending on
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  which lab did the test. So it's helpful to have
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  consistency with the lab. So verify with repeat test.
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  Consider getting a prostate MRI. Then you're going to pause.
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  If you're feeling good, wait another three months.
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  This is a slow moving train. I've seen men get so nervous and
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  I know you can do this. You could pay money on your own
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  and you get the PSA done. It's not worth your price of
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  admission because we need time to make logical, intellectual
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  interpretations. So I advocate a three month gap
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  at least. At least a one month gap before
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  you look at that number again. Another thing that I recommend
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  you don't do, you don't rush off and get expensive screening test
• 12:44
  alleged to be more sensitive, more specific.
• 12:47
  There are a number of them. There are blood tests or urine
• 12:49
  tests, genetic testing. The problem, all the testing,
• 12:55
  Shades of Grey. All you're going to get out of
• 12:57
  that is a percentage of likelihood that you have an
• 13:01
  aggressive cancer. It's not much more information
• 13:05
  than you had before you did the test, and all the tests are
• 13:09
  going to funnel you into the decision about getting a biopsy.
• 13:13
  We start our reflections with the conclusion that biopsies are
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  bad for you, that we don't want you to get them ever, that they
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  have the potential to spread cancer, that they elevate your
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  PSA. They cause harm, guaranteed
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  harm. It hurts, could get infected, a
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  lot of bad things. And that stupid Gleason score.
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  I I don't mean to disparage the guy.
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  He's probably a very nice man. I think he's no longer with us,
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  but he invented a pathologist looking at the the cells,
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  describing what they look like. OK, it's interesting.
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  Nice research project. But does it really have value to
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  help you make decisions? Very little.
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  Almost none. The Gleason score.
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  A biopsy does not predict what will come next.
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  It's not a crystal ball. You can't tell how aggressive
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  it's going to be in the future based upon a moment.
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  Now what is needed is sequential evaluation.
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  So PSA, yes, gap it out, repeat it.
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  A biopsy. Do not let them scare you into
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  it. An MRI, Yes, it's got a role
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  here. It can give us information about
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  the size of the gland, about its appearance, how likely it is to
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  be cancer or not. All that can be discerned with
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  an MRI without a biopsy. And when all else remains
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  ambiguous, the prostate specific membrane antigen PET scan is an
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  option to contemplate. I don't advocate this in the
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  absence of symptoms. Guys, it's radiation exposure.
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  You want to reserve that for when it's most critically
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  needed. So PSA is going up.
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  Know the formula. How big is a gland in milliliter
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  multiplied by 0.15 give you a corrected PSA level.
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  Consider just repeating the test and monitoring it.
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  As long as you're feeling good. Now you should be doing
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  something, but not biopsy. Now you should be doing
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  something, but not chemotherapy, not castration therapy.
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  That goes to the heart of the matter with the Pederuti
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  protocol. Fighting cancer like a man,
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  monitoring the PSA, trying to keep it blunted, and if it does
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  go up, interpreting it rationally.
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  All right guys, I hope that gives you some insights to the
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  PSA and how to handle it when it's going up.
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  Most important advice? Pause.
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  Think. Don't let them scare you into
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  doing something you may let it regret.